Which suture is most resistant, causing more drag but holds knots better?

• A. Silk
• B. Braided Vicryl
• C. Acrylic Suture
• D. Gut Suture

Answer: (A)

Handling characteristics of sutures—how much drag they create when passing through tissue and how securely knots hold—depend on surface texture and braid. Silk, a natural braided fiber, has a rough surface that increases resistance as it slides through tissue, producing more drag. That same roughness also increases friction between strands in a knot, giving excellent knot security. So silk tends to resist tissue passage more yet holds knots well, making it the best choice when high drag plus strong knot security is desired. In contrast, braided Vicryl is synthetic and absorbable; it handles nicely and knots are secure, but its surface is smoother than silk and its eventual absorption can reduce long-term knot security, so it does not combine maximum drag with the strongest knot security. Gut suture is smoother and more slippery when wet, which lowers drag but also reduces knot security, so knots can loosen more easily. An acrylic suture is not commonly used in standard practice and lacks the well-defined properties for drag and knot security that silk demonstrates.