Surgical Sutures

Surgical Sutures are medical devices used to hold body tissues together after an injury or surgery. It generally consists of a needle with an attached length of thread. A number of different shapes, sizes, and thread materials have been developed throughout history.

Surgical Sutures are used clinically, and are classified by spontaneous degradation (absorbable/non-absorbable), composition (natural/synthetic), and structure (monofilament/multifilament).  Absorbable sutures can be made out of catgut, as well as synthetic materials such as homopolymers and copolymers of glycolic acid, lactic acid, dioxanone and caprolactone. These materials are broken down in the body by a process called hydrolysis and proteolytic enzymatic degradation, and the process can be from ten days to 2 years depending on the material and the site of implantation. During degradation of an absorbable suture the suture loses tensile strength, and the rate of absorption could accelerate in a patient that has a fever or infection. This would be considered a disadvantage of using an absorbable suture as other problems or infections could occur from improper healing of the wound.

Non-absorbable surgical sutures are made out of a special silk or the synthetics polypropylene, polyester or nylon. These sutures are used either on the skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice, such as the heart or bladder.

*non-absorbable sutures used to close wound on thumb

**Comparison between Monofilament and Multifilament (Braided) Surgical Sutures:

Monofilament surgical sutures are made of a single strand. This structure is relatively more resistant to harboring microorganisms. The monofilament sutures exhibit less resistance to passage through tissue than multifilament suture. Great care must be taken in handling and tying monofilament suture because crushing or crimping of this suture can nick or weaken the suture and lead to undesirable and premature suture failure.

Multifilament sutures are composed of several filaments twisted or braided together. These materials are less stiff but have a higher coefficient of friction. Multifilament suture generally has greater tensile strength and better pliability and flexibility than monofilament suture. This type of suture handles and ties well. Because multifilament materials have increased capillarity, the increased absorption of fluid may act as a tract for the introduction of pathogens.

Monofilament Surgical Sutures Multifilament (Braided) Surgical Sutures
Monofilament sutures are made of a single strand of material. These sutures are typically used for delicate specialty procedures. Multifilament sutures are made of several strands of suture that are twisted or braided together. Multifilament sutures can be used for more complex procedures such as cardiovascular and orthopedic applications.
Advantages:

  • have less drag than multifilament suture
  • smooth surface, allows easy passage through tissue and non-capillary action
  • has no interstices to support bacteria growth

Disadvantages:

  • with thicker threads the wiriness that is a characteristic of all monofilament threads impairs handling and in particular renders knot-tying more difficult.
  • care should be used in handling because nicking or damaging them with forceps or needle holder weakens them and predispose them to breakage
Advantages:

  • Multifilament sutures are more pliable and flexible than monofilament sutures
  • Results in considerably better knot holding security
  • Better handling
  • Tight weaving of multifilament sutures provide minimum friction

Disadvantages:

  • Longitudinal orientation of the individual filaments within the thread results in relatively high capillarity, but the capillarity of braided threads is less than that of twisted threads.
  • Multifilament sutures have a rough surface that impairs passage through tissue during surgical procedure

Multifilament Sutures

Monofilament Suture

The ideal suture has the following characteristics when used during a general surgical procedure:

  • Suture is sterile
  • Suture is All-purpose: (composed of material that can be used in any surgical procedure)
  • Suture causes minimal tissue injury or tissue reaction (ie, nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic)
  • Easy to handle
  • Holds securely when knotted (ie, no fraying or cutting)
  • High tensile strength
  • Favorable absorption profile
  • Resistant to infection
    Different types of sutures are created to have the characteristics needed for specific types of surgical procedures.

*click on table to zoom in and see larger font

Some top manufacturers of surgical sutures  in the United States include Ethicon, a division of the Johnson & Johnson Company, Covidien and Kollsut Scientific Corporation.

polypropylene suture made by Ethicon: Division of Johnson and Johnson

The image below shows various suturing techniques that could possibly be used depending on the type of wound being closed. These suturing techniques range from simple to complex. The simplest suturing techniques would be used for closing a open wound that would be easy to reach for example a cut on a patients arm. A more complex suturing technique would be used if it is a more serious type of operation such as inserting a heart valve within a patient. This type of suturing has to be durable so that it can withstand the living environment within the patient.

Different Suturing Techniques

References:

[Final Version]

4 thoughts on “Surgical Sutures

  1. I think you have some great information here, I just think you need a little more info. You also need to add some advantages and disadvantages of each kind of suture or of absorbable sutures. I really liked the video you found.

  2. I have 5 comments:

    1) Please take care of your English usage, spelling and grammar. Thanks!!

    2) 2nd Paragraph: A description of “Absorbable suture materials” should include the words: “synthetic materials, such as homopolymers and copolymers of glycolic acid, lactic acid, dioxanone (check spelling!!) and caprolactone.” Also please include the words: “process can be from 10 days to 2 years depending on the material and the site of implantation.”

    3) The 4th paragraph should read: “Some top manufacturers in the United States include Ethicon, a division of the Johnson & Johnson Company, Covidien and Kollsut Scientific Corporation.”

    4) Explain the difference in textile structure between a monofilament and a braided suture. Indicate the advantages, disadvantages and preferred clinical usage of each type of surgical suture. This will enable you to refer to these two types of suture materials throughout your blog.

    5) I too like your use a Youtube video to show how 3 simple interrupted sutures can be used to close an incision. I also like the images of various suturing techniques that you show on your blog. Please explain when and where these different suturing techniques are used clinically.

    Thanks for adding these additional components to your blog.

    Martin W. King
    Professor of Biotextiles & Textile Technology
    North Carolina State University
    Office: (919) 515-1011
    Cellular: (919) 291-2563
    E-mail: martin_king@ncsu.edu
    URL: http://www.tx.ncsu.edu/biomedicaltextileslab/

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