Estimated reading time: 5 minutes
Suturing is one of the most fundamental yet most confusing topics for OBGYN residents—especially during exams and early OT postings. Different packets, unfamiliar markings, multiple brands, and endless viva questions often make sutures feel more complicated than they really are.
In this first part of a two-part series, Dr. Aditya Nimbkar simplifies suturing in OBGYN by breaking down commonly used suture materials, how to read suture packets, and how to answer suturing questions confidently in exams.
Why Sutures Matter More Than You Think?
If there is one skill that stays with you throughout residency and beyond, it is suturing. From LSCS and episiotomy repair to hysterectomies and laparoscopic vault closure, the right suture makes a significant difference to healing, infection rates, and patient comfort.
This session focuses on the most frequently used sutures in obstetrics and gynecology, starting with Vicryl and moving on to silk and Mersilene.
Understanding a Suture Packet: What to Read First
Before using any suture, always understand what the packet is telling you. Every suture packet contains critical information:
1. Suture Size (US Gauge System)
- 1, 2, 3 → thicker sutures
- 1-0, 2-0, 3-0, 4-0 → progressively thinner sutures
Think of 1-0 as the center point:
- Numbers without zeros → thicker
- Numbers with more zeros → thinner
2. Suture Length
- Usually mentioned in centimeters
- Common lengths: 70 cm or 90 cm
3. Needle Details
Each packet also mentions:
- Needle length (e.g., 20 mm or 30 mm)
- Needle shape (half circle, 3/8 circle)
- Needle type
- Round body (used for uterus, muscle)
- Tapered tip
4. Absorbable vs Non-Absorbable
Clearly mentioned on the packet and extremely important for exams.
The Three Golden Points to Describe Any Suture in Exams
Whenever you are shown a suture in viva, always describe it using three fixed parameters:
- Natural or Synthetic
- Absorbable or Non-absorbable
- Monofilament or Multifilament (Braided)
If you remember just this framework, your suturing viva will almost always go well.
Vicryl (Polyglactin 910): The Gold Standard
Vicryl is one of the most commonly used sutures in OBGYN.
Key Features
- Synthetic
- Absorbable (Delayed absorbable)
- Multifilament (Braided)
Strength & Absorption
- Loses 50% strength in ~3 weeks
- Loses 75% strength by 5–6 weeks
- Completely absorbed in 50–70 days
- Absorbed by hydrolysis
Advantages
- Excellent tensile strength
- Easy handling
- Ideal for:
- Uterine closure after LSCS
- Episiotomy repair
- Vaginal tears
- Abdominal & vaginal hysterectomy
- Laparoscopic vault suturing
- Multilayer myomectomy closure
Disadvantage: Wicking
Because Vicryl is braided, it allows capillary spread of fluids and bacteria, a phenomenon known as wicking. This makes it less suitable in infected fields and unsuitable for skin closure.
Rating: 9/10
A reliable, versatile, and time-tested suture.
Vicryl Plus: Added Infection Protection
Vicryl Plus is essentially Vicryl with a key upgrade.
Vicryl Rapid: Designed for Fast Healing Areas
Episiotomy wounds heal quickly, so prolonged suture presence causes discomfort and dyspareunia. Vicryl Rapid was developed to address this.
Key Features
- Gamma-irradiated
- 50% strength lost in 5–6 days
- Completely absorbed in 2–3 weeks
Ideal Use
- Episiotomy repair
- Vaginal lacerations
Not Suitable For
- Uterine suturing
Rating: 8/10
Perfect for perineal repairs, limited elsewhere.
Silk (Mersilk): A Suture of the Past
Characteristics
- Natural
- Multifilament
- Practically non-absorbable
- Loses 50% strength after 1–1.5 years
Why It’s Rarely Used Now
- Stays in tissue for years
- High risk of:
- Foreign body granuloma
- Chronic inflammation
Rating: 5/10
Given mostly out of respect for its historical importance.
Mersilene Tape: Still Very Relevant
Mersilene tape is entirely different from silk, despite the similar name.
Key Features
- Synthetic
- Permanent
- Multifilament
- Made of polyester
- Silicone-coated for smooth passage
Uses
- Cervical cerclage (Shirodkar, abdominal cerclage)
- Sling surgeries
- Cervicopexy
- Sacrocolpopexy
- Prolapse surgery in young women
Disadvantages
- Difficult handling
- Risk of erosion if exposed near skin or vaginal mucosa
Rating: 7/10
Essential in modern gynecologic surgery despite handling challenges.
What’s Coming in Part 2?
So, In the next session we will cover:
- Staplers
- Prolene
- Ethilon
- Catgut
- Linen
- Monocryl
- Barbed sutures (Stratafix)
Final Takeaway
Understanding sutures is not about memorizing brands—it’s about knowing why, where, and how to use them. Once you learn how to read a suture packet and apply the three-point description rule, both exams and OT work become far easier.
Stay tuned for Part 2 of this comprehensive suturing series.
