Everything You Need To Know About Sutures
Different Suture Types
Surgical sutures are typically divided into two types: non-absorbable and absorbable. However, they may also be differentiated depending on their construction (mono-filament or multi-filament), absorption profile, coating used, and on the synthetic or natural makeup of their materials. Suture type may further be classified depending on specific purpose, such as general sutures, ophthalmic sutures, cardiovascular sutures, orthopedic sutures, and so forth.
Non-Absorbable and Absorbable Sutures
When discussing the absorbable nature of sutures, those that are non-absorbable must be removed by hand, while those that are absorbable are capable of breaking down in the body over the course of time. The suture option that is used is entirely dependent upon the operation that is taking place, including variables such as procedure location and environment. Surgeons must select the option they feel is best, based on their education and years of experience.
Suturing done internally would require the incision site to be reopened for manual removal, while exterior suturing can be removed without reopening of the wound. For this reason, it is most common to find absorbable sutures used internally and non-absorbable sutures used externally.
Environment also plays a role in determining which type of suture to use. Stressful environments, such as the bladder (which has an adverse chemical presence) or the heart (with continual movement and pressure), may benefit from stronger suture material that is specifically created for the environment. Often, these specialized sutures are non-absorbable in order to lower degradation risk.
- Non-Absorbable Suture Materials: Polyester, Nylon (poylamide), Polypropylene, PVDF, silk, and stainless steel.
- Absorbable Suture Materials: Polyglactin 910, Polyglycolic Acid, Catgut, Polydioxanone, and Poliglecaprone 25.
Multifilament and Monofilament Sutures
This differentiation of sutures refers to the makeup of the material structure. Multifilament, or braided sutures, generally come coated in materials like wax, silicon, polycaprolactone, calcium stearate, or PTFE, and give improved knot security. The monofilament structure offers better passage through the tissues, and typically causes lower reaction in tissues than multifilament sutures.
- Multifilament or Braided Suture Materials: Polyglactin 910, PGA, silk, and polyester
- Monofilament Suture Materials: Nylon, Catgut, PVDF, Polypropylene, stainless steel, Polydioxanone, and Poliglecaprone
Natural and Synthetic Sutures
Whether or not a suture is natural or synthetic is dependent upon the origin of the material. Silk and catgut sutures are natural. All other types of suturing material are of a synthetic make.
Un-Coated and Coated Sutures
Sutures come with different coatings to enhance various properties of the sutures themselves during the closure procedure. These include aspects such as better knotting and ease of passage through patient tissues to lower overall reaction of the tissue. In general, coatings are given to multifilament types of sutures rather than monofilament sutures, because coating is more easily accomplished with braided sutures.
- Un-Coated Suture Materials: Stainless steel, PVDF, monofilament nylon, and monofilament polypropylene.
- Dr. Nate Whittaker, MD Emergency Medicine Specialist