Monofilament v. multifilament (braided or twisted) -
- Monofilament – stronger, low tissue drag and harbor less infection. But DO NOT handle as easily and multifilament
- Multifilament- handles easily but promotes tissue infection and reactivity as it acts as a capillary allowing liquids an bacteria to travel along the strand easily
- Tensile strength- Higher number of zeros the smaller the size and less strong the suture is (general guide below:)’
5-0 to 6-0 : face, eyebrow, nose, lip, eyelid, ear, penis
4-0 to 5-0: hand
3-0 to 5-0: Scalp, torso, extremities, foot/sole
2-0: Chest tube securing
- Fast-absorbing/plain/chromic Gut- strength retention 7 days and absorbs in 10-14 (chromic a little longer). Fast- absorbing less tensile strength than plain gut.
Fast-absorbing good for peds lacerations where removal might be difficult
- Vicryl- synthetic absorbable braided suture. 2 weeks of 65% tensile strength. Complete absorption 60-90 days
Great for buried suture to approximate wound edges and gain strength to keep wound closed; also great for nail bed closure
- Vicryl rapide- synthetic absorbable multifilament. 50% tensile strength at 5 days with 0% at 2 weeks. Absorption/falling off by 2 weeks.
- Nylon (Ethilon, Dermalon)- first synthetic suture/monofilament – high tensile strength (at 2 weeks), low $ and minimal tissue reactivity. Has poor memory so you need more knots to hold suture in place
- Prolene –synthetic/monofilament- similar to nylon in high tensile strength and low tissue reactivity. Plasticity noted allowing it to stretch and accommodate wound edema. Is slippery so requires extra throws to secure the knot.
- Silk- natural/braided – low tensile strength, evokes significant inflammatory response but with good knot security– rarely used cause we have nylon and prolene
Needles- 3 parts to a needle eye where the suture attaches; body where you hold on to; point tip to maximum cross section of body.
- Cutting- 2 opposing cutting edges – ideal for skin sutures that must pass through dense irregular thick dermal tissue
- Conventional cutting- have a 3rd cutting edge on the inside concave curvature of the needle (track faces wound edge so risk of cutting tissue)
- Reverse cutting- 3rd cutting edge on the outer convex curvature decreasing tissue cutout. Used for thick skin like palms and soles.
- Blunt – dull point used for friable tissue (fascia)
Finally a quick literature review comparing Absorbable v. non-absorbable (limited literature on this, not much at all looking at adults/elderly)
- 1997 J Emerg Med (Shetty, Dicksheet, Scalea) 5 year retrospective study of hand lacerations repaired with 5-0 vicryl or nylon and no complications or infections reported in study group and scar was comparable at 6 months in both group
- 2004 – Academic Emergency Medicine ( Karounis, Gouin, Eisman, Chalut, Pelletier, Williams) Randomized clinical trial comparing peds traumatic lacerations closed with absorbable plain gut sutures v. nonabsorbable nylon found comparable cosmetic outcomes
- 2008- Pediatric emergency medicine (Luck, Flood, Eyal, Saludades, Hayes, Gaughan)- Facial lacerations on pediatric population compared fast-absorbing cat gut v. nylon sutures – small study but showed no significant difference in scar appearance/parental satisfaction, infection rate, wound dehiscence or keloid formation.
- 2007 Pediatric Emergency Care (Al-Abdullah, Plint, Fergusson) meta analysis – lack of large/RCT evaluating absorbable v. nonabsorbable. However from the data reviewed appears non-absorbable sutures seem no better than absorbable in wound repair.