Surgical suture is a medical device used for apposition of bodily tissues after injury and surgery. A number of different materials, shapes and sizes of sutures are available for a medical professional to select from while suturing a surgical incision, internal organ, blood vessel, laceration or wound. Suturing is an important procedure which ensures healing of tissues and wounds after a medical procedure has been performed. Suturing ensures that the tissue to be healed is able to withstand stress till complete healing takes place. Suturing also prevents leakage of blood from lacerated tissues and minimizes scar formation. Sutures may be of synthetic or natural origin, and can be either absorbed by the body or stay in the body indefinitely or till they are removed. Some sutures are also treated with a coating, softening or antibacterial agent to add to their properties. There are various types of sutures available and a suture is chosen based on the location, environment and requirement of the area to be sutured. Sutures are used in all fields of surgery including obstetrics and gynecology, cardio thoracic, ophthalmology, urology, plastic surgery, orthopedics etc.
Types of sutures
Sutures are broadly divided into the following categories:
Absorbable and Non-absorbable sutures.
these sutures are broken down in the body as healing progresses and eventually dissolve completely. These sutures are not used when long term apposition of tissues is required. Absorbability begins as a loss of tensile strength followed by the loss of mass and finally dissolution due to proteolytic enzyme action. As the body might identify the suture as a foreign object, moderate tissue inflammation might occur.
Factors responsible for the rate of absorption of absorbable sutures are
Type of suture: plain gut is known to get absorbed faster than chromic gut
Infection: a suture is absorbed more readily by an infected tissue when compared to an uninfected tissue
Site of suturing: sutures are absorbed more rapidly in areas having increased proteolytic enzymatic activity like the stomach, cervix and vagina.
Absorbable sutures are either made from specially processed animal materials or synthetic polymers such as polylactic acid (vicryl), polyglycolic acid (dexon), polyglyconate (maxon) and polydioxanone (pds).
Non- absorbable sutures
these sutures resist the body chemicals and enzymes and don’t get dissolved in the body. They maintain long term tissue apposition and healing. Non- absorbable sutures provide prolonged tensile strength to the tissue. These sutures are also used in cases where there’s a risk of an absorbable suture getting broken down too early. These include polypropylene, nylon (polyamide), polyester, pvdf and stainless steel sutures.
Monofilament or Multifilament sutures
Based on their structures, sutures are categorized as Monofilament and Multifilament / Braided
Monofilament sutures provide better passage through tissues when weighed against multifilament sutures and cause lower tissue reaction. These include polypropylene, nylon, pvdf, stainless steel, poliglecaprone and polydioxanone sutures.
Multifilament/ Braided sutures
Multifilament sutures often provide better knot security when compared to monofilament sutures. They are also quite pliable. Multifilament sutures are made of several strands that are twisted or braided together. They are generally coated to smoothen out the surface and reduce capillarity. These include pga, polyglactin 910, silk and polyester sutures.
Coated and uncoated sutures
A suture may be coated to increase its pliability, strength and antimicrobial properties. Common suture coatings include beeswax, calcium stearate and polycaprolactone. Infection at the site of post surgical incisions is a very common post- surgery complication and sutures coated with antimicrobials like triclosan may reduce infection at the incision site.
Characteristics of sutures
Pliability – this refers to the ease of handling of the suture
Tensile strength – the amount of tension the suture can endure before breaking
Breaking strength – limit of tensile strength at which the suture breaks
Tissue reactivity – this refers to an inflammatory response of the body to the suture. It usually peaks in the first 2 to 7 days
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