What is the best suture material for surgical procedures?

Best Suture Material for Surgical Procedures

For surgical procedures, a slowly absorbable monofilament suture is strongly recommended as the best suture material, particularly for abdominal fascial closure, as it significantly decreases the incidence of incisional hernia. 1

Characteristics of Ideal Suture Material

The ideal suture material should have:

• Strong tensile strength and secure knot-tying properties 2
• Minimal tissue inflammation and infection risk 3
• Ability to stretch with wound edema and recoil with wound contraction 3
• Easy handling characteristics 2

Evidence-Based Recommendations for Suture Selection

Monofilament vs. Multifilament

• Monofilament sutures are strongly recommended over multifilament sutures (Grade 1A recommendation with high certainty of evidence) 1

  • Associated with significantly lower risk of incisional hernia in both elective and emergency settings 1
  • Lower resistance when passed through tissues 2
  • Reduced risk of infection and suture sinus formation 4
  • Better soft tissue healing compared to multifilament sutures 5

• Multifilament sutures:

  • Higher tensile strength and flexibility but greater tissue friction 2
  • Higher risk of harboring bacteria and prolonging inflammation 4
  • Showed greater microbial adherence in comparative studies 5

Absorbable vs. Non-absorbable

• Slowly absorbable monofilament sutures are recommended for fascial closure 1

  • Maintain adequate tensile strength during critical healing period 2
  • Undergo predictable hydrolysis rather than enzymatic degradation 2

• Non-absorbable sutures:

  • Monofilament nylon demonstrated low infectivity and satisfactory wound strength in infected wounds 4
  • Polypropylene showed superior clinical characteristics with least inflammatory reaction in oral surgery 5

Antimicrobial-Coated Sutures

• Antimicrobial-coated sutures (typically triclosan-impregnated) are recommended for fascial closure in clean, clean-contaminated, and contaminated fields (Grade 1B recommendation) 1
  • Significantly reduce surgical site infection rates (RR 0.67,95% CI 0.48–0.94) 1
  • Particularly effective in abdominal surgeries (RR 0.70,95% CI 0.50–0.99) 1
  • Most beneficial when used with prophylactic antibiotics 1

Suture Technique Considerations

• Small bite technique is suggested for midline laparotomy closure 1

  • Includes only aponeurosis (approximately 5mm from wound edge and 5mm between stitches) 1
  • Results in lower incidence of incisional hernias and wound complications 1

• Continuous suturing may be beneficial for skin closure 1

  • May reduce superficial wound dehiscence compared to interrupted sutures 1
  • Provides more uniform tension distribution 2

Specific Suture Materials by Strength

• Highest tensile strength in absorbable sutures:

  • Glycomer 631 (56.1N unknotted, 34.3N knotted) 6
  • Polyglyconate (34.2N knotted) 6

• Highest tensile strength in non-absorbable sutures:

  • Nylon (30.9N straight) 6
  • Polypropylene (18.9N knotted) 6

Common Pitfalls and Caveats

• Avoid using large bite technique as it can include fat and muscle tissue, leading to slackening, separation of wound edges, tissue devitalization, and infection 1
• Avoid multifilament sutures in potentially infected wounds as they can harbor bacteria even after 70 days 4
• Consider wound classification when selecting suture material - antimicrobial coating benefits vary by wound type 1
• Avoid retention sutures for routine laparotomy closures as there is insufficient evidence supporting their use 1