What are the types of absorbable and non‑absorbable sutures?

Types of Absorbable and Non-Absorbable Sutures

Both absorbable and non-absorbable sutures are available in monofilament and multifilament configurations, with specific materials chosen based on wound characteristics, tissue type, and clinical context.

Absorbable Sutures

Absorbable sutures are categorized by their absorption rate and composition:

Slowly Absorbable Sutures

• Synthetic polymers (preferred for fascial closure)
  • These maintain tensile strength longer and are strongly recommended for emergency laparotomy closure 1
  • Examples include polyglycolic acid (PGA) and related synthetic polymers 2
  • Slowly absorbable sutures should be chosen over rapidly absorbable materials for midline incisions to reduce incisional hernia rates 1

Rapidly Absorbable Sutures

• Not recommended for fascial closure due to higher incisional hernia rates 1
• May be appropriate for superficial tissue layers only

Natural Absorbable Sutures

• Catgut and treated catgut (now used infrequently) 3
• Undergo enzymatic degradation rather than hydrolysis 4
• Less predictable absorption patterns, especially in infected tissue 5

Absorbable Synthetic Mesh Materials

• Used for hernia repair in contaminated fields 6
• Offer cost advantages over biological meshes 6

Non-Absorbable Sutures

Synthetic Non-Absorbable Materials

• Monofilament synthetics (preferred in most situations)

  • Lower tissue friction and infection risk 4
  • Common sizes: 2-0 or 1-0 for diaphragmatic repair 6
  • Superior regarding infection, threading, and knot strength compared to natural materials 5

• Multifilament synthetics

  • Higher tensile strength and flexibility 4
  • Greater tissue friction and infection risk 4
  • Should be avoided in contaminated fields 5

• Polytetrafluoroethylene (PTFE/Gore-Tex)

  • Used for mesh reconstruction, particularly diaphragmatic repair 6
  • Does not adhere to bowel, reducing fistulation risk 6

Natural Non-Absorbable Materials

• Silk (now infrequently used) 3
• Cotton (rarely used currently) 5
• Inferior to synthetics for infection resistance 5

Key Clinical Considerations

Material Selection Based on Context

For emergency laparotomy: Slowly absorbable monofilament sutures are preferred, as they may decrease postoperative pain compared to non-absorbable materials while maintaining adequate strength 1. Current evidence shows no significant difference in incisional hernia rates between absorbable and non-absorbable sutures 1.

For contaminated or infected wounds: Monofilament or pseudomonofilament sutures are most suitable, as multifilament materials harbor bacteria in their interstices 5.

For diaphragmatic repair: Non-absorbable 2-0 or 1-0 monofilament or braided sutures in interrupted mattress configuration 6.

Important Caveats

• Absorption is significantly accelerated by infection 5, making material choice critical in contaminated fields
• The smallest suture size that accomplishes the purpose should be chosen to minimize tissue trauma 4
• Monofilament sutures have lower tissue resistance but multifilament sutures offer better handling and knot security 4
• Modern suture materials can be enhanced with antibacterial agents 4