For many surgeons, surgical silk represents the handling performance standard by which newer synthetic materials are judged, especially due to its superior handling characteristics. Silk filaments can be twisted or braided, the latter providing the best handling qualities. The silk for most suture sizes before the braiding process allows for a tighter, more compact braid which significantly improves suture quality. After braiding, the strands are dyed, scoured and stretched, and then impregnated and coated with a mixture of wax or silicone.

Each of these steps is critical to the quality of the finished suture and must be carried out in precise order. Surgical silk is usually dyed black for better visibility in tissue. Raw silk is graded according to strength, uniformity of filament diameter, and freedom of defects. Only top grades of silk filaments are used to produce silk surgical sutures. However, surgical silk loses tensile strength when exposed to moisture and should be used dry. Although silk is classified by the U.S.P. as a non-absorbable suture, long-term live studies have shown that it loses most or all of its tensile strength in about one year and usually cannot be detected in tissue after two years. Thus, it behaves in fact as a very slow absorbing suture.