A number of elements should be taken into consideration when choosing suture material:
An absorbable suture will lose at least half its tensile strength by 60 days. This half-life can range from 7 days for catgut to 4 weeks for PDS. The absorption of plain and chromic catgut is very unpredictable. Synthetic, absorbable sutures have a more predictable absorption length, ranging from 80 days for Vicryl to 180 days for PDS. With few exceptions, sutures should not be left in the skin permanently unless they are absorbable.
The strength of a suture is determined by the material of which it is comprised and by its diameter. Among the nonabsorbable sutures, polyester sutures are the strongest, followed by nylon, polypropylene and silk. For absorbable sutures, the order is polyglycolic acid, polyglactin and catgut.
Suture diameter is indicated by the USP rating which gives a number followed by a “zero,” with the higher number indicating a thinner suture. Even though a larger diameter suture is stronger, it'll also trigger higher tissue reactivity and leave a more noticeable scar. As a result, the thinnest suture that is of adequate strength should be used.
Monofilament sutures, such as Prolene, are smooth and pass easily via tissue. They trigger the least tissue reactivity and trauma and are more challenging for bacterial adhesion. The drawback is that they are difficult to deal with compared to multifilament sutures such as silk.
Knot security, which is proportional to the coefficient of friction of the suture, is generally higher in multifilament sutures, especially those that are braided. The lower the knot security, the more throws are needed to create a secure knot.
There is no uniform nomenclature that describes the characteristics of the needles. A simplified approach would be to classify needles as tapered, cutting or reverse-cutting. Tapered needles minimize trauma to the tissue. They are utilized to suture tissue that is fragile and can tear easily. Examples include cartilage and bowel wall.
Cutting and reverse-cutting needles are usually used in closing dermis, with the latter being more commonly used because of the creation of a tract that is much less likely to tear through the skin.
The optimal timing for removal of sutures varies widely from surgeon to surgeon. Sutures that are left in location too long can lead to epithelial tracking down via the skin along the length of the suture. This may result in punctate scars left from the sutures themselves. In cases in which impaired wound healing is expected and cosmesis is of secondary importance, sutures can be left in place for weeks or even months.
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