11/13/24, 7\:27 PM Guide | Suture material

Suture material

Table of contents

Introduction

When a junior surgical trainee is asked,
“W h i c h s u t u r e w o u l d y o u l i k e f o r s k i n ? ”
, a common response is “ W h a t e v e r T h e B o s s
l i k e s t o u s e !”
. This answer serves two purposes\: It maintains the status quo, but (more importantly) it also covers up the fact that
many of us have only a very basic understanding of suture materials. In light of this, I hope this overview will cover the basics of
why di
Suture types
The ideal suture material is sterile, easy to handle, strong (along all of its length), resistant to infection and cheap. It also has to
behave in the way we want it to, in a consistent manner. As you might imagine, it is extremely di
‘perfect’ suture, which is why there is a wide variety of materials available which o
Suture types are broadly split into the following categories\:
Absorbable vs nonabsorbable
Braided vs non-braided
Natural vs synthetic

Absorbable vs Non-absorbable

Absorbable

Absorbable sutures (e.g. Monocryl, Vicryl, PDS) are broken down by the body over time by processes such as hydrolysis and
enzymatic degradation. The amount of time this takes depends on the material, but also the location of insertion and the
individual patient characteristics. The absorption rate of a suture can increase in patients with ongoing infection, a fever or
https\://app.geekymedics.com/osce-guides/clinical-procedures/suture-material/ 1/211/13/24, 7\:27 PM Guide | Suture material
protein de
Skin closure of a clean surgical wound is most commonly achieved with an absorbable suture which provides soft tissue
approximation to aid the healing process without permanent implantation of a foreign tissue. Developed in the mid-90s,
Monocryl is a mono
retains approximately 20-30% of it's breaking strength at two weeks and is completely absorbed at around 100 days. Vicryl is a
widely used alternative and di
useful as they are less likely to loosen at the surgical knot, but they do have a theoretically increased propensity to infection
and may cause more of a local tissue reaction.

Non-absorbable

Non-absorbable sutures (e.g. nylon (Ethilon), silk, Prolene etc.) are used to provide longer-term tissue approximation. They can
be used on the skin, and removed at a later date, or used inside the body where they will be retained. Common uses for a non-
absorbable suture would include vessel repair/anastomosis, bowel repair, tendon repair and skin closure (where the
interrupted sutures would be later removed).
Nylon (Ethilon) and Prolene are both non-absorbable mono
low tissue reactivity and are therefore widely used. Prolene 6-0, for example, is a commonly used option to suture facial
wounds where the cosmetic outcome is key, as the low reactivity is thought to cause less scarring. Prolene is also used
routinely for vascular anastomoses, abdominal wall closure and in caesarean sections. It is often dyed blue to aid visibility.

Do people really use catgut?

Naturally occurring suture materials (e.g. catgut, silk, steel etc.) are not as commonly used as they once were. Catgut is a good
suture material made by twisting together strands of bovine intestine collagen. It boasts excellent handling properties but is
now banned in Europe and Japan due to the risk of disease transmission including bovine spongiform encephalopathy (mad-
cow disease).
Silk was used for a wide variety of uses before the introduction of synthetic materials. It is, however, still used to secure surgical
drains.
Steel is a sterile suture that can be mono
tendon repairs, but also in the closure of the sternum (we've all spotted this on a chest X-ray).

Does size matter?

The tensile strength and handling properties are a
manufactured in a variety of sizes. The size (4-0, 3-0 etc) describes the diameter of the suture strand. It is important to note that
the larger the number pre
plastic surgery is much
So, you've chosen your suture material. All that is left is working on your technique and not giving yourself a needlestick injury.
Source\: geekymedics.com
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