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.
**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.|
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 infectionDifferent types of sutures are created to have the characteristics needed for specific types of surgical procedures.
Some top manufacturers of surgical sutures in the United States include Ethicon, a division of the Johnson & Johnson Company, Covidien and Kollsut Scientific Corporation.
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.