Surgical Instruments Viva Voce Examination Notes, Question And Answers

Instruments

Artery Forceps (Haemostat)

• It is also called Spencer Well’s artery forceps. It has a ratchet and two blades with uniform serrations.
• It is used to control bleeding, not only from arteries but also from veins and capillaries. Once the bleeding points are caught, they are coagulated or ligature is applied.
• The curved artery is commonly used.

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• The smaller version of this is called mosquito forceps. This is extremely useful in repair of harelip, cleft palate or other plastic surgery operations.
• It is also available as a straight artery which is used to hold the stay sutures.

Allis Tissue Holding Forceps

• It has a ratchet and triangular expansion at the tip, where serrations are present.
• It can be used to hold tough structures such as fascia, aponeurosis, etc.
• Even though it can cause trauma, because of its better grip, it can be used to hold the duodenum for duodenal closure during gastrectomy.

Kocher’s Forceps

• This is similar to an artery forceps with serrations. It is available as curved and straight.
• There is a sharp tooth at the tip of the instrument.
• Hence, it has a better grip.
• Kocher’s forceps can be used to hold tough structures like aponeurosis, fascia, etc.
• During thyroidectomy, it can be used to hold the strap muscles for dividing them.
• Theodor Kocher, a Swiss surgeon, got the Nobel prize for his contribution to thyroid surgery.

Sinus Forceps

• This is like an artery force which has No ratchet.
• Serrations are confined to the tip so as to hold the wall of an abscess cavity, for biopsy.
• In Hilton’s method of drainage of an abscess, once the incision is made, the sinus forceps is thrust into the abscess cavity and by opening the blades in all directions, the loculi are broken. To facilitate free opening of the blades, sinus forceps has no ratchet.

Swab Holding Forceps

• This has a ratchet and two long blades
• The operating end is rounded with serrations
• It is used to hold the swab (gauze pieces) to prepare the parts with antiseptic agents at the time of surgery.
• This instrument can also be used as a blunt ‘dissector’ with the swab, while dissecting at a depth, e.g. lumbar sympathectomy, vagotomy.

Babcock’s Forceps

• An instrument with a ratchet and a triangular expansion with fenestrations at the operating end. It does not have any teeth. Thus, it is used to hold intestines during anastomosis or resection.
• This instrument can also be used to hold many other structures such as thyroid gland, mesoappendix, uterine tubes, etc.

Lane’s Forceps

• This is similar to Babcock’s forceps but the tip is more broad, expanded with a bigger opening.
• It is used to hold the appendix
• However, it does not seem to have any additional advantage when compared to Babcock’s forceps.

Dissecting Scissors

• This is also called Mayo’s scissors.
• It does not have ratchet and operating end is sharp

• This is used to dissect tissue planes during surgical operations and to cut or divide important structures.
• It is popularly called tissue scissors.

Straight Scissors

It is used to cut the sutures or knots. Hence, called suture-cutting scissors.

Dissecting Forceps

• This is a toothed forceps. It is also available as nontoothed forceps.
• Dissecting forceps with dissecting scissors makes good ‘tool’ for a surgeon to develop a tissue plane in majority of surgeries.
• The forceps is very useful to ‘pick’ individual layers such as serosa, seromuscular layers, mucosa, etc. during anastomosis.

Needle Holder

• This is a long instrument with a ratchet at nonoperating end.
• The operating end has two small blades with serrations.
• The instrument is used to hold the curved needles which are used to suture the parts.
• A firm grip is essential to apply proper sutures.

Scalpel With Blade

• This is popularly called surgeon’s knife.
• This is used to incise the skin and subcutaneous tissue.
• Due to the sharp nature, it can be used to divide a major vascular pedicle once ligatures are applied.

Cheatles Forceps

• It is a long instrument having a curved shaft
• The handle has no lock
• It is kept dipped in antiseptic solutions
• This instrument is used to pick up sterilised articles such as sponges, gauze pieces or other instruments and to transfer to the instrument trolley.

Deaver Retractor

• This is popularly called Deaver liver retractor
• It has a long blade and operating end is curved
• It can be used to retract the liver during vagotomy, cholecystectomy or gastrectomy, etc

• Since it has long blades, it can be used to retract the kidney upwards, during lumbar sympathectomy or to retract the urinary bladder during surgery on the rectum.

Morris Retractor

• This is a long instrument with broad operating end.
• This is used to retract the abdominal wall, once the peritoneum is opened.
• However, if a self-retaining retractor is used to widen the laparotomy wound, the use of a Morris retractor gets limited.

Czerny Retractor

• This is a double-hooked retractor on one side and a single blade on the other side.
• This is a superficial retractor, can be used to retract layers of the abdominal wall, muscles, etc. Thus, during appendicectomy, herniorrhaphy or thyroidectomy, this instrument is very useful.

Langenbeck Retractor

• This instrument has only one blade
• The uses of this are similar to that of Czerny’s retractor.

Moynihan’s Straight Occlusion Clamp

• This is a long instrument with a ratchet. The operating end has two long blades with serrations in the line of blades.
• This instrument is used to occlude the intestinal lumen to prevent spillage of intestinal contents during intestinal resection or intestinal anastomosis.
• This does not interfere with the vascularity of the intestine.

Payr’s Crushing Clamp

• This is a heavy instrument with double lever system, because of which it has a better grip
• The two short blades have uniform serrations
• During gastrectomy, when portion of the stomach is excised, this instrument is applied on the stomach side so that the stomach with this instrument is excised.

Desjardin’S Choledocholithotomy Forceps

• This is a long curved instrument with no ratchet
• The operating end is expanded with fenestrations
• The tip is blunt
• It is used to extract stones from common bile duct. It can also be used to extract stones from the ureter.

• Since it has long blades, it can be used to retract the kidney upwards, during lumbar sympathectomy or to retract the urinary bladder during surgery on the rectum.
• Since there is no ratchet, free opening is possible, and the stones do not get crushed.

Bake’s Dilator

• This is a long malleable instrument available in various diameters.
• It has a handle, long body and the tip is blunt.
• Once common bile duct exploration is completed, this dilator is passed, to assess for any distal obstruction.
• The free passage of Bake’s dilators of different sizes indicate that there is no distal obstruction (however, to be confirmed by cholangiogram).

Kocher’s Thyroid Dissector

• This has a long handle and the operating end is small and blunt with an opening.
• A few longitudinal serrations are present at the tip.
• This was used to dissect the upper pole of thyroid gland.
• This instrument can also be used to dissect the isthmus of the thyroid gland from the trachea.
• Silk thread can be fed into the opening so as to ligate the vascular pedicle or isthmus.
• With the availability of the right-angled forceps, this instrument is not in routine use nowadays.

Aneurysm Needle

• It is a long instrument with an eye at the operating end.
• It is called an aneurysm needle because it was used to ligate the feeding artery in an aneurysm. However today, this instrument is of limited use.
• During venesection or cut down, the silk suture can be threaded within the eye, passed round the vein and it is tied.

Trocar And Cannula

• This has two parts. The inner sharp part is the trocar and outer blunt part is cannula.
• It is used to drain hydrocoele fluid.
• Once hydrocoele sac is delivered, it is punctured with trocar and cannula, the trocar removed and the fluid drained.
• Make sure that trocar and cannula should match, otherwise injury to the deeper structures (testis) can occur.

Humby’s Knife

• This instrument has a handle and a long sheath.
• When in use, a disposable blade can be attached to it.
• The instrument is used to take skin graft. Hence, it is also called skin grafting knife.
• To facilitate the exact thickness of the skin to be removed, there is a screw at the operating end, with which, prior adjustment should be done.

Myer’s Metal Stripper

• This is a long metallic chain or a stripper used in varicose vein surgery.
• It has a handle which is T-shaped and the ‘advancing’ end which enters the vein. This is blunt. Once this end comes out of the cut end of the vein, a mediumsized head is connected to it.
• With gentle force (traction) exerted on the handle, the varicose vein can be stripped.
• Hence, it is also called vein stripper

Self-Retaining Retractor

• It is a strong, heavy instrument, with two blades.
• This is used to spread the laparotomy wound. Hence, it is called self-retaining retractor.

Rib Spreader

• This is also a strong heavy instrument with two long blades.
• Once an incision is deepened through the intercostal spaces and the pleura is opened, the rib spreader is used and by rotating the latch handle, the ribs are spread apart.

Proctoscope

• This is an instrument used to visualise the rectum and the anal canal.
• It has an outer sheath with the handle (A).
• An inner blunt part is called an obturator (B).
• Before introducing the proctoscope one must make sure that obturator and the outer sheath must match. Lubricate the instrument well before introducing it.
• In painful conditions such as fissure in ano, proctoscopy is contraindicated.
• Once the rectal examination is done, the proctoscope is held firmly with the left hand (buttocks separated), and the obturator is supported by the right hand. The instrument is slowly introduced inside. The obturator is removed and the rectum is visualised using a light source.

• A proctoscope is used to diagnose haemorrhoids, carcinoma rectum or rectal ulcers, etc. Biopsy can be taken with a biopsy forceps in nonhealing ulcers of the rectum. Haemorrhoids can be injected and pelvic abscesses can be drained into the rectum with the help of a proctoscope.

Lister’s Metal Dilator (Lister’s Bougie)

• This is a long instrument curved at the tip. Its diameter is written near the handle. It is available in various diameters. The difference between the two numbers is 3. The maximum size of the Lister’s dilator is 9/12.
• The tip is olive-pointed and the end of the handle is round. The minimum and maximum diameter of the instrument is written on the handle. The other type of bougie is Glutton’s bougie with a plain tip and the end of the handle is trapezoid. The maximum size of Glutton’s bougie is 24/28 and the difference between the two numbers is 4.

Male Metallic Catheter

• These catheters are used to drain urine in cases of retention of urine when the rubber catheter fails.
• It is a long instrument which is curved because the male urethra is long and curved.
• It has two eyes at the distal end which are situated laterally and at different levels so that the instrument does not become weak at that spot.
• Once the urine is drained, the catheter can be left in place by passing a thread through the two rings present at the proximal end and fixing them to patient’s thigh.
• Due to the fear of false passage, injury to the urethra and introducing infection, this catheter is not used nowadays. It is replaced by trocar suprapubic cystostomy.

Female Metallic Catheter

• Used to drain urine in females
• This is a short and straight instrument because the urethra is short and straight in females

• It has multiple holes at the tip
• Indications for usage of this catheter are very rare because acute retention of urine is rare in females and even if it occurs, a red rubber catheter can be passed.
• It is used to empty bladder before vaginal hysterectomy and other gynaecologic surgeries.
• Emptying the bladder is mandatory before any gynaecological examination of a patient.

Towel Clip

• This instrument has a ratchet and the operating end is sharp.
• This is available in different sizes.
• Once the part is cleaned and draped the clips are used to hold the towels in place.

Right-Angled Forceps Lahey’s Forceps

• This is a long instrument with a right angle at the operating end.
• This instrument is extremely useful in ligating the major vascular pedicles, e.g. superior thyroid pedicle—thyroidectomy.
• Cystic artery: Cholecystectomy
• Lumbar veins: Lumbar sympathectomy

Hudson’S Brace And The Burr

• This is a heavy instrument with a brace and the burr (drill).
• This is used to create openings into the cranium so as to get an access to the structures within.
• Thus once a ‘burr’ is made, drainage of blood, fluid or pus can be done.

Cricoid Hook

• This has a broad handle and a thin shaft with a hook at the operating end.
• This is used to stabilise the trachea by hooking the cricoid cartilage ‘up’.
• This step is essential in children wherein veins are very superficial and can get injured easily when a child moves the head and neck. By stabilising the trachea, it is easy to incise the trachea, without injuring the vessels.

Tracheal Dilator

• This is an instrument with no ratchet at the nonoperating end.
• The operating end is blunt and curved.
• The peculiarity of this instrument is that when the handle is opened, operating end is closed and when the handle is closed, operating end is opened.
• The tracheal dilator is used in the post-tracheostomy period, when the tube has to be changed due to blockage. In such situations, once the tube is removed, tracheal dilator is introduced, the opening in trachea is kept open, and the new tube is introduced. However, once the track is formed, tracheal dilator need not be used.

Fergusson’s Amputation Saw

• Amputation saws have teeth on its cutting edge to facilitate cutting through the bone and is of different sizes. They are manufactured with one- or two-sided cutting edges for limb amputations.
• Uses: In lower limb, amputations commonly—above knee (AK) amputation and below knee (BK) amputation.

Bone Nibbler

• It is also called double action bone nibbler, identified by long handle and small jaws, top jaw is used for cutting and lower jaw is used to hold the tissue firmly.
• Uses: To make cut end of the bone smooth after amputation rib cutting and to enlarge burr hole.

Bone File/Raspatory

• One side of the raspatory is used to hold as a handle, while its other side has sharp projections with both fine and coarse teeth on both sides with a flat blade.
• Uses: Blunt separation of the periosteum and connective tissue from the surface of the bone, smoothening of sharp bony edges after amputation and before fixing fractures.

Volkmann Curette

• The edges of the distal spoon-shaped part of this instrument are sharp which make it possible to remove the tissues.
• Uses: Scoop the granulation tissue, to clean the base of the infected wound, and to remove the infected bone in the case of osteomyelitis.

Debakey Forceps(Bayonet Style)

• They are typically large—some examples are upwards of 12 inches (36 cm) long, and have a distinct coarsely ribbed grip panel, as opposed to the finer ribbing on most other tissue forceps, a type of atraumatic tissue forceps.
• Uses: In vascular procedures to avoid tissue damage during manipulation. Less traumatic manipulation of tissue and used during suturing.

Beckman-Adson Laminectomy Retractor

• It has hinged blades with 4 × 4 prongs, adjustable swivel arms and a ratchet to hold tissue apart.
• Uses: Retraction in procedures involving deep tissues like in laminectomy for spinal surgeries.

Ribbon Malleable Retractor

• A malleable or ribbon retractor (manual) may be bent to various shapes.
• Uses: It is used at the end of the case to keep the viscera away during the fascial closure and is also used to retract deep wounds.

The Harmonic Scalpel

• The harmonic scalpel is a new device that has been introduced to surgery during the last decade. It is a device that uses high-frequency mechanical energy to cut and coagulate tissues at the same time.
• It uses ultrasound technology to cut tissues while simultaneously sealing the edges of the cut.
• Active tips of the harmonic scalpel employ a rigid active lower blade through which the vibrating energy is transmitted. The movable upper jaw is used to compress the vessel against the lower blade, thus allowing transfer of the vibrational energy.
  The instrument is similar to an electrosurgery instrument and can be used in all open and laparoscopic surgeries, but superior in that it can cut through thicker tissue, creates less toxic surgical smoke and may offer greater precision especially during a laparoscopic surgery.

Bipolar Cautery

• When the electric current is passing between the two parts of the instrument, we call it the bipolar diathermy/ cautery (e.g. bipolar forceps).

• It makes possible to perform a more precise work and the size of the burned area is small and is more useful when haemostasis is required close to the nerves.
• Uses: Thyroid surgery when close to RLN (recurrent laryngeal nerve) neurosurgery or spinal surgeries.

Allison’s Lung Retractor

• It is a retractor with a special type of blade, made of wires, in the form of a net over one end and a handle at the other end.
• Uses: For retraction of the lung in thoracotomy. It does not damage the lungs and the lungs can expand in between the wires.

Gigli Saw

• Composed of a wire as a blade and two handles to hold the wire on either side.
• Uses: For bone cutting in amputation surgeries similar to amputation saw such as below-knee and above-knee amputations commonly.

Joll’s Thyroid Retractor

• It is a self-retaining retractor, which is held by the two towel clip like forceps on both sides to hold the flaps and can be adjusted using a screw in between.
• Uses: To retract skin flaps during thyroid surgery.

Metal Tracheostomy Tube

• This has two tubes, the inner long and the outer short tube.
• This has no cuff.
• Once the tube is introduced, the tape is passed around the neck, passed through the opening and tied so as to keep the tube in place.
• If the tube is blocked, the inner tube can be removed, cleaned and reintroduced.
• Metal tracheostomy tubes are useful as permanent tracheostomy tube.

Cuffed Tracheostomy Tube

• This is made of polyvinyl chloride. It is a single tube.
• Once the tube is introduced within the trachea, the cuff is inflated by using 3–5 ml of air.

• The cuff prevents leakage of air and prevents acid aspiration syndrome (Mendelson’s syndrome).
• If this tube is blocked, it is an emergency. In such cases, the tube has to be cleaned and mucus plugs have to be removed. Otherwise, the tube is removed, the tracheal opening is kept open with the help of tracheal dilator and a new tube is introduced. Alternatively, endotracheal intubation may need to be done to ensure patency of the airway.

Corrugated Red Rubber Drain

• It is made of red rubber. It has corrugations on both sides. Whenever a major surgery is done, some amount of blood loss or anastomotic leakage is expected. This drain is used so that fluid can escape freely outside.
• Thus, it is used after thyroidectomy, gastrectomy, cholecystectomy, etc. The drain is removed after it stops draining. Usually it takes about 3–5 days.
• After laparotomy for peritonitis, these drains are used to prevent residual abscess in the postoperative period.

Malecot’s Catheter

This is made of red rubber. It has flower-shaped end and has a wide diameter. It is used to drain amoebic liver abscess. It is straightened with the help of an introducer and left in the cavity and brought outside. It is a self-retaining catheter. This is used to drain urinary bladder after transvesical prostatectomy or can be used as feeding gastrostomy tube. It can also be used to drain empyema thoracis.

Mousseau Barbin’S Tube

• This is also called MB tube. It is a funnel-shaped tube with Ryle’s tube like attachment. It is used in inoperable cases of carcinoma oesophagus to palliate dysphagia. It is stitched to the Ryle’s tube which is brought out through the mouth and it is slowly drawn in by pulling the other end of Ryle’s tube which is in the stomach, after doing a gastrostomy.
• Once the tube is below the level of growth, it is cut at a sufficient distance and is stitched to the stomach wall.
• With the availability of laser coagulation of the growth, and considering discomfort caused by the tube including its migration, the MB tube is not popular and not preferred.

Foley’s Self-Retaining Urinary Catheter

• This is made of latex with silicon coating. At the tip, there is a bulb, capacity of which is written at the other end.
• Before inflating the bulb, one must make sure that catheter is in the urinary bladder, not in the urethra. This is assessed by the free flow of urine.
• After introducing the catheter, the bulb is inflated using saline. Thus, it becomes self-retaining. After the usage, it is removed by deflating the bulb. It can also be used to drain the peritoneal cavity as in biliary peritonitis. An inflated bulb compresses the prostatic bed and controls bleeding after prostatectomy.

Red Rubber Catheter

This is used to drain urine temporarily. It causes urethritis if it is left long in the urinary bladder. Once the urine is emptied, it is removed. It is not a self-retaining catheter. Not routinely used nowadays because of the availability of Foley catheter. It is more stiff than a Foley catheter. Hence, in cases of stricture urethra, where Foley’s catheter cannot be passed, red rubber catheter may be used.

Nasogastric Tube/Ryle’s Tube

• This is also called a nasogastric tube. At the end of this tube there are lead shots. After introduction within the stomach, its position is confirmed by pushing 5–10 ml of air and auscultating in the epigastrium or aspirating gastric juice. It is a long tube having 3 marks. When the tube is passed up to the 1st mark, it enters the stomach.
• Usually, it is passed up to 2nd mark. Life-saving use of Ryle’s tube is in acute gastric dilatation.
• In the volvulus of the stomach, it is impossible to pass a Ryle’s tube.
• Ryle’s tube is used to decompress the stomach as in intestinal obstruction or pyloric stenosis.
• It is used in the diagnosis of GI haemorrhage.
• It is also used to provide enteral nutrition to comatose patients or critically ill patients.

T-Tube (Kehr’S)

• This is a flexible tube made of latex with a long vertical limb and a short horizontal limb.
• Whenever the common bile duct (CBD) is incised, it is sutured after inserting the T-tube. The short horizontal limb is placed vertically within the common bile duct after making 2–3 holes within. Some surgeons slit open the entire length of the short limb.
• The long limb is brought to the exterior from the most dependent part of the common bile duct and connected to a sterile container.
• The presence of the T-tube may prevent peritonitis due to biliary leakage in cases of residual stones blocking the lower end of the CBD.

Removal Of The Tube

1. About 7–10 days later, a T-tube cholangiography is done and the T-tube is removed with a gentle pull, provided following criteria are fulfilled.
2. The dye flows freely into the duodenum.
3. No filling defects in the CBD.
4. After clamping the tube for 24 hours, there is no abdominal pain or fever.
5. The patient is passing normal coloured stools. Once the tube is withdrawn, some amount of biliary leak may persist for 2–3 days and it stops by itself provided there is no distal obstruction.

Sengstaken Blakmore Double Ballon Triple Lumen Tube

• It is used in controlling bleeding oesophageal varices. It has 3 lumens and 2 balloons, a gastric balloon and an oesophageal balloon.
• The gastric balloon is inflated with about 200–250 ml of air and oesophageal balloon is inflated with about 40–60 ml of air. It is pulled upwards so as to snugly fit at the oesophagogastric junction and thus it acts by internal tamponade.
• The Sengstaken tube should not be kept in place for more than 48 hours because it can cause pressure necrosis of oesophagus.
• It should be deflated for a few minutes after 24 hours.
• Sengstaken tube should be used by an experienced physician. Oesophageal secretions and saliva cannot be aspirated while using this tube, and if gastric balloon is deflated suddenly, it slides up and causes choking. The oesophageal balloon should be immediately deflated in such situations.
• Modification of Sengstaken tube is called Minnesota tube or 4 lumen tube. It has 4 lumens. The 1st to inflate oesophageal balloon, the 2nd to inflate gastric balloon, the 3rd to aspirate like a Ryle’s tube, and the 4th lumen is used to aspirate oesophageal secretions. If there is any difficulty in breathing while using Sengstaken tube or Minnesota tube, bulb should be deflated or tube should be cut.

Suturing Needles

Traumatic:

• A round body needle is an eyed needle. These are used to suture soft tissues, muscles, tendons, vessels, intestines, etc.
• Cutting needles are used to suture slim and some tough structures. The cutting tip is limited to the point of the needle which tapers out to merge smoothly into a round cross-section. These are used in vascular anastomosis/surgery.
• A reverse cutting needle is used to suture mucoperiosteum: It is triangular in cross-section. It’s effects of the cutting edge is on the outer surface of the needle curvature. The advantage of reverse cutting is strength and increases the resistance to bending. These needles have an eye. The eye is wider than body of the needle, so tissue trauma is more.

Atraumatic Needle:

• These needles have no eye. Suture is attached to the needle by a process called swaging. Tissue trauma is less, and hence is used in suturing vessels or to repair a small tear in the bowl, etc. This was first devices by George Merson of England, hence most of these sutures are called Mersutures. These are disposable needles hence sharpness is not affected.
• Needles: They are the essential tools of a surgeon for suturing the defects of skin/fascia/intestinal anastomosis, vascular anastomosis. Parts of the needle: Needle has three main parts— shank, body, point. The body of the needle is either round, triangular or flattened.
• They are made of stainless steel.
• Traumatic : Needles with eye, suture material loaded into the eye. Needle holes in tissues are larger that suture material.

Atraumatic Needle Types:

Round bodied, cutting, reverse cutting, taper cut, blunt.

• Round-bodied needles: Uniformly round, gradually taper to a point designed to separate tissue fibres rather than cut through them soft tissue; intestinal and cardiovascular surgery. Cutting needles are used for suturing tough or dense tissue, e.g. skin, fascia.
• Reverse cutting in which the cutting edge is on the outside of the needle curvature.

Taper cut needle: It is a combination of round body needle (minimal trace) and penetration like a cutting needle.

Parts of the needle:

• Eye/eyeless: Here you thread the suture material.
• Junction of eye and body: Weakest
• Body: Straight/curved
• Needle length: Circumferential
• Tip: Pointed

Needle chord length: Linear distance between tip and end of the needle (eye):

Suture Materials

Absorbable

1. Plain catgut (7-day catgut):

• The word catgut is derived from kit-gut, which means the violin strings. It is the oldest suture material known.
• Catgut is derived from the submucosa of the sheep intestines.
• The plain catgut lasts for 7–10 days. Hence, its uses are minimal.
• It can be used to put ‘fat stitches’ (subcutaneous fat).
• It is biological, absorbable and monofilament.
• Sheep’s submucosa has a rich content of elastic tissue.

2. Chromic catgut (21-day catgut):

• When plain catgut is mixed with chromic salts, chromic catgut is obtained.
• The strength of the chromic catgut is about 15–25 days.
• Chromic catgut is widely used in the intestinal anastomosis, closure of urinary bladder, closure of common bile duct, gastrojejunostomy, etc.
• Catgut is a biological, absorbable, monofilament suture material.
• Chromic catgut is packed along with round body needle.
• The number 2–0 refers to the thickness of the suture.
• Knotting property is good.
• The catgut is preserved in 70% alcohol and is kept soft due to 5% glycerine.

3. Vicryl (polyglactin):

• This is a copolymer of glycolide and lactide.
• It is a synthetic and absorbable suture.
• Unlike catgut, this is absorbed by hydrolysis.
• Since the strength and reliability is more than catgut, vicryl is being used more and more for small intestinal and colonic anastomosis. It has replaced catgut in suturing bile duct also.
• Being synthetic, tissue reaction is less than that of chromic catgut.
• This has also replaced catgut while suturing common bile duct.
• Knotting property is good
• Vicryl can be used in the presence of infection.

4. Dexon (polyglycolic acid):

• Synthetic absorbable
• Braided
• Used like vicryl

5. PDS (polydioxanone suture):

• Like vicryl
• Costly
• Creamy in colour

Nonabsorbable

1. Prolene:

• This is polypropylene and nonabsorbable.
• It is monofilament, artificial and uncoated. Does not harbour micro-organism. Hence, the chances of infection are less.
• Since it is nonabsorbable, prolene can be used for abdominal closure, repair of hernias, repair of incisional hernia, etc.
• It has high memory (recoiling tendency after removal from the pocket) and hence multiple knots are required.

2. Sutupack:

• It is a monofilament or multifilament polyamide.
• Black in colour
• It is braided, uncoated and nonabsorbable.
• Uses of sutupack are similar to prolene.
• Knotting property is not very good. Hence, it is mandatory to put 4–5 knots.

3. Mersilk:

• This is nonabsorbable, braided silk, black in colour.
• It has been provided with a round body. This can be used in ligating bleeding points or anastomosis, etc.

4. Black silk:

• This is a nonabsorbable suture material.
• It is biological and derived from the cocoon of the silkworm larva.
• It is braided, coated with wax to reduce capillary action. Tissue reaction is much more with black silk because it is a foreign protein.
• In spite of this, it is widely used because of its easy availability and is cheap.
• Knotting property is excellent.

5. Cotton:

• White in colour
• Multifilament—infection rate is high
• Nonabsorbable, cheap