Doctor use sutures to repair wounds on the skin or other tissues. When the doctor stitches a wound, he or she will use a needle and a length of "thread" to close it.
Types of sutures
Sutures can be divided into a variety of categories.
Absorbable vs. Non-absorbable Sutures
Suture materials come in two types: absorbable and non-absorbable.
Absorbable sutures do not need to be removed by your doctor. This is because enzymes contained in your body's tissues naturally breakdown them.
Nonabsorbable sutures must be removed by your doctor at a later date or, in certain situations, left in place indefinitely.
1. Types of absorbable sutures
- Gut. This natural monofilament suture is used to treat interior soft tissue lesions or lacerations. Gut should not be utilised for cardiovascular or neurological surgeries. The body has the biggest sensitivity to this suture and will frequently scar over it. It is rarely utilised outside of gynaecological surgery.
- Polydioxanone (PDS). This synthetic monofilament suture can be utilised for a variety of soft tissue wound repair operations (including abdominal closures) as well as paediatric cardiac surgeries.
- Poliglecaprone (MONOCRYL). This synthetic monofilament suture is used for soft tissue repair in general. This product should not be utilised in cardiovascular or neurological treatments. This suture is most typically used to seal skin in an invisible way.
- Polyglactin (Vicryl). This synthetic braided suture is useful for repairing lacerations on the hand or face. It should not be utilised for heart or neurological operations.
2. Types of non-absorbable sutures
Nonabsorbable suture examples are provided below. These sutures are all appropriate for soft tissue repair in general, as well as cardiovascular and neurological treatments.
- Nylon. Suture made of natural monofilament.
- Polyester (Prolene). Suture made of synthetic monofilament.
- Silk. A natural suture that is braided.
- Polypropylene (Ethibond). A synthetic suture that is braided.
Braided vs. Monofilament Sutures
- Braided Sutures: Braided sutures are made up of multiple tiny strands that are twisted together. Although they are simpler to tie than non braided sutures, the microscopic spaces between suture strands can contain germs, increasing the risk of infection.
- Non Braided Sutures: Monofilament sutures, also known as non braided sutures, are formed of a single strand. These sutures are commonly utilised in skin closure in wounds where infection is a concern.
Natural vs. Synthetic Sutures
Sutures can be characterised as either natural or synthetic in nature.
Collagen from mammal intestines or synthetic collagen can be used to make natural sutures.
Artificial polymers are used to make synthetic sutures.
In suture sizing the smaller the suture, the higher the number.
The smaller the size, the lower the tensile strength.
- 9-0 or 10-0 for microsurgery
- 5-0 or 6-0 facial skin closure
- 3-0 or 4-0 for deep skin, muscle, and intraoral mucosa
The Ideal Suture Features
- Predictable absorption
- Use for any Procedure
- Easy to handle
- Minimal Tissue Reaction
- High Breaking Strength
- Holds Knots Securely
Sutures available in India:
Gore-Tex Suture – Non Absorbable
- Polytetrafluoroethylene (ePTFE) biomaterial
- Monofilament, Non-absorbable
- It Reduces blood loss, tissue trauma and it has Excellent handling characteristic
- Common Usage is in vascular surgery, Chordae tendineae / mitral valve repair, Hernia repair – Oral Health
Vicryl Rapide* (polyglactan 910)- Absorbable
- 50% tensile strength in 5 days
- 0 strength in 10-14 days
- Braided, coated synthetic
- Absorbable, low molecular weight
- Elicits lower tissue reaction than chromic gut
- Ideal for dental procedures
Coated Vicryl (Polyglactan 910)
- 75% tensile strength at 2 weeks, 40% at 3 weeks
- Absorption at 56-70 days
- Synthetic absorbable
- Frequent Uses are in general tissue/muscle approximation
Monocryl (Poliglecaprone 25)
- Tensile strength of 60-70 percent after 7 days, 30-40 percent after 14 days
- Absorption at 91-119 days
- Monofilament synthetic absorbable
- Highest strength among absorbables
- Most pliable with excellent handling properties
- Minimal acute inflammatory reaction
- Frequent use – Bladder, GI surgery…..
- Not much indication for dental use
PDS II (Polydioxanone)
- 70% tensile strength at 2 weeks, 50% at 4 weeks, 25% at 6 weeks
- Absorption 180-210 days
- Monofilament synthetic absorbable
- Non-antigenic, only slight tissue reaction
- Absorption complete at 6 months
- Appropriate for all forms of soft tissue closure.
- Frequently used for slow healing patients, compromised tissue Fascia, orthopedics…
A needle is also attached to suture material. The needle can have a variety of characteristics. It comes in a variety of sizes and with a cutting or non cutting edge. Larger needles can seal more tissue with each stitch, however smaller needles are more likely to reduce scarring.
Types of Suturing Needles
There are 4 types of suturing needles:
- Typically utilised in oral surgical procedures
- Two opposing cutting blades, with a third cutting edge on the needle's outer curve
- Reduces the risk of "cut-out"
- The reverse-cutting needle is stronger than a conventional cutting needle and is ideal for penetrating resistant tissues.
- Two opposing cutting edges with a third on the inside curve of the needle
- The needle's cutting tip changes from a triangular to a flattened shape.
- Not typically used in oral surgery - since the cutting edge tends to rip through the flap edge with restricted access
- Specifically designed for usage on tough and fragile tissues
- The needle's point has a sharp reverse cutting tip
- All three edges of the tip are sharpened to offer uniform cutting
- These needles are great for subcutaneous tissues since they are difficult to pass through the skin.
The needle's cord length (also known as bite width) is the distance between the swage (where the "thread" attaches to the needle) and the needle tip. Needle length is just the space between the swadge and the needle tip. You will receive better outcomes if you use the shortest needle feasible for your treatment.
Suture procedures are as varied as the types of sutures. They include the following:
- Continuous sutures. This method entails a series of stitches made using a single strand of suture material. Because stress is delivered uniformly along the continuous suture strand, this type of suture may be inserted quickly and is very strong.
- Interrupted sutures. To seal the incision, this suture method employs many strands of suture material. The material is cut and knotted off when a stitch is completed. This approach results in a wound that is firmly closed. If one of the stitches breaks, the other stitches will keep the incision closed.
- Deep sutures. This form of suture is inserted beneath the layers of tissue below (deep) the skin. They might be either continuous or interrupted. This stitch is frequently used to join fascial layers.
- Buried sutures. This sort of suture is used to keep the suture knot inside the body (that is, under or within the area that is to be closed off). This sort of stitch is usually not removed and is effective when using big sutures deeper in the body.
- Purse-string sutures. This is a sort of continuous suture that is wrapped around a region and tightened like a bag's drawstring. This form of suture, for example, might be utilised in your intestines to secure an intestinal stapling device.
- Subcutaneous sutures. These sutures are inserted into your dermis, the layer of tissue underneath your skin's upper layer. Short stitches are inserted parallel to your incision in a line. After that, the stitches are fixed at both ends of the incision.
The location of your sutures on your body will determine when they are removed. The following are some general guidelines:
- 7 to 10 days for the scalp
- 3 to 5 days for the face
- 10 to 14 days for chest or trunk
- 7 to 10 days for the arms
- 10 to 14 days for the legs
- 10 to 14 days for hands or feet
- 14 to 21 days for palms of hands or soles of feet
Your doctor will first sterilise the area before removing your sutures. They'll take one end of your suture and cut it as near to your skin as possible. The suture strand will then be gradually removed.