Can one close a deep wound with non absorbable suture for time sake then remove and resuture with absorbable suture
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"wound closure" AND "absorbable suture" AND "deep tissue"
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I now have enough information from authoritative sources to give a thorough answer. Here is the full response:
Closing a Deep Wound with Non-Absorbable Sutures Then Replacing with Absorbable - Is It Viable?
Short answer: No, this is not sound practice and is not recommended. The reasoning is grounded in wound biology, suture material properties, and infection risk. Here is the full breakdown.
Why Non-Absorbable Sutures Do Not Belong Permanently in Deep Tissue
Non-absorbable sutures (nylon, Prolene, silk, polyester) left in deep tissue act as permanent foreign bodies. They do not integrate - they persist indefinitely and trigger a chronic inflammatory response. Known consequences include:
- Suture sinus tracts - the body attempts to expel the foreign material through the overlying skin
- Chronic granuloma formation and low-grade wound infection
- Abscess formation, sometimes years later
- Increased risk of wound dehiscence if infection supervenes
This is why the standard teaching is: deep/buried layers (fascia, subcutaneous tissue, deep dermis) = absorbable sutures; skin surface only = non-absorbable sutures (which are then removed).
Pye's Surgical Handicraft (22nd ed.) does note that in specific high-risk situations (elderly patients, malignancy, bowel obstruction, contaminated wounds, malnutrition), some surgeons deliberately use non-absorbable sutures for fascial closure - but this is intentional and permanent for strength, not temporary.
The "Time-Saving" Rationale Falls Apart
The proposed plan - close deeply with non-absorbable, then reopen and resuture with absorbable - introduces more problems than it solves:
- Re-opening causes additional tissue trauma - you are creating a second wound event, with fresh bleeding, disruption of early hemostasis, and risk of hematoma
- Each pass of a needle through tissue increases infection risk
- Wound healing has already begun - by the time you return to re-suture, the wound is in the inflammatory phase and fibrin has started to deposit; disturbing this disrupts the healing cascade
- The gain is zero - you spend no less time overall; you spend more (two procedures instead of one)
What Delayed Primary Closure Actually Looks Like
There is a legitimate concept called delayed primary closure (tertiary intention), but it works very differently from what you describe. Per Pfenninger & Fowler's Procedures for Primary Care (3rd ed.):
"After anesthetizing, evaluating, and irrigating the wound, insert a small piece of petrolatum gauze between the wound edges... On the third day, the patient should return for definitive repair. The wound is then anesthetized, reirrigated, and closed primarily with nonabsorbable sutures (i.e., no deep sutures because they increase the chance of infection)."
Key point: in delayed primary closure, deep sutures are deliberately AVOIDED because they increase infection risk. The wound is kept open with packing, then closed at the surface level a few days later. It is used for wounds >12 hours old (>24 hours for facial wounds) or contaminated wounds where immediate closure would trap bacteria.
Per Schwartz's Principles of Surgery (11th ed.):
"Delayed primary closure, or healing by tertiary intention, represents a combination of the first two, consisting of the placement of sutures, allowing the wound to stay open for a few days, and the subsequent closure of the sutures."
What Should Be Done Instead
| Situation | Correct Approach |
|---|---|
| Clean wound, time-constrained | Close deep layers with absorbable suture now (Vicryl, PDS, Monocryl) - it takes the same time |
| Contaminated wound | Leave open, pack with moist gauze, delayed primary closure at day 3-5 with surface-only sutures |
| High-risk patient (malnourished, immunocompromised) | Mass closure with non-absorbable (Prolene) for fascial strength - intentionally permanent |
| Truly no time | Pack open, dress, definitive closure next case |
Bottom Line
There is no clinical scenario where temporarily placing non-absorbable sutures deep and then replacing them with absorbable ones is the right answer. Absorbable sutures should be chosen from the outset for deep layers - they take no more time to place, and they eliminate all the complications of retained foreign material. If time does not allow proper closure at all, the correct move is packing the wound open and returning for delayed primary closure, not a two-stage suture swap.
Sources:
- Pye's Surgical Handicraft, 22nd ed., Method of Closure section
- Pfenninger and Fowler's Procedures for Primary Care, 3rd ed., Delayed Primary Closure section
- Schwartz's Principles of Surgery, 11th ed., Classification of Wounds / Wound Healing
Where can i use non absorbable suture
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I have excellent data from Bailey & Love directly. Here is the complete answer:
Uses of Non-Absorbable Sutures
The core principle is simple: use non-absorbable sutures wherever you need permanent or long-term tissue support, or where the suture will be externally accessible and removed.
By Suture Type and Specific Use (Bailey & Love, 28th ed., Table 7.1)
| Suture | Primary Uses |
|---|---|
| Silk | Ligation and suturing where long-term tissue support is needed; securing external drains to skin |
| Nylon | General surgery: skin closure, abdominal wall mass closure, hernia repair, plastic surgery, neurosurgery, microsurgery, ophthalmic surgery |
| Polypropylene (Prolene) | Cardiovascular surgery, plastic surgery, ophthalmic surgery, subcuticular skin closure |
| Polyester | Cardiovascular, ophthalmic, plastic, and general surgery |
| Surgical steel wire | Sternal closure (sternotomy), tendon repairs, hernia repairs |
Organized by Clinical Site
1. Skin surface closure
The most common use. Nylon or Prolene interrupted/mattress sutures - placed externally, then removed at 5-14 days depending on site. Non-absorbable is preferred here because it causes less tissue reaction than absorbable at the skin surface and can be removed cleanly.
2. Vascular anastomoses
Polypropylene (Prolene) is the standard - it is smooth, non-elastic, and does not degrade. Bailey & Love states directly: "Vascular anastomoses require smooth, non-absorbable, non-elastic material." The anastomosis must hold permanently as the vessel wall does not regenerate to close the needle holes.
3. Cardiac surgery / sternotomy
Stainless steel wire for sternal closure. Polyester (Ethibond, Ticron) for valve annuloplasty rings and prosthetic valve fixation - PDS is explicitly contraindicated near heart valves.
4. Fascial / abdominal wall closure in high-risk patients
As discussed previously - in elderly patients, those with malignancy, bowel obstruction, contamination, or malnutrition, non-absorbable (Prolene) mass closure of the abdominal wall is used for durable strength. This is intentional and permanent.
5. Tendon repair
Nylon or steel for primary tendon repair (especially hand flexor tendons), where prolonged mechanical strength is required during healing - tendons are slow to heal and absorbable sutures would lose tensile strength before the tendon regains it.
6. Hernia repair
Nylon or polypropylene for tissue-based repairs (e.g., Shouldice, Bassini). Mesh is also typically fixed with non-absorbable suture or tacks. The hernia defect must be held permanently.
7. Ligature / ligation
Silk is the classic ligature for vessels - easy to tie, holds knots well. Still widely used for pedicle ligation in open surgery.
8. Securing drains, tubes, catheters externally
Silk or nylon to anchor drains to skin - these stay until the drain is removed.
9. Ophthalmic surgery
Fine nylon (10-0) or polypropylene for corneal and scleral closure. Extremely fine gauge, permanent hold.
10. Neurosurgery / microsurgery
Fine nylon for dural closure and nerve repair, where strength must outlast the slow healing of neural tissue.
11. Orthopaedic surgery
Steel wire and heavy non-absorbable suture for bone cerclage, tendon-to-bone fixation (transosseous repairs), and ligament reconstruction anchoring.
The Contraindication Worth Knowing
Silk must NOT be used with vascular prostheses (synthetic grafts) - it promotes infection around prosthetic material and can cause late graft infection years afterward. Polypropylene or polyester is used instead.
Quick Decision Rule
If the suture will be removed (skin) or must last permanently (vessels, heart, fascia in high-risk patients, tendons, hernia) → non-absorbable. If the tissue heals within weeks and the suture needs to disappear (subcutaneous, deep dermis, bowel, urinary tract, biliary) → absorbable.
Source: Bailey and Love's Short Practice of Surgery, 28th ed., Tables 7.1 and 7.2, and suture selection principles, p. 125-128
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