What types of suture materials are recommended for use in gynaecological procedures?

Suture Materials in Gynaecological Procedures

Monofilament absorbable synthetic sutures—specifically poliglecaprone (Monocryl) and polyglactin 910 (Vicryl)—are the preferred suture materials for gynaecological procedures because they minimize infection risk through reduced bacterial seeding while providing optimal tissue healing. 1

Primary Suture Material Selection

Monofilament sutures are strongly preferred over multifilament options because they cause significantly less bacterial seeding and have lower infection risk across all gynaecological procedures. 1 This recommendation is based on the understanding that multifilament sutures create interfilament spaces where bacteria can harbor and proliferate, whereas monofilament sutures present a smooth surface that resists bacterial colonization. 2

First-Line Options:

• Poliglecaprone (Monocryl): Recommended by the American College of Obstetricians and Gynecologists for vaginal and perineal repair due to minimal infection risk and reduced short-term pain. 1, 3
• Polyglactin 910 (Vicryl): Equally effective for vaginal and perineal repair with comparable infection rates to Monocryl. 1, 4
• Triclosan-coated Vicryl (Vicryl Plus): Should be considered when available, as it demonstrates reduced surgical site infection rates with an odds ratio of 0.62 (95% CI 0.44-0.88) compared to standard sutures. 1, 3

Important Caveat:

While clinical data show comparable infection rates between Vicryl and Monocryl in cesarean subcuticular closure (6.1% vs 5.1%, p=0.58), the theoretical advantage of monofilament structure for infection prevention remains valid. 4 The choice between these two materials can be based on surgeon preference and handling characteristics, though monofilament options maintain a slight theoretical edge. 1

Procedure-Specific Recommendations

Obstetrical Anal Sphincter Injuries (OASIS):

• Anorectal mucosa: Use 3-0 or 4-0 delayed absorbable sutures (polyglactin or poliglecaprone) with either interrupted or continuous non-locked technique. 1
• Internal anal sphincter: Use 3-0 delayed absorbable suture with end-to-end technique using mattress or interrupted sutures. 1

Second-Degree Lacerations and Episiotomy:

• All layers: Monofilament absorbable synthetic sutures minimize short-term pain and reduce analgesic requirements. 1, 3

Cesarean Delivery:

• Skin closure: Subcuticular suture with either 4-0 Monocryl or 4-0 Vicryl is preferred over staples, as sutures reduce wound separation and improve patient satisfaction. 5
• Subcutaneous tissue: When ≥2 cm thick, reapproximation should be performed using absorbable synthetic sutures. 5

Hysterectomy:

• Vaginal cuff closure: Monofilament absorbable synthetic sutures minimize infection risk and cause less tissue reaction. 1

Critical Technical Considerations

Never use locking continuous sutures in gynaecological repairs, as they create excessive tension that causes tissue edema and necrosis. 5, 1, 3 This is a common pitfall that significantly compromises healing outcomes.

Optimal Suturing Technique:

• Continuous non-locking technique is essential for all layers of repair because it distributes tension evenly, reduces pain, decreases analgesic use, and lowers the need for suture removal. 1, 3
• For perineal skin specifically, continuous non-locking subcutaneous suturing avoids damage to nerve endings on the skin surface, thereby reducing pain. 5, 3

Obsolete Materials:

Catgut and chromic catgut should not be used in modern gynaecological surgery due to inferior outcomes compared to synthetic alternatives. 3, 6

Key Selection Factors

When choosing suture material, consider these biomechanical properties: 7, 8

• Tensile strength: Must match the mechanical demands of the tissue being repaired
• Tissue reactivity: Lower reactivity reduces inflammation and improves healing
• Absorption rate: Should align with tissue healing timeline
• Handling properties: Memory, elasticity, and knot strength affect surgical ease

Perioperative Infection Prevention

Beyond suture selection, implement these measures to optimize outcomes: 5, 1, 3

• Prophylactic antibiotics: First-generation cephalosporin (cefazolin 2g) or second-generation cephalosporin (cefoxitin 2g)
• Vaginal preparation: Povidone-iodine (or chlorhexidine gluconate if iodine allergy)
• Surgical counts: Count all instruments, sponges, and sutures pre- and postoperatively
• Adequate anesthesia: Regional or general anesthesia for complex repairs