From the Guidelines
No, catgut should not be used for skin closure due to its association with more pain and a higher risk of requiring resuturing compared to standard synthetic sutures. According to a recent study published in the American Journal of Obstetrics and Gynecology 1, the use of catgut for postpartum perineal repair was associated with more pain and the highest risk of requiring resuturing compared to standard synthetic multifilament sutures.
Some key points to consider when choosing a suture material for skin closure include:
- The risk of infection and bacterial seeding, which may be lower with monofilament sutures 1
- The need for removal of unabsorbed suture material, which is higher with standard synthetic sutures 1
- The potential for tissue reaction and inflammation, which can affect scarring and wound healing
- The absorbability and durability of the suture material, with catgut breaking down too quickly to provide adequate support for skin wounds
Alternative suture materials that may be preferred for skin closure include:
- Non-absorbable sutures like nylon, polypropylene, or silk for optimal wound support and cosmetic results
- Modern synthetic absorbable sutures like Vicryl (polyglactin 910) or Monocryl (poliglecaprone 25) for superficial layers beneath the skin, while the skin itself should still be closed with non-absorbable materials or skin adhesives 1
From the Research
Catgut for Skin Closure
- Catgut can be used for skin closure, as shown in a study where buried subcuticular catgut sutures were used in 350 cases after surgery, resulting in excellent healing with fine linear scars in 92% of patients 2.
- The use of catgut for skin closure has been compared to other materials, such as poliglecaprone-25 and polyglactin-910, with similar results in terms of wound complications and cosmetic appearance 3, 4.
- A study from 1985 found that a new rapid strength loss catgut suture material can be used for skin closures in wounds of the face and body, with superior results compared to other materials 5.
- Another study found that the fear of poor results with catgut as a skin suture is unfounded, and that catgut can be safely used for skin closure with good handling and economy 2.
- There is also evidence that catgut does not cause allergic reactions, with a study finding no allergic manifestations in 137 patients who were previously thought to be allergic to catgut sutures 6.
Advantages and Disadvantages
- Advantages of using catgut for skin closure include easy availability, economy, and good handling 2.
- Disadvantages of using catgut for skin closure include the potential for infection and dehiscence, although this was found to be low in a study where buried subcuticular catgut sutures were used 2.
- Comparison with other materials, such as poliglecaprone-25 and polyglactin-910, has shown similar results in terms of wound complications and cosmetic appearance, but with some differences in terms of suture extrusion and lumpiness 3, 4.