From the Guidelines
Monocryl (poliglecaprone 25) suture is a suitable choice for perineal repair due to its monofilament structure, which reduces the risk of bacterial seeding and may be less likely to cause infection, as supported by the most recent evidence from 2024 1. When considering the use of Monocryl for perineal repair, it's essential to note that this synthetic, absorbable suture causes minimal tissue reaction, maintains adequate tensile strength for 2-3 weeks, and completely absorbs within 90-120 days.
Key Considerations
- For perineal repair, typically 3-0 or 4-0 Monocryl is used for vaginal mucosa and perineal muscle, while 4-0 or 5-0 may be used for skin closure if needed.
- The suture's flexibility and smooth passage through tissue make it comfortable for patients during the healing process.
- Monocryl has been shown in clinical practice to cause less pain and discomfort compared to some other suture materials like Vicryl.
- Its monofilament structure also reduces the risk of bacterial wicking that can occur with braided sutures.
Suturing Techniques
- When using Monocryl for perineal repair, continuous suturing techniques are often preferred over interrupted sutures as they may further reduce postpartum pain, as noted in the context of episiotomy repair 1.
- Continuous non-locking intracutaneous sutures can result in less short-term pain, dyspareunia, and amount of suture material used.
- Using a non-locking technique is preferred because locking suture can cause excessive tension leading to tissue edema and necrosis.
Evidence Support
- A Cochrane review included in the 2024 study 1 compared catgut, standard synthetic (multifilament and monofilament), and rapidly dissolving synthetic suture for postpartum perineal repair, finding no significant short- or long-term pain or wound healing differences between use of standard multifilament, rapidly-absorbing standard multifilament, and monofilament sutures.
- The 2023 World Society of Emergency Surgery guidelines 1 also support the use of monofilament sutures, like Monocryl, due to their association with a significantly lower risk of incisional hernia compared to multifilament sutures.
From the Research
Suture Material Properties
- Monocryl (poliglecaprone 25) is an absorbable monofilament suture material 2, 3, 4, 5, 6
- It has been compared to other suture materials such as Vicryl (polyglactin 910) and silk in various studies 2, 3, 4, 5, 6
Perineal Repair
- There is evidence to suggest that Monocryl can be used in perineal repair, particularly in skin closure after mediolateral episiotomies 3
- A randomized controlled trial found that Monocryl and Vicryl Rapide had similar pain scores, but Monocryl had less self-reported dehiscence 3
Suture Handling and Strength
- Handling of suture materials can affect their strength and extension 2
- Monocryl has been shown to have reduced tensile strength after damage, but its handling properties are still suitable for use in laparoscopic surgery 2
Knot Security
- The security of knots tied with Monocryl has been evaluated in several studies 4, 6
- Increasing the number of throws can improve knot security for Monocryl and other absorbable suture materials 4
- Monocryl has been shown to have similar knot security to Vicryl, but less than some other monofilament suture materials such as Maxon 6