Recommended Sutures for Vaginoplasty
Use monofilament absorbable synthetic sutures, specifically poliglecaprone (Monocryl) or polyglyconate (Maxon), for vaginoplasty procedures, as these materials minimize bacterial seeding, reduce infection risk, and provide optimal tensile strength during the critical healing period. 1
Primary Suture Material Selection
Monofilament absorbable sutures are the gold standard because they cause significantly less bacterial colonization compared to multifilament options, which is critical in vaginal tissue repair 2, 1
Poliglecaprone (Monocryl) is specifically recommended by the American College of Obstetricians and Gynecologists as the primary choice for vaginal repair due to reduced infection risk and decreased short-term pain 1
Polyglyconate (Maxon) provides excellent tensile strength retention during the critical wound healing period and elicits lower chronic inflammatory response compared to other synthetic sutures 3
Rapidly-absorbing synthetic sutures like polyglactin 910 (Vicryl Rapide) eliminate the need for suture removal, which may justify their higher cost in select cases 2, 1
Enhanced Infection Prevention Option
Consider triclosan-coated sutures (Vicryl Plus) when available, as they significantly reduce surgical site infection rates with an odds ratio of 0.62 (95% CI 0.44-0.88) compared to non-coated sutures 2, 1
The World Health Organization supports antimicrobial-coated sutures for optimal infection prevention across multiple wound classes and surgical types 1
Meta-analysis of 18 studies involving 7,458 patients demonstrated that triclosan-coated sutures reduced SSI risk (OR 0.72,95% CI 0.59-0.88, P=0.001) 2
Suturing Technique Recommendations
Use continuous non-locking technique for all layers of vaginal repair, as this distributes tension more evenly, reduces short-term pain, decreases analgesic requirements, and lowers the need for suture removal 2, 1
Avoid locking sutures entirely—they cause excessive tissue tension leading to edema, necrosis, and impaired healing 2, 1
For subcuticular closure, use continuous non-locking subcutaneous technique to avoid damaging superficial nerve endings that cause pain 2
Materials to Avoid
Never use catgut sutures for vaginoplasty, as they are associated with significantly more pain, higher risk of requiring resuturing, and inferior outcomes compared to synthetic alternatives 2
Avoid multifilament sutures when monofilament options are available, as multifilament materials have higher bacterial seeding rates 2, 1
Critical Technical Considerations
Ensure sutures are not placed too tightly, as this strangulates tissue and impairs healing 1
Use small bite technique (approximately 5mm from wound edge) to ensure adequate tension distribution and minimize tissue damage 4
Count all surgical instruments, sponges, and sutures pre- and postoperatively 2
Administer prophylactic antibiotics (first-generation cephalosporin such as cefazolin 2g) before incision 2