The perfect seam: the main characteristics of different types of suture materials

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

Suture Material Specifications

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	Sutures that lose most of their tensile strength within 60 days are considered absorbable. They are destroyed by tissue enzymes or hydrolysis.  Resorbable sutures are usually used as deep sutures; they do not need to be removed after the operation; Non-absorbable sutures are used for superficial sutures and require manual removal after surgery.
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. 3-0 - thick strong seam; 6-0 - thin, relatively weak seam.
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: To adapt to postoperative edema, without tissue incision; Maintain tension on wound edges after edema has been eliminated.
Ease of use and safety of nodes	Low friction suture glides well through the tissue, but the knot will unravel more easily; The high memory suture will return to its original position. Although these seams are strong, they can be difficult to handle and reduce the safety of knots; High compliance suture is easy to tie into a secure knot.
Tissue response to material	Shows the severity of the inflammatory response to the suture: Inflammatory response is higher for natural materials such as silk and gut; Below for synthetic fibers such as nail he.

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.

Read the most interesting articles in Telegram!

 

Multifilament suture also has higher capillarity, so it can more easily absorb and transport fluid, increasing the chance of bacteria from entering the skin surface.

Invisible threads: a refined cosmetic suture technique

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 desired

it.

Absorbable sutures: types and features of application

1. 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.

Thin scar after plastic surgery: how to achieve such a result

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.

More useful and interesting information on our channel on YouTube: