From the Guidelines
When it comes to choosing the type of suture, monofilament sutures are the preferred choice due to their association with a significantly lower risk of incisional hernia compared to multifilament sutures, as evidenced by the 2023 World Society of Emergency Surgery guidelines 1. The choice of suture material is crucial in preventing complications such as incisional hernias and surgical site infections.
- Monofilament sutures, such as those made from polydioxanone (PDS) or poliglecaprone 25 (Monocryl), are preferred due to their lower risk of incisional hernia 1.
- The use of antimicrobial-coated sutures, such as triclosan-coated sutures, has been shown to reduce the risk of surgical site infections (SSIs) in various studies 1.
- However, the benefit of antimicrobial-coated sutures may vary depending on the type of surgery and patient population, with some studies showing a significant reduction in SSIs in emergency surgery settings 1.
- Retention sutures may be considered as an addition to suture closure of emergency laparotomy in patients with high-risk conditions for incisional hernia and wound dehiscence, but their use is not universally recommended due to the lack of high-quality evidence and potential for increased postoperative pain 1. Some key points to consider when selecting a suture include:
- Suture material: monofilament or multifilament
- Suture size: ranging from 11-0 (finest) to 7 (thickest)
- Suture type: absorbable or non-absorbable
- Patient population: emergency surgery, elective surgery, or high-risk patients
- Wound location and tissue type: abdominal, cardiac, or other surgical sites Overall, the choice of suture material and technique should be individualized based on the patient's specific needs and the surgeon's professional judgment, with the goal of minimizing complications and optimizing wound healing and cosmetic outcomes.
From the Research
Types of Sutures
- Absorbable sutures: These sutures are designed to be broken down by the body over time and are often used for internal wounds or for wounds that are not under a lot of stress 2.
- Nonabsorbable sutures: These sutures are designed to remain in the body indefinitely and are often used for external wounds or for wounds that are under a lot of stress 2.
- Monofilament sutures: These sutures are made from a single strand of material and have lower resistance when passed through tissues, but may have lower tensile strength than multifilament sutures 2.
- Multifilament sutures: These sutures are made from multiple strands of material and have higher tensile strength and flexibility, but may have greater tissue friction and pose risks of suture sinus and infection 2.
- Barbed sutures: These sutures have small barbs that help to distribute wound tension and eliminate the need for knots, increasing the efficiency of closure 2.
Characteristics of Sutures
- Tensile strength: The amount of force that a suture can withstand before breaking, which is limited by suture size 2.
- Handling: The ease with which a suture can be manipulated and tied, with modern sutures having good handling properties 2.
- Knot-tying properties: The ability of a suture to hold a knot securely, with some sutures having better knot-tying properties than others 3.
- Absorption time: The amount of time it takes for an absorbable suture to be broken down by the body, which can be controlled by modifying the collagen or polymer structure of the suture 2.
Comparison of Sutures
- Poliglecaprone-25 and polyglactin-910: These two sutures have been compared in several studies, with poliglecaprone-25 resulting in significantly less extruded sutures than polyglactin-910, although both resulted in similar-appearing scars 4, 5.
- Monocryl (poliglecaprone 25) and other absorbable sutures: Monocryl has been compared to other absorbable sutures, including PDS-2, Maxon, Vicryl, and Dexon-Plus, with varying results in terms of knot security and other characteristics 3.