How to prevent necrosis in surgical sutures?

From the Guidelines

To prevent necrosis in sutures, the use of triclosan-coated sutures is recommended as they significantly reduce the prevalence of surgical site infections compared to non-coated sutures, as evidenced by recent studies 1.

Key Considerations

• The use of triclosan-coated sutures has been shown to decrease the rate of surgical site infections, which is a major factor in preventing necrosis in sutures 1.
• Maintaining proper wound care, including keeping the area clean and dry, changing dressings regularly, and avoiding tension on the wound edges, is crucial in preventing necrosis 1.
• Ensuring sutures are not too tight and using the 'small bite' technique in the closure of midline laparotomy can help reduce the risk of tissue devitalization and infection 1.
• Monitoring for early signs of infection or tissue compromise, such as increasing redness, warmth, swelling, pain, or discharge, is essential for prompt intervention before tissue death occurs 1.
• Maintaining adequate blood supply to the area by avoiding smoking, managing diabetes if present, and not applying excessive pressure to the wound is also important in preventing necrosis 1.

Additional Recommendations

• The use of wound protectors, particularly dual-ring constructed wound protectors, has been shown to have protective effects in reducing incisional surgical site infections 1.
• Intraoperative normothermia and the use of active warming devices in the operating room can help decrease the rate of surgical site infections 1.
• The application of negative-pressure wound therapy may be effective in reducing postoperative wound complications, especially in patients with a high risk of infection 1.
• Retention sutures could be considered as a possible addition to suture closure of emergency laparotomy only in case of patients with very high-risk conditions for incisional hernia and wound dehiscence 1.

From the Research

Preventing Necrosis in Sutures

To prevent necrosis in sutures, several factors must be considered when choosing a wound closure material and suturing technique.

• The selection of optimal suture materials for tissue approximation is crucial to maximize wound healing and scar aesthetics, as stated in 2.
• Knowledge regarding the characteristics of suture materials is essential to minimize ischaemia, excess wound tension, and tissue injury.
• The use of the smallest suture size that will accomplish the purpose can help minimize tissue trauma and foreign material within tissues, as mentioned in 2.
• Monofilament sutures have lower resistance when passed through tissues, whereas multifilament sutures possess higher tensile strength and flexibility but greater tissue friction and pose risks of suture sinus and infection, as discussed in 2.

Suture Materials and Techniques

Different suture materials and techniques can be used to prevent necrosis in sutures, including:

• Absorbable sutures, such as polydioxanone, which can be used for the routine closure of clean abdominal wounds, as recommended in 3.
• Non-absorbable sutures, such as nylon or polypropylene, which can be used for skin closure, as described in 4.
• Running subcuticular sutures, which can be used as an alternative to interrupted sutures, as suggested in 4.
• Barbed sutures, which can eliminate knots, distribute wound tension, and increase efficiency of closure, as mentioned in 2.

Considerations for Suture Selection

When selecting a suture material and technique, several factors must be considered, including:

• Wound tension, as discussed in 5.
• Desire for wound edge eversion or inversion, as mentioned in 5.
• Desired hemostasis, as discussed in 5.
• Repair type, as described in 5.
• Patient's ability to care for the wound and return for suture removal, as mentioned in 5.
• Skin integrity, as discussed in 5.
• Wound location, as described in 5.