Type of suture
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Here is a complete overview of suture types, synthesized from Bailey & Love's Short Practice of Surgery (28th ed.), Dermatology 2-Volume Set (5th ed.), and Hinman's Atlas of Urologic Surgery:
Types of Sutures
Sutures are classified in three main ways: by absorbability, by physical structure (configuration), and by material origin.
1. Classification by Absorbability
A. Absorbable Sutures
These are broken down by the body (either by enzymatic proteolysis for natural materials, or hydrolysis for synthetic ones) and do not require removal.
Natural Absorbable
| Suture | Tensile Strength Duration | Tissue Reactivity | Notes |
|---|---|---|---|
| Plain Gut (Catgut) | Lost within 7-10 days; fully digested in 60-70 days | Moderate | Derived from bovine/ovine intestinal collagen; rarely used today |
| Chromic Gut | ~10-14 days | Less than plain gut | Treated with chromium salts; used for mucosal surfaces, skin grafts |
| Fast-Absorbing Gut | 50% at 5-7 days | Low | Heat-treated; popular for skin grafts and epidermal closure; doesn't need removal |
Synthetic Absorbable (SAS)
More predictable absorption, lower tissue reactivity, absorbed by hydrolysis.
| Suture (Brand) | Configuration | Tensile Strength | Reactivity | Uses |
|---|---|---|---|---|
| Polyglycolic acid (Dexon) | Braided | 20% at 21 days | Low | Subcutaneous closure, vessel ligature |
| Polyglactin 910 (Vicryl) | Braided | 75% at 14d; 25% at 28d | Low | Subcutaneous closure, vessel ligature |
| Polydioxanone (PDS II) | Monofilament | 60-80% at 4 weeks | Low | High-tension subcutaneous closure |
| Polyglycolate (Maxon) | Monofilament | 80% at 35 days | Low | High-tension subcutaneous closure |
| Poliglecaprone 25 (Monocryl) | Monofilament | 50-60% at 7d; 0% at 21d | Minimal | Subcutaneous (avoid high-tension sites) |
| Polyglylate 6211 (Caprosyn) | Monofilament | 20% at 10 days | Minimal | Rapid-absorption subcutaneous closure |
B. Non-Absorbable Sutures
Resistant to hydrolysis and enzymatic degradation. Usually removed from skin in 5-14 days (earlier on the face, later on trunk/extremities). Some are left permanently for deep tissues (e.g., vascular anastomoses, hernia repairs).
Natural Non-Absorbable
| Suture | Notes |
|---|---|
| Silk | Braided; easy to handle; loses strength after ~2 months; never used in vascular anastomoses (risk of late fistula) |
| Cotton | Loses strength rapidly; occasionally used in intestinal anastomosis outer layer |
Synthetic Non-Absorbable
| Suture | Configuration | Strength | Notes |
|---|---|---|---|
| Nylon (Ethilon, Dermalon) | Mono or braided | Loses strength over time | Polyamide; common skin suture |
| Polypropylene (Prolene) | Monofilament | Retains indefinitely | Least reactive synthetic; ideal for vascular anastomoses |
| Polyester (Dacron, Ethibond) | Braided | Good | Cardiovascular surgery, hernia repair |
| Polyethylene | Monofilament | Good | Very low reactivity |
| Stainless Steel | Mono or multifilament | Excellent | Sternal closure, orthopedics |
2. Classification by Physical Structure
| Type | Characteristics |
|---|---|
| Monofilament | Single strand; smooth, slides easily through tissue; less bacterial harborage; harder to knot; can fracture if damaged by instruments |
| Multifilament (Braided) | Multiple twisted/braided strands; easier to knot; better handling; has capillary action (bacteria can lodge in interstices); some are coated with silicone to reduce this |
3. Classification by Origin
| Category | Examples |
|---|---|
| Natural biological | Catgut, silk, cotton |
| Synthetic | Nylon, polypropylene, Vicryl, PDS, Monocryl |
4. Tissue Reactivity - Spectrum (Least to Most)
Polypropylene / Nylon / Steel / Polyethylene → Synthetic absorbable / Multifilament non-absorbable → Silk / Cotton → Catgut (most reactive)
5. Special Type: Barbed Sutures
A newer category - monofilament sutures with tiny barbs etched along their length (spaced ~1 mm apart). Once placed, barbs anchor the suture and prevent backward slipping, eliminating the need for knot-tying. Available in both absorbable and non-absorbable forms. Particularly useful in laparoscopic and robotic surgery (e.g., renal closure in partial nephrectomy, vesicourethral anastomosis in prostatectomy). - Hinman's Atlas of Urologic Surgery
6. Suture Size (Gauge)
Suture thickness is classified by diameter. Size "0" is larger than sizes preceded by a number (e.g., 2-0 = 00 is finer than 0, and 5-0 is very fine). The finer the suture, the less tissue damage but also the less tensile strength.
Key Properties to Consider When Choosing a Suture
- Tensile strength and duration needed
- Tissue reactivity (synthetic < natural)
- Absorbability required (buried vs. surface)
- Knot security (braided > monofilament)
- Infection risk (monofilament preferred in contaminated fields)
- Memory (high in synthetic monofilaments - reduces knot security)
- Handling ease (braided sutures handle better)
Sources: Bailey and Love's Short Practice of Surgery 28th Ed., pp. 125-127; Dermatology 2-Volume Set 5th Ed., p. 144.1; Hinman's Atlas of Urologic Surgery, pp. 31-32
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