Suture Material: All You Need To Know

Typically, when a junior surgical trainee is asked which suture you would use on the skin, the standard answer is whatever the boss prefers to use. This answer has two purposes – it maintains the status quo, but it also covers the fact that many are unaware of the suture materials. This basic overview should guide you.

The ideal suture material is usually sterile, easy to handle, strong, resistant to infection, and affordable. It should also behave the way we want it to, i.e., consistent. As you can see, it is incredibly challenging to produce the perfect suture and precisely why there are varied materials available that offer unique characteristics.

Suture types are split into different categories:

Non-absorbable

Non-absorbable ones such as prolene suture get used for offering long-term tissue approximation. They are ideal for skin and removed later. Sometimes, they are used inside the body where they get retained. Typical uses of these non-absorbable sutures are vessel repair, bowel repair, tendon repair, and skin closure.

The prolene suture and nylon one offer good strength to low tissue reactivity and are hence used widely. Prolene 6-0 is one example here that is commonly used for facial wounds where the cosmetic outcome is essential. The low reactivity causes less scarring. Prolene gets used widely for vascular anastomoses, abdominal wall closure, and C-section surgeries. They get dyed blue for helping with visibility.

Absorbable

The absorbable sutures get broken down by the body over time through hydrolysis and enzymatic degradation. The time it takes depends not only on the material but also on the insertion and the individual patent characteristics. The suture's absorption rate increases in patients due to infection, fever, or protein deficiency. Skin closure of the surgical wound is commonly achieved with absorbable sutures. One of the absorbable sutures used in practice is Polyglactin 910 sutures. It is a sterile surgical suture made of copolymer, made of 90 per cent glycolide and 10 per cent L-lactide.

Even braided sutures under the absorbable ones are useful as they loosen at the surgical knot. But they may cause local tissue reaction.

Are catgut sutures still used?

The naturally made sutures like catgut do not get used as commonly they once were. It is a good suture material made by twisting together the strands of bovine intestine collagen. They have excellent handling properties and are currently banned in Europe and Japan due to the risk of transmission of mad cow disease.

Does the size matter?

The strength and handling properties get affected by the thickness of the suture thread. Hence, these threads get manufactured in varied sizes. The size determines the diameter of the suture strand. The larger the number prefix, the smaller the diameter of the thread.