From the Guidelines
In plastic surgery, the use of monofilament sutures, such as Monocryl (poliglecaprone 25) or Prolene (polypropylene), is recommended due to their association with a lower risk of incisional hernia and minimal tissue reaction, as supported by the most recent and highest quality study 1. The choice of suture material and needle type depends on the specific surgical site, tissue type, and desired cosmetic outcome.
- Absorbable sutures, such as Vicryl (polyglactin 910) or PDS (polydioxanone), are suitable for deep tissue closure and provide extended support for tissues requiring longer healing times.
- Non-absorbable options, such as nylon (Ethilon) or silk, offer excellent handling but may cause more tissue reaction. Regarding needles,
- cutting needles have sharp edges ideal for tough tissues like skin
- reverse cutting needles have the cutting edge facing away from the wound to prevent tissue tearing
- taper needles are round and create minimal trauma, making them suitable for delicate tissues
- blunt needles are used for friable tissues to minimize bleeding. The method of skin closure, whether continuous or interrupted stitches, does not significantly affect the incidence of surgical site infections, but continuous sutures may provide a better seal and reduce the risk of superficial wound dehiscence, as suggested by a Cochrane meta-analysis 1. Additionally, the use of adhesive strips or tissue adhesives does not reduce the incidence of surgical site infections or improve cosmetic outcomes, as shown in a prospective study 1. However, the most recent guideline recommends the use of slowly absorbable sutures, such as Monocryl (poliglecaprone 25), for the closure of emergency laparotomy, due to their potential to decrease pain 1. It is essential to consider wound tension, healing time, and potential scarring when selecting the appropriate suture and needle type, as supported by the World Society of Emergency Surgery guidelines 1.
From the Research
Types of Sutures
- Absorbable sutures: derived from mammalian collagen, undergo enzymatic degradation, or synthetic polymers that undergo hydrolysis 2
- Nonabsorbable sutures: typically cause an inflammatory reaction, eventually encapsulated by fibrous tissue formation, and can lead to chronic inflammation or suture extrusion 2
- Monofilament sutures: lower resistance when passed through tissues, but may have lower tensile strength 2, 3
- Multifilament sutures: higher tensile strength and flexibility, but greater tissue friction and pose risks of suture sinus and infection 2
Thread Materials
- Natural materials: collagen, catgut, and treated catgut 4
- Synthetic materials: polybutester, polytetrafluoroethylene (ePTFE), and POLYSORB™ 3
- Absorbable materials: CAPROSYN™, a rapidly absorbing monofilament suture 3
Needle Types
- SURGALLOY™: a new high-nickel stainless steel used to manufacture surgical needles 3
- S45500 stainless steel alloy: used to make cutting edge needles, but has inferior performance characteristics compared to SURGALLOY™ 3
Suture Selection
- The choice of suture material should be based on the biological interaction of the materials employed, the tissue configuration, and the biomechanical properties of the wound 3
- The ideal suture material should have great strength, knot security, elasticity, and minimal tissue reactivity 4, 5
- No single suture material is ideal for all situations, and the choice of suture material depends on the specific clinical situation and the desired outcome 2, 5, 6