How long do absorbable (dissolving) sutures such as plain gut, chromic gut, polyglactin (Vicryl), poliglecaprone (Monocryl), polydioxanone (PDS), and polyglycolic acid (Dexon) retain tensile strength and become fully absorbed in a typical adult without complicating factors?

Absorbable Suture Dissolution Timeline

Slowly absorbable monofilament sutures (polydioxanone/PDS and polyglyconate/Maxon) retain 50-75% tensile strength after 1 week and maintain the highest strength over 28 days (71% and 59% respectively), while multifilament sutures (polyglactin/Vicryl, polyglycolic acid/Dexon) and rapidly absorbable materials (poliglecaprone/Monocryl, plain and chromic gut) lose strength precipitously within 1-7 days. 1, 2

Tensile Strength Retention by Suture Type

Slowly Absorbable Monofilament (Longest Duration)

• Polydioxanone (PDS) retains 71% of initial breaking strength at 28 days post-implantation 2
• Polyglyconate (Maxon) maintains 59% of original strength at 28 days 2
• These materials are recommended for fascial and deep tissue closure because they provide extended wound support during the critical 2-4 week healing period 1, 3
• Strength retention between days 14-28 ranges from 171-182 Newtons, which is crucial for preventing incisional hernias 3

Multifilament Sutures (Intermediate Duration)

• Polyglactin 910 (Vicryl) and polyglycolic acid (Dexon) exhibit precipitous strength loss after 7 days of implantation 2
• Both materials retain less than 30% of original strength in physiologic conditions after 21 days 4
• Polyglactin 910 is stronger than polyglycolic acid at all time periods from 0 to 35 days 5
• These sutures show increased diameter over time due to inflammatory tissue infiltration 2

Rapidly Absorbable Materials (Shortest Duration)

• Poliglecaprone (Monocryl) demonstrates precipitous strength decrease after just 1 day of implantation 2
• Plain catgut rapidly loses strength in digestive fluids and physiologic environments within days 6
• Chromic gut loses most strength within 1 week, though it shows slightly better retention than plain gut 2, 7
• Chromic gut fragments by week 4 in joint tissues 7

Complete Absorption Timeline

Slowly Absorbable Synthetics

• Polyglactin 910 (Vicryl) shows virtually complete absorption by 90 days based on histologic examination 5
• Polyglycolic acid (Dexon) demonstrates considerable material persistence at 120 days, with slower absorption than Vicryl 5
• Polydioxanone (PDS) and polyglyconate (Maxon) maintain integrity for 5-8 weeks before disintegrating 6

Natural Materials

• Plain catgut disintegrates too rapidly (within days) to be appropriate for most surgical applications 6
• Chromic gut retains some integrity for approximately 2 weeks but shows susceptibility to rapid digestion in physiologic fluids 6

Clinical Implications and Pitfalls

Critical Recommendations

• Never use rapidly absorbable sutures for fascial or deep tissue closure, as they lose critical tensile strength before adequate wound healing occurs (typically requiring 2-3 weeks), increasing incisional hernia risk 1, 3
• Avoid multifilament sutures when monofilament options are available, especially in contaminated fields, because interstices within braided materials harbor bacteria and increase infection risk 1
• Choose slowly absorbable monofilament sutures (4-0 poliglecaprone or polyglactin) for continuous subcuticular skin closure to eliminate the need for removal while maintaining adequate strength 1

Environmental Factors Affecting Dissolution

• Alkaline environments (such as infected urine with Proteus mirabilis) dramatically accelerate strength loss for all suture types 4
• Digestive fluids cause rapid catgut disintegration but have minimal effect on synthetic absorbables for 2-3 weeks 6
• Infected environments reduce tensile strength retention, though slowly absorbable synthetics still outperform catgut 4

Tissue-Specific Considerations

• In high-load orthopedic applications, polydioxanone degrades slowly but may fragment early, which is clinically important in delayed wound healing scenarios 7
• For alimentary tract surgery, synthetic absorbables maintain integrity for the 2-3 weeks needed for visceral wound healing, whereas catgut disintegrates too rapidly 6
• Triclosan-coated absorbable sutures reduce surgical site infection risk (OR 0.72; 95% CI 0.59-0.88) without compromising absorption characteristics 1, 3