What is the preferred suture material between silk and Vicryl (polyglactin 910) for internal sutures?

Vicryl (Polyglactin 910) Is Superior to Silk for Internal Sutures

For internal sutures, Vicryl (polyglactin 910) is recommended over silk due to its lower infection risk, controlled absorption properties, and reduced tissue reaction. 1, 2

Comparison of Vicryl vs. Silk for Internal Suturing

Infection Risk

• Triclosan-coated Vicryl (Vicryl Plus) significantly reduces surgical site infection (SSI) risk compared to non-coated sutures (OR 0.62,95% CI 0.44-0.88) 1
• Silk, being a braided non-absorbable material, harbors more bacteria and increases infection risk compared to synthetic materials like Vicryl
• Multiple meta-analyses demonstrate that antimicrobial-coated sutures (particularly Vicryl Plus) reduce SSI risk across various surgical procedures 1

Absorption Properties

• Vicryl is absorbed through controlled hydrolysis with a half-life tensile strength of approximately 2 weeks 3
• Silk requires removal or remains permanently in tissues, potentially serving as a nidus for infection
• Vicryl's controlled absorption eliminates the need for suture removal while maintaining adequate tensile strength during critical healing phases 3

Tissue Reaction

• Vicryl produces less inflammatory reaction compared to silk and catgut 4
• In comparative studies, Vicryl demonstrates superior biocompatibility with less tissue reactivity 4
• Even in oral tissues where exposure to bacteria is high, Vicryl produces comparable inflammation to silk but with the benefit of absorption 4

Clinical Applications and Considerations

Surgical Site Infection Prevention

• Triclosan-coated Vicryl sutures have been shown to reduce SSI risk in:
  • Abdominal surgeries (RR 0.70,95% CI 0.50-0.99) 1
  • Clean, clean-contaminated, and contaminated wounds 1
  • Digestive surgeries (RR 0.67,95% CI 0.48-0.94) 1

Handling Characteristics

• Vicryl has handling characteristics similar to silk but with the added benefit of absorption 4, 5
• Vicryl is available as a braided suture, providing good knot security while maintaining ease of use 5
• No significant suture-related complications have been observed with Vicryl in general and thoracic surgical procedures 5

Special Considerations

• For high-infection risk procedures, triclosan-coated Vicryl (Vicryl Plus) should be considered as it consistently shows reduced SSI rates 1
• In obstetric procedures, Vicryl has demonstrated comparable SSI rates to monofilament sutures like Monocryl 6

Pitfalls and Caveats

• Vicryl may be retained longer than desired in certain tissues (e.g., oral cavity) and may need to be managed like silk in these scenarios 4
• The benefit of triclosan-coated sutures may not extend to all surgical scenarios, particularly in dirty procedures 1
• PDS (polydioxanone), another absorbable suture, shows no significant difference in SSI rates with triclosan coating compared to non-coated versions for abdominal fascial closure 1

In conclusion, Vicryl is the preferred choice over silk for internal sutures due to its controlled absorption, reduced tissue reaction, and lower infection risk, especially when using triclosan-coated versions in higher-risk procedures.