Understanding Surgical Sutures: Types, Uses, and Characteristics

Surgical sutures, commonly known as stitches, are critical tools in the medical field, used to close wounds and facilitate healing. They come in various types, each designed for specific purposes and conditions. This article delves into the different types of surgical sutures, highlighting the distinctions between absorbable and non-absorbable sutures, as well as the differences between dyed and undyed sutures.

Types of Surgical Sutures

Absorbable Sutures

Absorbable sutures are designed to break down and be absorbed by the body over time. They are typically used in internal tissues where follow-up removal would be impractical. These sutures are beneficial in reducing the risk of infection and minimizing the need for additional surgical interventions.

1. Plain Gut:

• Derived from the intestines of sheep or cows.
• Used for rapidly healing tissues.
• Absorbs quickly, usually within 70 days.

2. Chromic Gut:

• Treated with chromium salts to delay absorption.
• Lasts longer than plain gut, up to 90 days.
• Commonly used in gynecological and gastrointestinal surgeries.

3. Polyglycolic Acid (PGA):

• Synthetic absorbable suture.
• Offers high tensile strength and predictable absorption.
• Often used in gastrointestinal and gynecological surgeries.

4. Polyglactin 910 (Vicryl):

• Made from a copolymer of glycolic acid and lactic acid.
• Absorbs within 56-70 days.
• Suitable for a wide range of surgical applications, including soft tissue approximation and ligation.

5. Poliglecaprone 25 (Monocryl):

• Monofilament suture with excellent pliability.
• Absorbs within 91-119 days.
• Ideal for soft tissue closures and subcuticular suturing.

6. Polydioxanone (PDS):

• Monofilament suture with prolonged absorption time (180-210 days).
• Used in pediatric cardiovascular surgery and in situations where extended wound support is needed.

7. Polyglyconate (Maxon):

• Synthetic monofilament suture.
• Absorption profile similar to PDS.
• Used in both general soft tissue closure and pediatric cardiovascular procedures.

8. Polyglycolide-co-caprolactone (PGCL, Monosyn):

• Absorbs within 90-120 days.
• Combines glycolic acid and e-caprolactone for soft tissue approximation and ligation.

9. Rapid Polyglycolic Acid (Rapid PGA):

• Absorbs quickly, within 42 days.
• Used for rapidly healing tissues and short-term wound support.

10. Polydioxanone (PDO):

• Absorbs within 180-210 days.
• Provides prolonged tensile strength for slow-healing tissues.

Non-Absorbable Sutures

Non-absorbable sutures are designed to remain in the body indefinitely unless removed. They are typically used for skin closure, cardiovascular surgery, and orthopedic procedures where long-term support is required.

1. Silk:

• Natural fiber, non-absorbable suture.
• Excellent handling properties.
• Often used in cardiovascular and gastrointestinal surgeries.

2. Nylon:

• Synthetic, monofilament or multifilament suture.
• Known for its strength and minimal tissue reactivity.
• Commonly used in skin closures and microsurgery.

3. Polypropylene (Prolene):

• Synthetic monofilament suture.
• High tensile strength and minimal tissue reaction.
• Suitable for vascular and plastic surgeries.

4. Polyester:

• Synthetic multifilament suture.
• Coated to reduce tissue drag.
• Used in cardiovascular, ophthalmic, and orthopedic surgeries.

5. Polyethylene (Ethibond):

• Strong and durable multifilament suture.
• Used in orthopedic and cardiovascular surgeries.

6. Stainless Steel:

• Incredibly strong and durable.
• Used in orthopedic surgery and for sternal closure.
• Resistant to infection and tissue reactions.

Dyed vs. Undyed Sutures

Sutures can be either dyed or undyed, depending on the needs of the surgery and the preference of the surgeon.

Dyed Sutures:
Dyed sutures are colored to enhance visibility during surgery. The dye used is typically inert and biocompatible, ensuring it does not cause adverse reactions in the body. Dyed sutures are particularly useful in procedures where it is crucial to distinguish the suture from the surrounding tissues, such as in deep or complex surgeries. Common colors include blue, black, and violet.

Undyed Sutures:
Undyed sutures, also known as plain sutures, retain their natural color. They are often preferred in situations where the presence of dye might interfere with the healing process or where aesthetics are a concern, such as in facial or cosmetic surgeries. Additionally, undyed sutures are used in surgeries involving tissues that are naturally colored, where a dyed suture would not provide any additional benefit in terms of visibility.

Key Considerations in Suture Selection

When selecting sutures, several factors must be considered to ensure optimal healing and minimal complications:

• Tissue Type: Different tissues require different suture materials based on their healing properties and the stress they endure.
• Duration of Support Needed: Absorbable sutures are ideal for tissues that heal quickly, while non-absorbable sutures are better for tissues requiring prolonged support.
• Risk of Infection: Absorbable sutures can reduce the risk of infection by eliminating the need for suture removal, whereas non-absorbable sutures might increase infection risk if left in place for too long.
• Suture Handling: Surgeons often choose sutures based on their handling characteristics, such as knot security, flexibility, and ease of use.

Understanding the different types of surgical sutures and their specific applications is essential for effective wound closure and patient recovery. Absorbable sutures offer the advantage of biodegradability, making them suitable for internal tissues, while non-absorbable sutures provide long-term support for more durable tissue structures. The choice between dyed and undyed sutures depends on the need for visibility and aesthetic considerations. By carefully selecting the appropriate suture type, surgeons can enhance surgical outcomes and promote optimal healing.