What are the indications and considerations for using polyamide (non-absorbable) suture material in surgical procedures?

Polyamide (Nylon) Suture Material: Clinical Indications and Considerations

Polyamide (nylon) is a non-absorbable monofilament suture that should be reserved primarily for skin closure requiring removal within 7-9 days, as current evidence favors slowly absorbable monofilament sutures for fascial closure to reduce postoperative pain while maintaining equivalent outcomes for incisional hernia and surgical site infections. 1

Primary Indications for Polyamide Sutures

Skin Closure (Interrupted Transcutaneous Technique)

• Polyamide is appropriate for interrupted skin closure when suture removal is planned at 7-9 days postoperatively 1
• This timing balances adequate wound healing with complication prevention 2
• Non-absorbable transcutaneous sutures like polyamide require removal, unlike absorbable subcuticular alternatives 1

When NOT to Use Polyamide

For fascial/abdominal wall closure, slowly absorbable monofilament sutures are preferred over non-absorbable materials like polyamide because:

• No evidence suggests non-absorbable sutures are superior for preventing incisional hernia or surgical site infections 1
• Absorbable sutures may decrease postoperative pain 1
• The 2023 World Society of Emergency Surgery guidelines specifically recommend slowly absorbable monofilament sutures for emergency laparotomy closure 1

Critical Technical Considerations

Suture Removal Timing

• Remove polyamide sutures at 7-9 days postoperatively 1, 2
• Removal before 7 days increases wound dehiscence risk, particularly in patients with obesity or diabetes 2
• Consider local anesthetic infiltration at removal sites if significant pain is anticipated 3

Comparison with Absorbable Alternatives

• A 1989 prospective study comparing polyamide (Ethilon) versus absorbable polyglyconate showed no statistical difference in incisional hernia rates (6.0% vs 6.2%) or wound infection rates (21.0% vs 15.4%) 4
• A 2014 systematic review of 10 RCTs demonstrated absorbable sutures lead to lower risk of wound breakdown (OR = 0.12; 95%CI: 0.04,0.39; P < 0.0004) compared to non-absorbable sutures 5

Practical Algorithm for Suture Selection

Choose Polyamide When:

• Performing interrupted transcutaneous skin closure 1
• Patient follow-up for suture removal is reliable 2
• Cosmetic outcome with planned removal is desired 6

Choose Slowly Absorbable Monofilament Instead When:

• Closing fascial layers or abdominal wall 1
• Patient follow-up is uncertain (no removal required) 1
• Reducing postoperative pain is a priority 1
• Using continuous subcuticular technique for skin closure 1

Common Pitfalls to Avoid

Inappropriate Use for Deep Closure

• Do not use polyamide for fascial or deep layer closure when slowly absorbable monofilament options are available 1
• The evidence strongly supports monofilament configuration over multifilament for any deep closure to reduce incisional hernia risk 1

Suture Removal Errors

• Avoid excessive force during removal, which causes tissue trauma and bleeding 3
• Apply steri-strips across the incision after removal to provide additional support during final healing 3

Ignoring Patient-Specific Factors

• Wound infection dramatically increases failure rates regardless of suture choice (28.6% vs 3.8% in non-infected wounds with polyamide) 4
• Respiratory failure and wound infection play more important roles than suture material selection in wound failure 4

Material Properties

• Polyamide is a monofilament non-absorbable synthetic suture with good tensile strength and elasticity 7, 6
• It handles easily and forms secure knots 6
• Causes minimal tissue inflammation compared to older materials like silk 6
• Does not stretch to accommodate wound edema as effectively as some newer synthetic materials 6