Does a simple buried suture need to be absorbable?

Simple Buried Sutures Should Be Absorbable

Yes, simple buried sutures should be absorbable to prevent complications and optimize wound healing outcomes. While there is no direct evidence specifically addressing buried sutures in the provided guidelines, the principles of suture selection for optimal wound healing can be applied to this scenario.

Rationale for Using Absorbable Sutures in Buried Applications

• Absorbable sutures are designed to break down over time within the body, eliminating the need for removal and preventing long-term foreign body reactions that could lead to complications 1
• Slowly absorbable sutures are recommended for closure in surgical settings due to their ability to maintain adequate tensile strength during the critical wound healing period while eventually being absorbed by the body 1
• Non-absorbable sutures, when left buried in tissues, can act as permanent foreign bodies that may lead to granuloma formation, chronic inflammation, or serve as a nidus for infection 2

Types of Absorbable Sutures for Buried Applications

• Slowly absorbable sutures are preferred over rapidly absorbable options for buried applications as they:

  • Maintain tensile strength longer during the critical wound healing period (2-4 weeks) 1, 3
  • Have high-quality evidence supporting their use with a 99.2% agreement percentage among surgical experts 1
  • Demonstrate a lower incisional hernia rate and fewer wound complications 1

• Monofilament vs. multifilament considerations:

  • Monofilament sutures (like poliglecaprone 25/Monocryl) are often preferred for buried applications as they:
    • Cause less tissue drag and trauma 3
    • Have fewer interstices that could harbor bacteria 3
    • Demonstrate excellent handling properties while maintaining adequate tensile strength 3

Clinical Application Guidelines

• For optimal wound healing with buried sutures:
  • Use a slowly absorbable monofilament suture material 1, 3
  • Employ the "small bite" technique (approximately 5mm from wound edges and between stitches) when applicable 1
  • Maintain a suture-to-wound length ratio of at least 4:1 for continuous closures to reduce complications 1

Potential Complications of Non-Absorbable Buried Sutures

• Permanent presence of foreign material in tissues 2
• Potential for chronic inflammation and granuloma formation 2
• Risk of suture extrusion through the skin long after healing 4
• Possible need for surgical removal if complications develop 2

Common Pitfalls to Avoid

• Using rapidly absorbable sutures for buried applications where longer tensile strength is needed 1
• Selecting braided/multifilament sutures for buried applications where bacterial colonization is a concern 3
• Applying excessive tension on buried sutures, which can lead to tissue ischemia and poor healing 1
• Failing to consider the specific tissue requirements and healing timeframe when selecting suture material 2

By following these evidence-based recommendations, clinicians can optimize wound healing outcomes and minimize complications when using buried sutures in surgical practice.