Tissue reaction is highest with which of the following suturing materials?

Appeared in: PGIMS Rohtak NO - 2017

Explanation

Plain catgut is a natural suture derived from purified collagen from animal intestines.
It is absorbed by the body through enzymatic proteolysis, a process that elicits a strong inflammatory response.
This intense tissue reaction is the highest among the common suture materials, leading to rapid loss of tensile strength.
Synthetic sutures, in contrast, are generally less reactive.

Option B: Chromic catgut is plain catgut treated with chromium salts. This treatment slows the absorption rate and, importantly, reduces the intensity of the tissue's inflammatory response compared to plain catgut.
Option C: Nylon is a synthetic, non-absorbable monofilament suture. It is known for being biologically inert and causing minimal to no tissue reaction.
Option D: Vicryl (Polyglactin 910) is a synthetic absorbable suture. It is broken down by hydrolysis, a process that causes only a mild, low-level tissue reaction, far less than the enzymatic degradation of catgut.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Tissue reactivity of different surgical suture materials as background academic context rather than a clinical decision trigger.
Suture selection directly impacts wound healing. Choosing a highly reactive suture like plain catgut in compromised tissue can worsen inflammation, delay healing, and increase infection risk.
In modern clinical practice, low-reactivity synthetic sutures (e.g., Vicryl, Monocryl, PDS, Nylon) are preferred for most applications to ensure better cosmetic outcomes and reduce complications.
Catgut sutures are now rarely used in many parts of the world due to their high reactivity and the availability of superior synthetic alternatives.

How to Approach the Question

First, identify the keyword in the question: 'highest' tissue reaction.
Recall the basic classification of sutures: natural versus synthetic.
Remember the fundamental principle: Natural sutures (like catgut, silk) are generally more immunogenic and cause a greater tissue reaction than synthetic sutures (like Nylon, Vicryl).
Differentiate between the two types of catgut. 'Plain' catgut is untreated, while 'chromic' catgut is treated to reduce reactivity and slow absorption. Therefore, plain catgut must be more reactive than chromic catgut.
Consider the absorption mechanism. Enzymatic degradation (catgut) is a highly inflammatory process, whereas hydrolysis (Vicryl) is much milder.
Based on these points, conclude that the untreated, natural, enzymatically-digested plain catgut will provoke the strongest tissue reaction.

Concept Tested & Keywords

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E6 Gynecology Williams p. 430-440

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 81-83

Practise the full PGIMS Rohtak NO - 2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.