Reverse Cutting. PERMA-HAND™ Silk Suture is indicated for use in general soft tissue approximating and/or ligation, including use in cardiovascular, ophthalmic, and neurological procedures. PERMA-HAND Suture elicits an acute inflammatory reaction in tissue, which is followed by a gradual encapsulation of the suture by fibrous connective tissue. While silk sutures are not absorbed, progressive degradation of the proteinaceous silk fiber in vivo may result in gradual loss of all of the suture’s tensile strength over time. Due to the gradual loss of tensile strength which may occur over prolonged periods in vivo, silk suture should not be sued where permanent retention of tensile strength is required.