Sutures are medical equipment used for closing a wound or an incision. It is a thread or strand of fine material used by the surgeons to close wounds during surgery or by doctors for surface wounds. Sutures are primarily used to close any dead space, to support wounds till the healing increases and improve their tensile strength, minimizing any risks of bleeding or infection. By bringing the tissues closer, sutures give them a chance to fuse together over time, thereby closing the skin. Different kinds of sutures are introduced for different kinds of wounds.
There are primarily two types of sutures available in today’s time – absorbable and non-absorbable.
Absorbable sutures are made with processed collagen (animal products that are specially processed) and synthetic polymer materials such as polylactic acid (Vicryl), polyglycolide (Maxon), polyglycolic acid (Dexon) and polydioxanone (PDS), which can be broken down by the body. They are mostly used for wounds involving rapidly healing tissues. Another type of suture used for wounds is the mattress suture. If maintaining a long-term tissue wound closure is the doctor’s goal, then non-absorbable sutures will be preferred. Usually made with polypropylene and nylon, they strongly resist the body chemicals which cause absorbable sutures to break down.
Non-absorbable sutures are used in the exteriors of the body, and usually need to be removed after a couple of days to weeks depending on the healing pace of the wound. Exceptions for non-external applications of non-absorbable sutures include using sutures in critical organs such as the heart or the bladder. In such cases, the sutures are customized so that there is no chemical risk of degradation involved.
Another basis of classification is the filament structure, differentiating the sutures into monofilament and multifilament.
Multifilament sutures come with various braids that help in securing knots in tissues whereas monofilament easily passes through tissues. A classic example of the latter is the Stratfix suture, known for its knotless pattern that helps control closure approximation, paving way for a neat finish. The way the sutures work also depends on the techniques that are applied. Continuous suturing is applicable to long wounds. One needs to minimize the tension of the wound and continuous sutures can work really neatly infusing the wound together. However, it is dependent on the surface; it is ideal for split-thickness or full-thickness graft.
Another popular way of suturing is interrupted, which comes with stronger tensile strength and enough bandwidth for the surgeon to correctly align the wound edges while making adjustments. Running locked sutures are recommended for areas with good vascularization like the scalp. Then there is vertical mattress suture, ideal for reducing dead space and minimizing wound tension, although the crosshatching nature of the same makes it the treatment very delicate. Therefore, surgical sutures are of many kinds, and all play their role with their own characteristics for closing different kinds of wounds.