Suture Types
There are two main types of suture material — absorbable and non-absorbable.
Absorbable Sutures
- These sutures have different absorption times which impacts the healing time and the strength of the wound closure.
- Absorbable sutures can be made from either mammals or synthetic materials. They may be treated with dyes or other coatings to allow for better absorption. The body digests these sutures using enzymes.
Surgical Gut (select the + hotspots in the image to reveal information)
- The surgical gut typically comes from the submucosal area of a sheep’s small intestine, or from cattle or hog’s intestinal serosa.
- The surgical gut sutures can be treated with chromium salts or remain untreated, which is known as the plain gut.
- Plain gut sutures are typically used for the approximation of soft tissue or ligation, commonly used in ophthalmology surgery.
- Surgically treated gut sutures allow for slower absorption. This lets wounds continue healing while the suture remains intact.
- Tissue enzymes are responsible for digestion and the absorption of the surgical gut.
- These sutures come in alcohol solution wet packing to maintain their pliability. If the package is open and not used, the alcohol evaporates, altering its pliability.
- If the suture is being used in ophthalmology procedures, it can be restored by immersing it in water or sterile saline. For other procedures, there is enough moisture in the tissue fluid to restore it.
- Too much moisture can decrease the tensile strength.
Synthetic Absorbable Sutures
- These synthetic braided and monofilament types of sutures provide wound approximation for two to three weeks due to the tensile strength. Then they are rapidly absorbed by the body.
- There are also other synthetic polymers that can last up to three months before absorption, which allows even longer support for wound healing. This is generally used for oncology and elderly patients.
- Hydrolysis is the process in which synthetic sutures are absorbed. This is a chemical process in which fluid reacts with the polymer, breaking down the molecular structure.
- Unlike surgical gut sutures, these synthetic sutures come in dry packages since moisture reduces their tensile strength.
(Cromb, 2019)
Some examples of Synthetic Absorbable Sutures include (select the + hotspots in the image to reveal information):
Vicryl Rapid
Vicryl
Monocryl
PDS
Non-Absorbable Sutures
Non-absorbable sutures resist digestion from tissue enzymes. These types of sutures can also have a coating to reduce friction when passing through tissues. Additionally, fibres can be dyed or left uncoloured. The most common non-absorbable suture materials are silk, nylon, polyester fibre, polypropylene, and stainless steel wire.
Silk
Polyester fibre
Stainless steel wire
Nylon
Polypropylene
There are three classifications of non-absorbable sutures:
Class I: These are silk or synthetic fibres that are monofilament and braided or constructed with a twist.
Class II: These fibres are made of cotton or linen. They can also be coated with synthetic or natural fibres. This coating does not significantly impact strength but does increase the thickness of the suture.
Class III: These are metal wires either in monofilament or multifilament form.
(Cromb, 2019)