What is PDS Suture? A Guide to Polydioxanone in Surgical Medicine

October 7, 2025 •

4 min read

PDS, or Polydioxanone, suture is a synthetic, absorbable monofilament suture that retains its tensile strength longer than many other synthetic absorbable materials, with up to 50% strength remaining after four weeks. This characteristic makes PDS suture a cornerstone in surgical medicine for procedures that require extended wound support.

Quick Summary

An overview of polydioxanone (PDS) suture, a synthetic, absorbable monofilament used for deep and internal wound closure. It details the material's extended tensile strength retention and slow, predictable absorption via hydrolysis, resulting in minimal tissue reaction. The synopsis outlines key applications, contrasts PDS with other sutures, and reviews its benefits and limitations in surgery.

Key Points

Polydioxanone Composition: PDS suture is a synthetic, absorbable monofilament made from poly(p-dioxanone).
Slow Absorption via Hydrolysis: PDS degrades predictably through a gradual process of hydrolysis over approximately 180 to 210 days, providing long-term support.
Extended Strength Retention: The suture retains significant tensile strength for an extended period, making it suitable for slow-healing tissues under stress.
Monofilament Advantages: Its smooth, single-stranded design results in minimal tissue drag, reduced inflammation, and a lower risk of infection.
Common Applications: PDS is frequently used for abdominal closures, pediatric cardiovascular surgery, and other procedures requiring durable, absorbable support.
Trade-offs in Handling: While durable, the monofilament structure can be stiff and have a 'memory', affecting knot security and handling compared to braided sutures.

Understanding the Polydioxanone (PDS) Suture

PDS suture is a synthetic absorbable surgical suture, with PDS being the trade name for polydioxanone. Composed of the polymer poly(p-dioxanone), it is a crucial material in modern surgery due to its unique combination of strength and absorbability. Unlike many other absorbable sutures that are braided, PDS is a monofilament, meaning it is a single, smooth strand. This structure has significant clinical implications, influencing its handling, passage through tissue, and interaction with the body.

The Chemical Composition and Absorption Process

At its core, polydioxanone is a colorless, crystalline, biodegradable synthetic polymer. Its absorption process in the body is both predictable and reliable, occurring via a simple mechanism called hydrolysis. During hydrolysis, water within the body's tissues gradually and systematically breaks down the polymer's chemical bonds, causing the suture to lose tensile strength and mass over time. The process is not dependent on enzymatic reactions, which can be inconsistent in different tissue types or in the presence of infection, making PDS absorption more consistent.

The absorption timeline is a defining feature of PDS. While the suture begins to lose its tensile strength relatively early, its mass remains largely intact for several months. It retains approximately 70% of its initial tensile strength at two weeks, 50% at four weeks, and 25% at six weeks. The suture is completely absorbed by the body within 180 to 210 days. This extended timeline provides crucial support for tissues that heal slowly, distinguishing it from faster-absorbing sutures.

Key Characteristics of PDS Suture

Several properties make PDS a preferred choice for specific surgical applications:

Monofilament Structure: The smooth, single-stranded design of PDS allows it to glide through tissue with minimal trauma and drag. This reduces tissue irritation and is associated with a lower risk of infection compared to braided sutures, which can harbor bacteria within their filaments.
Extended Tensile Strength: PDS provides extended wound support for up to six weeks, a longer period than many other absorbable sutures. This is ideal for supporting slow-healing tissues under tension, such as fascial closures.
Minimal Tissue Reaction: PDS elicits a low inflammatory response in the body, as it is a synthetic and highly biocompatible material. This minimal foreign body reaction is advantageous for delicate tissues and can lead to cleaner, more predictable healing.
Handles Well, But Has Memory: PDS, especially the newer PDS II version, is known for its improved handling characteristics. However, as a monofilament, it can be stiffer than braided sutures and exhibit a slight "memory," or tendency to retain its coiled shape from the package.
Infected Tissue Suitability: The monofilament nature and slow hydrolysis make PDS suitable for use in infected tissues, as it is less likely to harbor bacteria than braided alternatives.

Common Surgical Applications

Due to its unique properties, PDS suture is utilized across a wide range of surgical specialties:

Abdominal and Fascial Closures: Its prolonged strength retention makes it a standard for closing the linea alba (midline abdominal wall) and other fascia layers, which require long-term support.
Pediatric Cardiovascular Surgery: It is indicated for use in pediatric cardiovascular tissue where the ability for the suture to absorb as the tissue grows is desired.
Ophthalmic Surgery: Used for delicate procedures in the eye, PDS offers the benefit of extended support without the need for suture removal.
Orthopedic Surgery: In cases of ligament or tendon repair that require gradual healing and support, PDS is an effective option.
Gastrointestinal and Urologic Surgery: Its ability to maintain integrity in the presence of bodily fluids, including urine and bile, makes it suitable for repairing tissues in these systems.

PDS Suture vs. Other Common Sutures

To better understand the role of PDS, it is helpful to compare it with another common absorbable suture, Vicryl (polyglactin 910).


Feature	PDS (Polydioxanone)	Vicryl (Polyglactin 910)
Structure	Monofilament (single strand)	Multifilament (braided strands)
Strength Retention	Extended; retains significant strength for up to 6 weeks	Moderate; loses strength more rapidly, significant drop after 3 weeks
Absorption Time	Slow; complete absorption in 180-210 days	Moderate; complete absorption in 60-90 days
Tissue Reaction	Minimal inflammatory response	Minimal inflammatory response
Handling	Can be stiff with memory, newer versions are improved	Excellent handling and knot security
Knot Security	Can be poorer than multifilament, requires extra throws	Excellent knot security
Infection Risk	Low due to monofilament structure	Slightly higher risk due to braided structure

Advantages and Disadvantages of PDS

Advantages:

Extended Support: Provides sustained tensile strength for slow-healing tissues.
Low Infection Risk: The monofilament construction minimizes bacterial colonization.
Predictable Absorption: Hydrolysis ensures a reliable and consistent absorption timeline.
Minimal Tissue Reactivity: A low inflammatory response promotes cleaner healing.
Smooth Passage: The single strand glides easily through tissue, reducing drag and trauma.
Versatility: Useful in various demanding surgical fields, including pediatric and ophthalmic surgery.

Disadvantages:

Handling and Memory: The material can be stiff and prone to coiling, which can make handling more difficult.
Knot Security: Requires more deliberate and careful knot tying to ensure security compared to braided sutures.
Cost: PDS sutures are often more expensive than other absorbable options like Vicryl.

Conclusion

In conclusion, PDS suture is a highly valued material in pharmacology and surgery, primarily known for its extended tensile strength and slow, predictable absorption via hydrolysis. Its monofilament structure provides the distinct advantages of minimal tissue trauma and reduced infection risk, making it ideal for deep and internal closures that require prolonged tissue approximation. While its stiffness and handling can be a drawback compared to braided sutures, its overall benefits in terms of biocompatibility and strength retention make it a vital tool for surgeons addressing slow-healing or high-tension tissues. The choice between PDS and other materials, such as Vicryl, depends on the specific clinical needs of the procedure, balancing factors like handling, strength, and absorption time to optimize patient outcomes.

To learn more about surgical biomaterials, you can visit the ScienceDirect topics on biomaterials.

Frequently Asked Questions

Yes, PDS (Polydioxanone) suture is an absorbable suture that dissolves completely in the body through a process called hydrolysis. This occurs over several months, with complete absorption typically occurring between 180 and 210 days.

The main benefit of PDS is its extended tensile strength retention. It provides prolonged wound support for up to six weeks, which is longer than many other synthetic absorbable sutures like Vicryl.

Yes, PDS is suitable for use in infected tissues. Its monofilament structure prevents it from harboring bacteria as easily as multifilament (braided) sutures, and its predictable absorption is not significantly affected by infection.

PDS is a monofilament, which can be stiffer and have a 'memory' or tendency to coil. Newer versions, like PDS II, have improved handling characteristics, but it still requires careful knot tying to ensure security compared to braided sutures.

PDS retains its strength for a long period relative to other absorbable sutures. It maintains about 70% of its initial tensile strength after two weeks, 50% after four weeks, and 25% after six weeks.

While it can be used for subcuticular (below the skin) closure, PDS's long resorption time is often not necessary for fast-healing superficial tissues. Faster-absorbing sutures might be more appropriate for simple skin closure.

PDO is the abbreviation for the polymer polydioxanone, while PDS is the trade name for polydioxanone suture manufactured by Ethicon. In surgical contexts, the terms are often used interchangeably to refer to the same type of suture material.