From the Guidelines
Absorbable sutures are suggested for the closure of emergency laparotomy due to decreased pain, while non-absorbable sutures may be considered for skin closures requiring extended support or high-tension areas 1. When deciding between absorbable and non-absorbable sutures, several factors come into play, including the location of the wound, tissue type, required tensile strength, infection risk, and patient factors like age and healing capacity.
- Absorbable sutures, such as slowly absorbable monofilament sutures, are ideal for internal tissues and wounds where suture removal would be difficult or unnecessary, and may decrease pain 1.
- Non-absorbable sutures, on the other hand, are preferred for skin closures requiring extended support, high-tension areas, or when precise timing of suture removal is desired, and are commonly used for exterior skin closures, vascular surgeries, and orthopedic procedures. Key considerations for suture material selection include:
- Suture length-to-wound length ratio, with a recommended ratio of at least 4:1 for continuous closure of midline abdominal wall incisions in emergency surgery 1.
- The use of antimicrobial-coated sutures, which may decrease the incidence of incisional hernia and surgical site infections in clean-, clean-contaminated, and contaminated fields 1.
- The choice of suture technique, with continuous suturing suggested for fascial closure due to reduced time and equivalent outcomes compared to interrupted sutures 1.
From the Research
Suture Material Selection
The selection of suture materials depends on several factors, including:
- Absorbable or non-absorbable properties
- Monofilament or multifilament structure
- Duration of tensile strength
- Type of tissue being sutured 2
Absorbable Sutures
Absorbable sutures are used in various surgical procedures, such as:
- Continuous closure of clean and contaminated abdominal wounds 3
- Hair transplantation surgery 4
- Traumatic wound closure to avoid additional hospital visits for suture removal 5 These sutures are hydrolyzed in tissues and do not require removal, reducing the risk of complications and promoting patient comfort.
Non-Absorbable Sutures
Non-absorbable sutures are commonly used in:
- Interrupted skin closure techniques 6
- Donor closure in hair transplantation surgery 4
- Traumatic wound closure, although they require removal and may cause additional discomfort and complications 5
Comparison of Absorbable and Non-Absorbable Sutures
Studies have compared the outcomes of absorbable and non-absorbable sutures in various surgical procedures, including:
- Continuous versus interrupted skin closure techniques, which found that continuous subcuticular sutures with absorbable material may reduce superficial wound dehiscence 6
- Running closure of clean and contaminated abdominal wounds, which found that absorbable sutures had a lower incidence of late suture sinus formation 3
- Traumatic wound closure, which found that absorbable sutures had a similar infection rate to non-absorbable sutures and reduced postoperative hospital visits 5
Key Findings
- Absorbable sutures can be used in various surgical procedures, including clean and contaminated wounds, and may reduce complications and promote patient comfort 3, 4, 5
- Non-absorbable sutures are commonly used in interrupted skin closure techniques and may require removal, causing additional discomfort and complications 6, 5
- The choice of suture material depends on the specific surgical procedure, tissue type, and patient needs 2