Page 72 - Virtual Vascular Vol 15

Sutures

Article contribution by Sabrina Wong M23

Natural vs synthetic
• The use of natural materials for the
closing of wounds have dated back as far as
3000BC by the Egyptians. Cotton, linen,
catgut were common materials used, before
synthetic materials slowly rendered the use
of most of them obsolete. Only silk remains
in use.

• Synthetic material is superior as it
produces minimal inflammatory reaction and
has more predictable tensile strength and
handling properties. They can also be
manufactured to be coated with lubricant to
aid handling or impregnated with antiseptics
to decrease the risk of infection.

Absorbable vs non-absorbable
• Absorbable sutures (e.g., Monocryl, Vicryl,
PDS) can be broken down by the body
through hydrolysis or other enzymatic
reactions, so they lose tensile strength over
time. The absorption time or half life of each
suture is determined by the material used
and patient factors. For example, Monocryl
can be completely absorbed by the body by
100 days.
• Non-absorbable sutures will stay in the
body indefinitely and retain their tensile
strength for 60 days. Prolene (polypropylene)
and Nylon are common examples. Stainless
steel sutures are sometimes used in
orthopedics and in sternal closure in
cardiothoracic surgeries. A well recognized
complication of non-absorbable suture is a
sinus tract formation.

Monofilament vs multifilament
• Most suture materials can be classified
into monofilaments (e.g., Prolene) or braided
forms (e.g., Vicryl, silk). Monofilaments pass
through tissues more easily, and there is
smaller risk of infection as the formation of
bacterial biofilms and adherence is reduced.
However, braided sutures tie with better
knot security and handle better.
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