What are the recommended types of suture materials for gynaecological procedures?

Recommended Suture Materials for Gynaecological Procedures

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

The Four Primary Suture Material Types

1. Poliglecaprone (Monocryl) - First Choice

• This monofilament absorbable synthetic suture is strongly preferred because it causes significantly less bacterial seeding compared to multifilament options and has the lowest infection risk 2, 1
• Recommended by the American College of Obstetricians and Gynecologists for vaginal and perineal repair 1
• Minimizes short-term pain and reduces analgesic requirements 1, 3
• Ideal for vaginal cuff closure in hysterectomy due to reduced tissue reaction 1, 4

2. Polyglactin 910 (Vicryl) - Excellent Alternative

• This braided multifilament synthetic suture is equally recommended by ACOG for gynaecological procedures 1
• Consider triclosan-coated Vicryl (Vicryl Plus) when available, as it demonstrates reduced surgical site infection rates with an odds ratio of 0.62 (95% CI 0.44-0.88) per WHO recommendations 1, 3, 4
• Clinical data shows comparable infection rates between 4-0 Vicryl and 4-0 Monocryl for cesarean subcuticular closure (6.1% vs 5.1%, p=0.58) 5
• Appropriate for subcutaneous closure in multiple surgical contexts 3

3. Rapidly-Absorbing Synthetic Sutures

• These materials eliminate the need for postpartum suture removal 3
• Consideration should be made for using rapidly-absorbing suture despite increased cost because of the significantly lower need for postpartum suture removal 2
• No significant short- or long-term pain differences compared to standard synthetic sutures 2

4. Standard Multifilament Sutures (Not Preferred)

• Associated with more pain and the highest risk of requiring resuturing 2
• Greater need for removal of unabsorbed suture material 2
• Should be avoided in favor of monofilament options due to increased bacterial seeding risk 2, 1

Procedure-Specific Recommendations

For Obstetrical Anal Sphincter Injuries (OASIS)

• Use 3-0 or 4-0 delayed absorbable sutures (polyglactin or poliglecaprone) for anorectal mucosa closure 1
• Apply with either interrupted or continuous non-locked technique 1
• Internal anal sphincter repair requires 3-0 delayed absorbable suture using end-to-end technique 1

For Second-Degree Lacerations and Episiotomy

• Monofilament absorbable synthetic sutures are the clear choice to minimize short-term pain and reduce analgesic requirements 1
• Use continuous non-locking technique for all layers 1, 3

For Hysterectomy Vaginal Cuff Closure

• Monofilament absorbable synthetic sutures (poliglecaprone or polyglactin 910) are strongly preferred 4
• These minimize infection risk through reduced bacterial seeding and cause less tissue reaction 4

Critical Technical Considerations

Essential Suturing Technique

• Always use continuous non-locking technique for all layers of repair—this distributes tension evenly, reduces pain, decreases analgesic use, and lowers the need for suture removal 1, 3, 4
• For perineal skin, use continuous non-locking subcuticular stitch to avoid damage to nerve endings 3

Absolute Contraindications

• Never use locking continuous sutures—they create excessive tension causing tissue edema and necrosis 1, 3, 4
• Avoid transcutaneous interrupted sutures on perineal skin as they damage superficial nerve endings and increase pain 3, 4
• Catgut and chromic catgut are obsolete and should not be used in gynaecological surgery 6

Common Pitfalls to Avoid

• Do not use overly tight sutures that can strangulate tissue and impair healing 3, 4
• Avoid standard multifilament sutures when monofilament options are available due to higher infection risk 2, 1
• Do not select suture material based solely on cost—rapidly-absorbing sutures may justify increased expense through reduced need for removal 2, 3
• While multifilament sutures may have superior handling characteristics, the infection risk outweighs this benefit 7, 8

Essential Perioperative Measures

• Ensure adequate anesthesia (regional or general preferred for complex repairs) 1, 4
• Perform surgical-site vaginal preparation with povidone-iodine or chlorhexidine gluconate (for iodine allergy) 1, 4
• Administer prophylactic antibiotics: first-generation cephalosporin (cefazolin 2g) or second-generation cephalosporin (cefoxitin 2g) 1, 4
• Count all surgical instruments, sponges, and sutures pre- and postoperatively 1, 4