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Author: Dr Todd Gunson, Dermatology Registrar, Broadgreen Hospital, Liverpool, United Kingdom, 2008.
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Summary
The choice of an appropriate suture for any wound closure will make a large contribution to the final functional and cosmetic result. Often, two layers are used:
The choice of suture is determined by a balance of the various characteristics of suture materials most appropriate for the specific wound closure situation.
Absorbable vs Non-absorbable |
The major subdivision of sutures. Sutures that lose the majority of their tensile strength within 60 days are considered absorbable. They are degraded by tissue enzymes or hydrolysis.
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Tensile Strength |
Depends on UPS size (thickness). Surgeons prefer to use the smallest size that will provide adequate strength. The strength increases as the first digit decreases.
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Plasticity and Elasticity |
The ability to retain length and strength after stretch, and the ability to regain its original length after stretch, respectively. This is important:
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Ease of handling and Knot security |
Determined by a number of related characteristics.
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Multifilament vs Monofilament |
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Tissue reactivity |
Refers to the degree of inflammatory response to the suture.
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Surgical Gut |
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Polyglactin 910 (Vicryl®, Polysorb®) |
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Poliglecaprone 25 (Monocryl®) |
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Polydioxanone (PDS II®) |
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Polytrimethylene carbonate (Maxon®) |
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Glycomer 631 (Biosyn®) |
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Nylon (Ethilon®, Dermalon®, Surgilon®, Nurolon®, Nylene®) |
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Polybutester (Novafil®) |
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Polypropylene (Prolene®, Surgilene®, Surgipro®) |
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Silk (Dysilk®) |
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Polyester (Dacron®, Mersilene®, Ethibond®) |
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The three major parts of a surgical needle are the tip (or point), the body, and the shank.
Staples provide a quick alternative for large scalp and trunk wounds.
Surgical glue may be appropriate where there is little or no wound tension.
Wound closure tapes (e.g. Steristrips®) are often helpful to support the wound following subcuticular closure, use of surgical glue, or after removal of epidermal sutures.
In general the smallest suture that will provide adequate support for the healing wound should be used.
Polyglactin 910 provides a versatile deep suture in most cases, although Poliglecaprone 25 may be preferred in situations where minimal tissue reaction is essential, and Polytrimethylene carbonate in high tension wounds. Monofilament absorbable sutures are preferable in contaminated wounds.
Nylon or Polybutester are considered standard epidermal sutures for most situations. Polypropylene is ideal for running subcuticular sutures, and either Silk or Polyester for mucosal applications.
A 3/8 or 1/2 circle reverse cutting needle is suitable for most wound closures. 5-0 or 6-0 sutures are typically used for facial repairs, while 4-0 or 3-0 are standard for most wounds on the trunk and extremities.
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