Types of Surgical Sutures

Surgical suture materials are used in the closure of most wound types. Lets start with Types of Surgical sutures.

The ideal suture should allow the healing tissue to recover sufficiently to keep the wound closed together once they are removed or absorbed. A closure is a mean of primary closure to promote wound healing.

The main factors used to classify sutures types are:

1- Absorbable vs. non-absorbable

2- Synthetic vs. natural

3- Monofilament vs. multifilament

Absorbable sutures are made of materials which are broken down in tissue after a given amount of time, which
depending upon the material can be from ten days to 8 weeks. They are made use of as a result in many of the internal
tissues of the body. In many cases, 3 weeks is sufficient for the wound to close securely. The suture is not needed any more, and the fact that it disappears is an advantage, as there is no foreign material left inside the body as well as no requirement for the patient to have the sutures removed.

Absorbable sutures were originally made of the intestines of sheep, the so called catgut. The majority of absorbable sutures are currently made of synthetic polymer fibers, which might be braided or monofilament; these offer various advantages over gut sutures, significantly convenience of handling, low cost, reduced tissue reaction, constant performance and assured non-toxicity.

Absorbable natural

1. Plain catgut
2. Chromic catgut

Absorbable synthetic

1. Monocryl (polygliceproner)
2. Vicryl (polyglactin 910)
3. Vicryl rapid
4. Dexon (polyglycolic acid)
5. PDS (polydioxanone)

• Vicryl rapide = 42 days
• Vicryl = 60 days
• Monocryl = ~100 days
• PDS = ~200 days

In general, surgeons generally use either polypropylene or polydioxane sutures for fascia, depending on exactly how solid the fixing needs to be. Deep dermis closure is with either polyglycolic acid or poliglycaprone 25 sutures. If shutting the epidermis with a running subcuticular suture, poliglycaprone 25 is preferred. If one is performing interrupted sutures on the skin surface area, nylon is ideal; polydioxane for near dark hair as well as rapid absorbing or chromic gut suture if it gets on a kid or in a location where sutures are tough to remove. Numerous excellent selections exist depending upon surgeon choice, experience, and the wanted outcome. TYPES OF SURGICAL SUTURES^​1​

Non-absorbable natural

Silk

Non-absorbable synthetic

1. Prolene [polypropylene]
2. Nylon
3. Ethilon [Polyamide]
4. Polyester

Non absorbable sutures are made of materials which are not metabolized by the body, as well as are utilized
either on skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in
which absorbable sutures are not appropriate. This is the case, for instance, in the heart and in capillary,
whose balanced activity requires a suture which remains longer than three weeks, to give the wound enough
time to close. Other organs, like the bladder, include liquids which make absorbable sutures disappear in only a.
few days, too early for the wound to recover. There are a number of materials made use of for non absorbable sutures. The most common is a natural fiber, silk, which undertakes a special manufacturing procedure to make it adequate for its usage.
in surgery. Various other non-absorbable sutures are made of man-made fibers, like polypropylene, polyester or nylon;.
these may or may not have coatings to enhance their performance characteristics. Lastly, stainless steel cables.
are generally made use of in orthopedic surgical treatment as well as for sternal closure in heart surgery.TYPES OF SURGICAL SUTURES

Monofilament

Catgut, monocryl, PDS, prolene, ethilon

Monofilament sutures create much less reaction than do braided sutures, yet require even more connections to guarantee a sufficient upkeep of the knot contrasted to braided suture. Monofilament sutures are typically non- absorbable.

Polyfilament or Braided

Vicryl, vicryl rapid, dexon, silk, polyester

Braided suture generally provokes a greater inflammatory response however, requires less connections to keep the knot stability. These include silk, cotton and Mersilene.

TYPES OF SURGICAL SUTURES

Surface

Most sutures have a smooth surface. There are more recent sutures made with barbs. These barbs aid approximate wounds and also do not require knots for protection. They a lot more uniformly distribute tension along the wound. These sutures are additionally recognized to be more time reliable.

Suture Size.

The diameter of the suture will influence its handling properties and also tensile strength. The larger the size ascribed to the suture, the smaller sized the diameter is, for example a 7-0 suture is smaller sized than a 4-0 suture. When picking suture size, the tiniest size possible should be chosen, considering the natural strength of the tissue.

As a guide the following are specific areas of their usage:

1. 1-0 and 2-0: Used for high stress areas requiring strong retention, i.e. deep fascia repair
2. 3-0: Used in areas requiring good retention, i.e. scalp, torso, and hands
3. 4-0: Used in areas requiring minimal retention, i.e. extremities. Is the most common size utilized for superficial wound closure.
4. 5-0: Used for areas involving the face, nose, ears, eyebrows, and eyelids.
5. 6-0: Used on areas requiring little or no retention. Primarily used for cosmetic effects.

Strength

One more critical property of a suture is its tensile or breaking strength that typically originates from suture width. Sutures are numbered by their size relative to their diameter. Thick suture numbering is from 0-10, with # 10 being the biggest diameter. Thin sutures are those that have the greatest number of zeroes after them and also variety from 1-0 to 12-0 (12-0 having the least breaking strength).

The strength of the sutures varies according to their size, which can be established by an evenly used number. A 6-0 suture is more fragile and has less strength than a 4-0 suture.

Dye

Any suture can have the addition of a dye. The dye aids with suture visualization. If sutures are under the epidermis, it is more suitable to have them undyed so that they are not visible.

Surgical Needles

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1. 1.

   MOY RL, WALDMAN B, HEIN DW. A Review of Sutures and Suturing Techniques. The Journal of Dermatologic Surgery and Oncology. September 1992:785-795. doi:10.1111/j.1524-4725.1992.tb03036.x