What types of suture materials are recommended for use in gynaecological procedures, considering factors such as patient allergies and procedure-specific requirements?

Types of Suture Materials and Their Significance in Gynaecological Procedures

For gynaecological procedures, monofilament absorbable synthetic sutures—specifically poliglecaprone (Monocryl) or polyglactin 910 (Vicryl)—are the preferred suture materials, as they minimize infection risk through reduced bacterial seeding while providing optimal tissue healing. 1, 2

Primary Suture Material Recommendations

Monofilament Absorbable Synthetic Sutures (First-Line Choice)

• Poliglecaprone (Monocryl) and polyglactin 910 (Vicryl) are the suture materials of choice recommended by the American College of Obstetricians and Gynecologists for vaginal and perineal repair. 1, 2

• Monofilament sutures are strongly preferred because they cause less bacterial seeding and have significantly lower infection risk compared to multifilament options. 3, 1, 2

• For vaginal cuff closure in hysterectomy, monofilament absorbable synthetic sutures minimize infection risk through reduced bacterial seeding and cause less tissue reaction. 1

Enhanced Antimicrobial Options

• Triclosan-coated Vicryl (Vicryl Plus) demonstrates reduced surgical site infection rates with an odds ratio of 0.62 (95% CI 0.44-0.88) and should be considered when available. 1, 2

• The World Health Organization recommends considering antimicrobial-coated sutures for optimal infection prevention. 2

Rapidly-Absorbing Synthetic Sutures

• Rapidly-absorbing polyglactin 910 (Vicryl Rapide) can be used for perineal repair, as it eliminates the need for postpartum suture removal despite increased cost. 3, 2

• This option is particularly valuable for reducing the burden of suture removal in postpartum patients. 3, 2

Procedure-Specific Suture Selection

For Obstetrical Anal Sphincter Injuries (OASIS)

• 3-0 or 4-0 delayed absorbable sutures such as polyglactin or poliglecaprone should be used for anorectal mucosa closure, applied with either interrupted or continuous non-locked technique. 3

• The internal anal sphincter repair requires 3-0 delayed absorbable suture using end-to-end technique with either mattress or interrupted sutures. 3

For Second-Degree Lacerations and Episiotomy

• Monofilament absorbable synthetic sutures minimize short-term pain and reduce analgesic requirements. 2

• Standard synthetic sutures (both multifilament and monofilament) show no significant differences in short- or long-term pain or wound healing. 3

For Cesarean Delivery Subcuticular Closure

• Both 4-0 Vicryl and 4-0 Monocryl demonstrate comparable rates of surgical site infection (6.1% vs 5.1%, P=0.58) and other wound complications. 4

• Physician preference is acceptable for choice between these materials, as clinical outcomes are equivalent. 4

Obsolete Suture Materials to Avoid

• Catgut and chromic catgut are obsolete in gynaecological surgery and should not be used. 5

• Catgut compared with standard synthetic multifilament sutures is associated with more pain and the highest risk of requiring resuturing. 3

• Chromic catgut frequently causes infectious granulation and postoperative hemorrhage in vaginal stump procedures. 6

Critical Technical Considerations

Suturing Technique Matters

• Continuous non-locking technique is essential for all layers of repair, as it distributes tension evenly, reduces pain, decreases analgesic use, and lowers the need for suture removal. 1, 2

• Never use locking continuous sutures, as they create excessive tension causing tissue edema and necrosis. 1, 2

Avoiding Common Pitfalls

• Avoid overly tight sutures that can strangulate tissue and impair healing. 1, 2

• Do not use transcutaneous interrupted sutures on perineal skin, as they damage superficial nerve endings and increase pain. 1, 2

• Multifilament sutures theoretically carry higher infection risk due to bacterial seeding, though clinical data show comparable outcomes to monofilament in some contexts. 4

Patient Allergy Considerations

For Iodine Allergy

• Use chlorhexidine gluconate instead of povidone-iodine for surgical-site vaginal preparation if the patient is allergic to iodine. 3

For Penicillin Allergy

• Administer clindamycin instead of cephalosporins for prophylactic antibiotic coverage when penicillin allergy is present. 3

• Alternative regimen includes metronidazole with consideration of adding gentamicin for adequate coverage of both vaginal and bowel flora. 3

Essential Perioperative Measures

• Ensure adequate anesthesia (regional or general preferred for complex repairs). 1, 2

• Perform surgical-site vaginal preparation with povidone-iodine or chlorhexidine gluconate. 1, 2

• Administer prophylactic antibiotics: first-generation cephalosporin (cefazolin 2g) or second-generation cephalosporin (cefoxitin 2g). 1

• Count all surgical instruments, sponges, and sutures pre- and postoperatively. 3, 1