Choosing The Right Suture: Factors Surgeons Consider

Selection of the proper sutures is essential for successful surgical outcomes. The surgeon should evaluate wound type, patient condition, or suture properties. It is necessary to know the types of materials used for suturing: silk, absorbable, and non-absorbable. Monofilament and multifilament sutures are different in behaviour and properties. Choose specialized options or metal sutures. Each type will have its effects on healing. The article elaborates on the types of sutures and their usage in a well-studied decision. The proper suture has a specific bearing on the time a wound takes to heal, how many complications arise, and how quickly a patient can recover following surgery. With a proper understanding of suture materials, a surgeon makes both the technical success of the procedure and long-term patient satisfaction. The following sections will elaborate more on the types of sutures and their respective applications.  

What Are Sutures?

Sutures are threads or materials used by surgeons to close wounds or incisions. They provide mechanical support during healing, decrease the risk of infection, and promote tissue repair. The nature of sutures varies widely; each suture type has characteristics based on the type of medical issue it is intended to address. Sutures form a bridge to hold tissues together until nature takes its course in the healing process. For centuries now, sutures have been an important aspect of surgical procedures, from the use of natural fibres to the present use of sophisticated synthetic materials. Their primary purpose is to lessen the tension on the wound and align the tissues to reduce the risk of infection or reopening of the wound, that is, dehiscence. Sutures are modernized to maintain the motivation behind using sutures for different surgical contexts: strength, durability, and bio-compatibility.

Sutures come in many types and configurations. There are absorbable or nonabsorbable suture materials, each serving its purpose based on the specific tissue aspect and how long it takes to heal. Sutures also come in different sizes and strengths, so surgeons can use sutures customized for the requirements of the procedure. Facial surgery sutures, for example, are very different from orthopaedic surgery sutures. To maximize patient outcomes, it is necessary to understand these distinctions. Besides, with advances in suture technology, the antimicrobial coat and biodegradable sutures were developed, which improved efficacy and safety.

Types Of Suture Material

1. Absorbable Suture Material

Absorbable or dissolving sutures may be natural or synthetic polymers that break down within the body over time and are absorbed. These sutures are thus not to be removed afterwards, making them ideal for internal tissues. Typical materials include polyglycolic acid (PGA) and poliglecaprone (Monocryl™). They will dissolve through enzymatic reactions or hydrolysis; the process depends on the suture materials. Absorbable sutures are preferred by surgeons for use in surgeries where removal would be cumbersome and result in unnecessary post-operative trauma.

Advantages:

• It requires no return visits to the office to remove sutures, which is a definite advantage for internal or deep wounds.
• Less scarring of the internal tissues results in a better cosmetic result.
• Applicable to several surgeries, including gastrointestinal, gynaecological type and some cardiovascular procedures.

Disadvantages:

• Weakening of tensile strength with time. The holding quality of tissues decreases with suture material absorption.
• Indeed, it is not for use in wounds requiring long-term or permanent support, as they may resolve before complete tissue healing.

Absorbable sutures are found in both monofilament and multifilament varieties. As a rule, monofilament absorbable sutures (e.g. polydioxanone (PDS™)) run smoothly through tissues, raising minimal risk of infection. Braided poly-glycolic-acid (PGA) sutures, plural-filament absorbable sutures, provide superior knot security and may cause a more significant risk of bacterial colonization.

2. Non-Absorbable Suture Material

Non-absorbable sutures do not dissolve and remain present in the body until removed manually after healing is thought to occur. They are also used extensively for skin closures and cardiovascular surgeries where permanent or longer-lasting support is required. Examples are nylon, polypropylene (Prolene™), and polyester sutures. Non-absorbable sutures are used when the healing period is so long that sustained support is needed for repair.

Advantages:

• High-stress areas for support offer increased mechanical properties from the infusion of nylon and polypropylenes.
• Such sutures support and sustain the wound for long periods when healing or under tension.
• Corresponds favourably with the foreign body reaction-enzymatic breakdown is avoided. 

Disadvantages:

• Requires follow-up visits for removal, which can inconvenience the patient.
• It may provoke a foreign-body reaction if left on too long.

Surgeons prefer non-absorbable sutures for any external closure because of their strength and ease of handling. Also, they are favoured in operations requiring accurate approximation, such as plastic surgery or some delicate microsurgical approaches.

Monofilament and Multifilament Sutures

Monofilament Sutures

Monofilament sutures are made from a single strand and provide a smooth introduction into the tissue with a lower potential for infection due to a simple, non-porous configuration. Monofilament is the surgery type that has the least traumatic tissue manipulation.

Advantages

• Above all, less drag in the surrounding tissue means there is less potential for irritation and subsequent inflammation.
• They can resist bacterial colonization; thus, they are indicated for use in contaminated or infected wounds.
• In vascular surgery, maintaining a sterile area is of the utmost significance.

Disadvantages

• Their tendency to break with over-tightening when the surgeon is tying a knot.
• Less flexible to work with and sometimes difficult to manipulate for less-experienced surgeons.

Multifilament Sutures

Multifilament sutures are braided or twisted from several strands, allowing them to secure knots better and offer greater tensile strength for high-pressure closures. These are commonly used in general and orthopaedic surgery, where ample support is needed.

Advantages

• They have a strong tensile strength, allowing them to stand up well under challenging surgical conditions.
• They are generally easier to handle and tie, thus providing improved workability in the operating room.
• They tend to approximate the wound better because of their flexibility.

Disadvantages

• A more significant tissue drag may produce discomfort during the healing process.
• Greater susceptibility to infection, owing to the braided structure, which traps bacteria.

Factors Surgeons Consider When Choosing Sutures

• Type of tissue: Soft absorbable sutures are indicated for adjacencies of the fragile tissue, while non-absorbable soft primers are needed for sturdier tissues.
• Duration of healing: Suture material is selected depending on whether the suture is for short or long-term support. Absorbables are preferable for the short term, and in other instances, non-absorbables are required.
• Infection risk: Generally, the surgeon would choose monofilament sutures to operate in high-risk areas.
• Patient issues: In choosing suture material, allergies, medical history, and general health must be considered.
• Cost: Silk is much cheaper, but synthetic ones may sometimes work better. 

Suture Types And Uses

Suture Type	Material	Primary Use
Absorbable	Polyglycolic acid	Internal soft tissues, GI surgeries
Non-Absorbable	Nylon, Prolene	Cardiovascular, skin closure
Silk Suture	Natural silk	Soft tissue repair, oral surgery
Metal Sutures	Stainless steel	Orthopedic, sternum closures
Monofilament Sutures	Nylon, Prolene	Plastic surgery, vascular procedures
Multifilament Sutures	Silk, braided PGA	General surgeries, high-tension areas

Common Types of Suture Material

1. Silk Sutures

Silk sutures are natural, non-absorbable materials commonly used to close soft tissues. They are derived from the silkworm’s cocoon and have been used in surgery for centuries. Silk sutures are considered non-absorbable but may degrade with time when exposed to body fluids.

Uses:

• Gastrointestinal surgeries.
• Skin and mucosal closures.
• Ophthalmic and cardiovascular procedures.

Pros:

• The excellent handling properties include ease of tying and passage through tissues.
• Economical: an ideal choice for numerous surgical applications.
• Pliability allows for adjustment of tension during wound approximation.

Cons:

• Bacterial colonization increases the likelihood of infections.
• These sutures can degrade with time, mainly when set in a moist environment.

2. Metal Sutures

Metal sutures like stainless steel are used in orthopaedic and sternum closures. These sutures have unrivalled strength and durability, critical in high-stress tissue procedures.

Uses:

• Bone fixation, including fixing fractures and implants.
• High-stress surgical sites, such as the sternum, after open heart surgery.

Pros:

• High tensile strength ensures stabilization in demanding surgical conditions.
• Highly resistant to infection and corrosion, offering long-term reliability.
• Used in internal and external situations.

Cons:

• Difficult to handle and tie, calling for great expertise.
• Irritation to the tissues if not placed correctly.

Best Practices For Suture Selection

• Match the suture strength to the tissue requirements.
• For infected/contaminated wounds, use monofilament sutures.
• Absorbable for internal closure to require minimum visits for removal.
• Multifilament for tension closure to give added security to the knot. 

Advancements In Suture Technology

With the advancement of many medical techniques, advanced technologies have advanced their surgical requirements, increasing patient comfort and the operation’s success. Modern sutures come equipped with antimicrobial coating, bioabsorbable properties, and high tensile strength for different types of cases.

Antimicrobial-coated sutures coat substances like triclosan to keep bacterial growth in check surrounding the wound region. This product is crucially beneficial in many cases likely to develop infections. Moreover, bioengineered sutures have been designed to enable surgeons to tailor material for its pace of degradation to the time it takes for tissue to heal.

Hybrid sutures are one more innovation. They combine mo-nofilament and multifilament properties with the potential to overcome the limitations of both. Absorbable sutures are currently being developed to dissolve predictably better, thus reducing the risk of complications associated with early degradation.

Smart sutures containing embedded sensors monitoring wound-associated physiological changes are novel technologies poised to transform postoperative care. Such sutures can warn individuals against infection, changes in pH, or tensile stress in real-time, allowing proper reactions before any resulting complications arise.

As technology progresses, future sutures will likely offer increased precision, increased biocompatibility, and assured efficacy in all surgical applications. 

Suture Safety And Storage Guidelines

Proper handling and storage of each suture are imperative to retain their potency for the surgery. Sutures are always to be stored in their packages in a cool, dry place to avoid exposure to moisture, heat, or direct sunlight, which may damage their strength and sterility.

The surgeon must verify the state of the packaging for any signs of damage or expiry before use. Due to the possibility that a damaged suture may operate improperly, this can add complexity to wounding and infection. The sterility of sutures is also of primary concern; once opened, the suture material should be used quickly to avoid its sterility.

Surgical techniques should ensure that the suture experiences reduced tension and that repeated manipulation does not weaken it. A monofilament suture will kink under excessive force, while multifilament sutures can fray if uncontrolled.

Post-surgery, the leftover suture should be discarded according to hospital procedures for disposal to ensure patient safety and compliance with medical waste regulations. By abiding by these standards, one can ensure sutures work efficiently and effectively for positive surgical results. 

Environmental Impact Of Suture Materials

Healthcare’s environmental footprint of suture production and disposal is an emerging concern. The surgical processes have high carbon footprints, particularly for sutures manufactured from petroleum-based materials. In addition, sterile packaging generates vast amounts of medical waste.

With sustainable alternatives such as surgical sutures made from biodegradable polymers or plant-based materials, there is now less dependence on non-renewable sources, reducing long-term impacts. Certain manufacturers are looking at reuse or packaging suture material in biodegradable materials.

The other aspect involves reusable surgical instruments and a general reduction in single-use sutures without compromising patient safety. Increasingly, such facilities have adopted green initiatives whereby the need for sterility must be balanced alongside sustainable practice.

The ecological awareness of suture materials will magnify manufacturers’ and healthcare providers’ quest for sustainable solutions. There will be innovations in implants and increased awareness and investigation into potential products for healthcare and greener production systems. 

Conclusion

The choice of suture material is key to proper surgical outcomes. Leading suppliers like Nuvo Medsurg provide a wide range of suture options to meet diverse surgical needs. Surgeons should guide themselves according to the type of tissue healed, the duration of healing, and the chance of infection when deciding between absorbable and non-absorbable. It is essential to know the properties of silk sutures, metal sutures, and the monofilament-multifilament suture distinction for their appropriate use. These considerations work with others in improving healing and surgical outcomes. You can also explore our surgical sutures category to select the most suitable materials for your procedures. Proper suture selection also helps minimise intraoperative complications and optimise surgical procedures, thus improving patient care.

View all surgical sutures & related products