Which suture material is most likely to provoke a tissue or allergic reaction?

Correct answer: D. Silk

• A. Nylon is synthetic and, particularly as a monofilament, produces minimal tissue reaction — which is why it is favoured for skin and lip laceration repair.
• B. PTFE is synthetic, monofilament and essentially inert, which is why it is preferred for implant and graft surgery where plaque accumulation must be minimized.
• C. Polypropylene is a synthetic monofilament and one of the least reactive suture materials available.
• D. CORRECT. Silk is a natural, braided, multifilament protein material. Being a foreign protein it provokes the greatest inflammatory and hypersensitivity response of the common suture materials, and its braided structure wicks bacteria and fluid along the strand into the wound.

Note: Two properties determine reactivity: NATURAL versus SYNTHETIC (natural materials — silk, plain and chromic gut — are far more reactive) and BRAIDED versus MONOFILAMENT (braided wicks bacteria and accumulates plaque). Silk is both natural and braided, which makes it the maximally reactive option. Its advantages are excellent handling and knot security, which is why it persists in oral surgery despite this.