The selection of the appropriate suture for any wound closure will greatly contribute to the final functional and cosmetic outcome.
Surgery often uses two layers of sutures:
- Deep sutures are needed to keep the wound closed until it is completely healed;
- Superficial sutures are required to accurately approximate the edges of the epidermis for the best cosmetic result.
Different types of suturesa are required for different depths and wounds.
At estet-portal.com we figured out what characteristics different types of materials have, as well as what seams are best used for working in different areas.
- Suture Material Characteristics
- Multifilament vs. monofilament suture
- Absorbable sutures: types and features of application
- Non-absorbable sutures: types and features appliedia
The choice of suture material is determined by
balancing the various characteristics of the suture materials that are most appropriate for the particular wound closure situation.
Resorbable and non-absorbable
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Sutures that lose most of their tensile strength within 60 days are considered absorbable. They are destroyed by tissue enzymes or hydrolysis.
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Thickness and Strength |
Tensile strength depends on the size (thickness) of the suture. Surgeons prefer to use the smallest size that will provide sufficient tension.
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Plasticity and elasticity |
The ability to maintain length and strength after being stretched, and the ability to regain its original length after being stretched, respectively. This is important:
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Ease of use and safety of nodes |
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Tissue response to material |
Shows the severity of the inflammatory response to the suture:
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H2 Multifilament suture versus monofilament
Multiple strand suture is easier to work with and knits well, but has the potential to contain micro-organisms between the fibers leading to an increased risk of infection. It should be avoided on contaminated wounds.
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Monofilament suture has a lower risk of infection and a lower coefficient of friction, but is more difficult to work with, and the reliability of knots in its application leaves much to be desiredAbsorbable sutures: types and features of application1. Surgical colon:
- Regular intestine loses its strength after 7-10 days and is completely resorbed by 60 days. Currently, it is rarely used due to poor strength and high tissue reactivity;
- Chromium Gut is made with chromium salts to reduce enzyme absorption and therefore retain strength for 10-14 days, making it useful for mucosal closure.
- Fast Absorbent Colon is produced by preheating and can be used for attaching skin grafts or in low tension areas where the wound is well supported by deep sutures and removal of the suture may be difficult. Maintains strength 3-5 days.
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2. Polyglactin 910 (Vikril®, Polysorb®) – Synthetic braided copolymer that retains 75% strength up to 2 weeks and 50% strength up to 3 weeks. Absorption is usually completed by 3 months. Works well, is minimally reactive and does not tear tissue.
3. Polyglecapron 25 (Monocryl®) – monofilament with 50-60% strength retention within 7 days with complete absorption within 3 months. It provides better control and knot security than most other monofilament sutures, with less tissue reaction than Vicryl® and is therefore useful where minimal tissue reaction is required.
4. Polydioxanone (PDS II®) – monofilament polymer with long lasting tensile strength (70% after 2 weeks, 50% after 4 weeks) and can last for more than 6 months.
Polydioxanone is suitable for high stress areas or contaminated wounds, but being a monofilament has poor handling and knot security. Its minimal tissue reaction makes it good for cartilage repair where inflammation can lead to significant discomfort.5. Polytrimethylene carbonate (Maxon®) – monofilament that combines the long-term strength of PDS® and good handling and toughness of Vicryl®. 80% strength after 2 weeks, 60% after 4 weeks and complete absorption after 6 months. Minimal tissue reaction.
6. Glycomer 631 (Biosyn®) – monofilament similar to Monocryl® performance, but with increased strength, similar to Maxon®.
Non-absorbable sutures: types and features of application
1. Nylon (Ethilon®, Dermalon®, Surgilon®, Nurolon®, Nylene®) – inexpensive monofilament with good tensile strength and minimal tissue reactivity. The downsides are its handling and knot safety, but it remains one of the most popular non-absorbable sutures in dermatological surgery.
2. Polybutester (Novafil®) – monofilament with good workmanship and excellent elasticity. It responds well to tissue swelling and is also suitable for subcutaneous sutures.
3. Polypropylene (Prolene®, Surgilene®, Surgipro®) – the monofilament polymer with a very low coefficient of friction makes it a suture material for performing subcutaneous sutures. It has good ductility but limited elasticity, poor knot protection, and is relatively expensive. Approved by some for facial sutures.
4. Silk (Dysilk®) – braided natural protein with unrivaled processing, knot security and pliability (making it ideal for mucosal surfaces), but is limited by its low tensile strength and high coefficient of friction, capillarity and tissue reactivity.
5. Polyester (Dacron®, Mersilene®, Ethibond®) – braided multifilament suture with high strength, good workmanship and low tissue reactivity. The pliability makes it excellent for mucosal surfaces without silk reactivity.
Suture material: which sutures should the surgeon prefer
It is also important to consider the characteristics of the needle when choosing a suture.The most common needle body configuration in dermatological surgery – curved. The sharper the tip of the needle, the sharper and more expensive the needle.
A round needle with a pointed end is the least likely to cause tissue rupture and is used mainly for suturing fasciae, muscles and aponeuroses. The body can be flattened to facilitate gripping the needle holder and limit twisting during placement.
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