Catgut
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catgut suture surgical material history properties
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Here is a comprehensive overview of catgut as a surgical suture material:
Catgut (Surgical Gut)
What Is It?
Catgut — despite its name — comes not from cats but from the submucosal layer of sheep intestine (or occasionally the serosal layer of beef intestine). It is a natural, absorbable suture material that has been used in surgery for centuries.
Types
| Type | Description |
|---|---|
| Plain catgut (PCG) | Untreated; absorbed fastest |
| Chromic catgut (CCG) | Treated with chromium salts to delay absorption and prolong tensile strength |
| Fast-absorbing catgut | Processed for very rapid surface absorption |
Mechanism of Absorption
Catgut is broken down by proteolytic enzymes (white blood cell lysozymes), not by hydrolysis as synthetic absorbables are. This makes its absorption time highly variable and unpredictable, unlike synthetic sutures.
Properties & Performance
| Property | Plain Gut | Chromic Gut |
|---|---|---|
| Tensile strength duration | ~5–7 days | ~10–14 days |
| Absorption time in tissue | 10–40 days | 15–60 days |
| Tissue reactivity | Greatest (among all sutures) | Greatest |
| Knot security | Poor | Fair |
| Handling | Poor | Poor |
| Infection risk | Higher than synthetics | Higher than synthetics |
- Catgut is stronger than soft wound tissue for no more than 7 days; chromic catgut for 10–21 days.
- In the oral cavity, plain gut dissolves in 3–5 days; chromic gut in 7–10 days.
- On the skin surface, fast-absorbing catgut disappears in 9–13 days.
- Remnants of catgut have been found in wounds more than 2 years after placement despite nominal absorption timelines.
Tissue Reactivity
Catgut provokes the most tissue reaction of any suture material — more than cotton and silk, and far more than synthetics:
Most Reactive → Catgut, Cotton, Silk → Synthetic absorbable → Nylon, Steel, Polyethylene, Polypropylene → Least Reactive
This significant inflammatory response means catgut is contraindicated in contaminated wounds, as the infection rate in experimentally contaminated wounds closed with catgut is higher than with polyglycolic acid sutures.
Absorption Comparison (Subcutaneous Tissue)
- Catgut: ~1 month
- Polyglactin (Vicryl): 2–3 months
- Polyglycolic acid (Dexon Plus): 4 months
- PDS: 6 months
- Polyglyconate (Maxon): 7 months
Special Circumstances
- Paraplegics: Catgut is poorly absorbed; sterile abscesses commonly form around buried catgut. Nonabsorbable sutures (e.g., nylon) are preferred for episiotomy repair in these patients.
- Infected urine: Catgut sutures actually retain the most strength in this environment (compared to synthetic sutures).
- Episiotomy: Polyglycolic acid/polyglactin sutures are superior to chromic catgut for episiotomy repair — less pain, better healing.
Clinical Comparison to Modern Alternatives
Synthetic absorbable sutures (Vicryl, PDS, Dexon) have largely replaced catgut in modern surgery because they offer:
- More predictable absorption times (via hydrolysis)
- Less tissue reactivity
- Better tensile strength
- Lower infection rates
Catgut's main surviving niches are procedures where very short-term tensile strength is adequate and rapid absorption is desirable (e.g., mucosal suturing, pediatric skin closure where suture removal is difficult).
Sources: Roberts and Hedges' Clinical Procedures in Emergency Medicine, p. 785–806; Hinman's Atlas of Urologic Surgery, Selection p. 491–498; Creasy & Resnik's Maternal-Fetal Medicine, p. 4268.
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