Can Ethilon (nylon) sutures be used for subcuticular suturing?

Using Ethilon (Nylon) Sutures for Subcuticular Suturing

Ethilon (nylon) sutures are not recommended for subcuticular suturing as they are non-absorbable monofilament sutures that would require removal and provide less optimal outcomes compared to absorbable alternatives. 1

Optimal Suture Selection for Subcuticular Closure

Recommended Suture Types

• Absorbable monofilament sutures are the preferred choice for subcuticular closure according to current wound care guidelines 1
• Specific recommended options include:
  • Poliglecaprone-25 (Monocryl) - maintains 50-75% tensile strength after one week 1, 2
  • Polydioxanone (PDS II) - commonly used in 4-0 or 5-0 sizes for dermal sutures 3

Why Ethilon is Not Ideal for Subcuticular Closure

1. Non-absorbable nature: Ethilon would require removal, which defeats a key advantage of subcuticular suturing - the elimination of suture removal 1
2. Wound support duration: Absorbable sutures provide longer support for the wound (50-75% tensile strength after one week) 1
3. Wound complications: Research shows that non-absorbable interrupted sutures (like Ethilon) are associated with higher rates of wound dehiscence compared to absorbable subcuticular sutures 4

Evidence-Based Benefits of Absorbable Subcuticular Sutures

• Lower wound dehiscence rates: Cochrane review evidence shows statistically significantly lower rates of superficial wound dehiscence with continuous subcuticular sutures compared to interrupted non-absorbable sutures (RR 0.08; 95% CI 0.02 to 0.35) 4
• Patient satisfaction: Subcuticular closure with absorbable sutures is associated with higher patient satisfaction scores compared to transdermal sutures 5
• No removal needed: Absorbable subcuticular sutures do not require removal, providing convenience and eliminating a follow-up visit 1

Clinical Considerations for Subcuticular Suturing

Technique Recommendations

• Ensure meticulous irrigation before closure to eliminate all visible residue 1
• Consider using Steri-Strips for additional support in areas where cosmetic outcome is important 1
• Maintain an occlusive dressing for a minimum of 48 hours to promote healing 1

Potential Pitfalls to Avoid

• Using non-absorbable sutures subcuticularly: This would necessitate removal, which can be difficult and potentially traumatic when placed subcuticularly
• Inadequate wound preparation: Ensure thorough irrigation before closure to minimize infection risk 1
• Inappropriate tension: Excessive tension on subcuticular sutures can lead to poor cosmetic outcomes and tissue damage

Special Situations

• For contaminated wounds, consider antimicrobial-coated absorbable sutures rather than non-absorbable options like Ethilon 1
• In high-tension areas or patients with impaired healing factors, consider additional support methods rather than switching to non-absorbable sutures 1

In conclusion, while Ethilon (nylon) sutures are excellent for many applications, they are not the optimal choice for subcuticular closure. Absorbable monofilament sutures provide better outcomes with fewer complications and greater patient satisfaction.