Suture Types, Materials and Benefits

A suture is a type of thread or wire used to close wounds or surgical incisions. The material is threaded through a needle and then stitched through a wound. Suturing is a common wound closure technique and offers higher tensile strength than surgical glues or staples.

Sutures have been around in some form for thousands of years, and materials have ranged from animal hair to blades of grass. Today, sutures are easy to handle, offer a minimal risk of infection and are designed specifically to tolerate wound changes. In this post, we'll investigate the different types of sutures, their uses and benefits.

How Many Types of Sutures Are There?

Sutures are available in many different materials, and the following characteristics classify them:

• Absorbable vs. non-absorbable
• Synthetic vs. natural
• Monofilament vs. multifilament
• Size

Absorbable Sutures vs. Non-Absorbable Sutures

Absorbable sutures eventually break down and are eliminated by the body via enzymatic degradation or hydrolysis. Some absorbable sutures are designed to degrade rapidly while others are treated to extend the absorption time. As absorbable sutures degrade, they lose tensile strength. They are often used to temporarily close a wound until tissues adequately heal or in situations where it would be challenging to remove sutures.

Non-absorbable sutures are not designed to be broken down by the body and may require removal after an exterior wound has healed. Non-absorbable sutures can remain in the tissue within the body. These types of sutures are used for long-term closures or slow-healing tissues.

Synthetic vs. Natural

Absorbable or non-absorbable sutures can either be synthetic or natural. Natural sutures originate from a biological source. Silk is an example of natural suture material. Synthetic sutures consist of human-made material, such as nylon.

Monofilament vs. Multifilament

Monofilament sutures feature a single thread. This type of suture passes through tissue smoothly and does not harbor microorganisms easily. Multifilament sutures consist of several threads twisted or braided together. This type of suture offers great knot security, flexibility and is easy to handle. Multifilament sutures can be coated to pass through tissue easily.

Suture Size

The size of a suture represents its diameter and follows a scale similar to negative and positive numbers. In the center of the scale, you'll find zero. To the right of zero, the numbers and sizes progressively get larger. For example, a size-two suture is smaller than a three. A large suture might be used to stitch abdominal tissue.

To the left of zero, suture sizes get progressively smaller. Small suture sizes are represented by a number followed by zero. For example, a 3-0 suture is smaller than a 2-0 suture. An extremely small suture, such as one with a 10-0 size, might be used to repair an eye incision.

As sutures get smaller, they lose tensile strength. Physicians typically pick the smallest suture possible that will adequately keep a wound closed to minimize tissue trauma. Here's a list to demonstrate the various suture sizes and applications:

• 10-0 to 8-0: Used to perform delicate procedures such as ophthalmic surgery or nerve repair
• 7-0 to 6-0: Used to perform facial plastic surgery or repair small vessels and arteries
• 5-0 to 4-0: Used for skin closures or larger vessel repair
• 3-0 to 2-0: Used to close muscle layers or wounds where there is a lot of tissue tension
• 0 to 1: Used to close deep layers in the back, fascia layers in the abdomen or joint capsules
• 2 to 5: Used to repair tendons

Types of Absorbable Sutures: Indications and Benefits

In general, absorbable sutures lose tensile strength in about one to three weeks and are completely absorbed within three months. Absorbable sutures reduce the need for follow-up appointments to remove the suture and may decrease scarring and infections. Here some of the different types of absorbable sutures:

Surgical Gut

Surgical gut is a natural suture material consisting of purified fibers derived from healthy sheep or cow intestines. Surgical gut is available in plain or chromic. Plain gut has the following traits:

• Retains tensile strength for 7 to 10 days
• Absorbed within 70 days
• Yellowish-tan color

Plain gut may be used for tissues that heal quickly and do not require a lot of support, such as suturing epidermal wounds that only need stitches for about a week. Plain gut can also be treated to accelerate absorption further. Plain gut is not used internally.

Chromic gut had been treated with a chromium solution to extend absorption time. It has the following characteristics:

• Retains tensile strength for 21 to 28 days
• Absorbed within 90 days
• Brown or blue-dye color

Plain gut and chromic gut are both monofilament structures made of highly purified collagen, and suture sizes range from 7-0 to three. The body absorbs this suture material via enzymatic digestion. The greatest advantage of surgical gut is its rapid absorption.

Polydioxanone (PDS II)

Polydioxanone (PDS II) is a synthetic, monofilament suture created from the polymer of paradioxanone. PDS II is indicated for application in various types of soft tissue approximation, including pediatric cardiovascular procedures and ophthalmic and plastic surgeries. PDS II has the following characteristics:

• Retains 74% tensile strength after two weeks
• Absorbed via hydrolysis within 180 to 238 days
• Ranges in size from 10-0 to 2
• Clear or violet color

PDS II offers several benefits, such as:

• Soft and pliable
• Low tissue drag
• Strong knot security
• Can be used when an infection is present
• Does not harbor bacterial growth

Poliglecaprone 25 (Monocryl)

Poliglecaprone 25, available as the brand Monocryl, is a synthetic, monofilament suture created from the copolymer of glycolide and caprolactone. It is indicated for use in general soft tissue suturing or ligation. Monocryl has the following characteristics:

• Retains 50% tensile strength seven days after implantation
• Absorbed via hydrolysis within 90 to 120 days
• Available in sizes 6-0 to 2
• Clear or violet color

Monocryl offers benefits such as:

• Exceptional knot security
• Minimal tissue reaction
• Easy handling

Polyglactin 910 (Vicryl)

Polyglactin 910 is a synthetic, multifilament suture that's also available in monofilament form. It's made of a copolymer produced from glycolide and L-lactide. It's known by its brand name Vicryl or Vicryl Rapide. Coated Vicryl is indicated for use in ligation or general soft tissue approximation. Vicryl Rapide is indicated only when short-term wound care is needed and for use in superficial soft tissue suturing.

Vicryl features the following traits:

• Retains 50% tensile strength 21 days after implantation
• Absorbed within 56 to 70 days
• Uncoated sizes range from 10-0 to 9-0 and coated is available in sizes 9-0 to 2
• May be dyed violet or undyed

With Vicryl Rapide, you can expect the following:

• Retains 50% tensile strength five days after implantation
• Absorbed within 42 days
• Coated sizes range from 5-0 to 1
• Undyed

Vicryl is a preferred suture material in dentistry because it offers the following benefits:

• Contributes to faster wound healing
• Does not allow adherence of plaque
• Offers easy handling

Vicryl may also be the ideal choice for suturing facial or hand lacerations.

Panacryl

Panacryl is a synthetic, braided suture made of a copolymer of lactide and glycolide. It is indicated for use in general soft tissue procedures and is especially helpful if wound support is needed for up to six months. Panacryl offers the following characteristics:

• Retains roughly 80% of its tensile strength three months after implantation
• Absorbed within a year and a half or longer via hydrolysis
• Available in sizes 3-0 to 2
• Undyed

Benefits of Panacryl include:

• Minimal tissue reaction
• Maintains its strength longer than other absorbable sutures

Types of Non-Absorbable Sutures: Indications and Benefits

Non-absorbable sutures may be preferred for superior handling traits and might be selected if indefinite tensile strength is needed. However, even some suture materials that are classified as non-absorbable degrade over time. Here are common non-absorbable suture materials, and their uses and benefits.

Nylon

A nylon suture is a polyamide polymer and may be available under the brand Ethilon or Nurolon. Ethilon nylon sutures have a monofilament structure and are indicated for use in ligation or general cardiovascular, neurological or ophthalmic soft tissue procedures. Ethilon sutures have the following traits:

• Degrades 15% to 20% a year via hydrolysis
• Available in sizes 11-0 to 2
• May be clear or dyed black or green

Benefits of Ethilon sutures include:

• High tensile strength
• Minimal tissue reaction
• Good handling
• Can be easily removed

Nurolon is a braided suture and is indicated for use in general soft tissue procedures.

Nurolon has the following characteristics:

• Generally loses 15% to 20% tensile strength per year
• Available in sizes 6-0 to 1
• May be clear or dyed black

Benefits of Nurolon sutures include:

• Looks and feels like silk
• Minimal tissue reaction
• Can be used in all tissues where non-absorbable, multifilament sutures are appropriate

Polypropylene (Prolene)

A polypropylene suture, known as Prolene, is a synthetic monofilament suture. It is indicated for use in ligation or general soft tissue approximation. Prolene offers the following characteristics:

• Retains tensile strength and won't degrade by tissue enzyme activity
• Gradually becomes encapsulated by fibrous connective tissues
• Available in sizes 10-0 to 2
• Clear or dyed blue

Prolene is often the preferred choice for plastic and cardiovascular surgeries and is recommended if a minimal reaction to the suture is desired, such as with use in infected wounds. Benefits of Prolene include:

• Can be used for prolonged healing and in the presence of infection
• High tensile strength
• Strong knot security
• Does not adhere to tissue
• Makes an ideal pull-out suture

Silk

Silk sutures consist of fiber spun by silkworm larvae. The material is processed to remove natural waxes and sericin gum and might be coated with silicone, oil or wax. Silk sutures may consist of braided or twisted filaments. Although silk is considered non-absorbable, it is actually a slowly absorbing material and cannot be found in a body's tissue after about two years due to enzymatic degradation.
You can expect the following traits with silk sutures:

• Loses tensile strength in about a year
• Ranges in size from 9-0 to 5
• Naturally cream-colored and then dyed black

Silk is the most commonly used non-absorbable suture and may be preferred by some surgeons because it is easy to handle. Silk sutures are mainly used in ophthalmology but might also be applied in cardiovascular or neurological procedures. Silk sutures offer the following benefits:

• Good tensile strength retention for its duration
• Excellent knot security
• Superior handling

Polyester (Ethibond Excel)

A polyester suture, such as Ethibond Excel, consists of a braided strand that's coated with polybutilate — a biologically inert lubricating compound. This allows the suture to pass through tissue with ease despite its braided structure. Ethibond Excel is indicated for use in general soft tissue procedures or ligation.
Characteristics of this suture material include:

• Retains tensile strength
• Might be coated or uncoated
• Available in sizes 7-0 to 5
• May be undyed or green

Ethibond Excel is commonly used in cardiovascular procedures and favored for the following benefits:

• Superior pliability
• Minimal tissue reaction
• Excellent handling

Stainless Steel

Stainless Steel is the only metallic suture material still widely used. These sutures consist of 316L stainless steel, which is a low-carbon formula. Stainless steel sutures are indicated for use in abdominal wall or sternum closures, orthopedic procedures and hernia repair. Stainless steel sutures may also be applied in neurosurgery. This material has the following characteristics:

• Available as monofilament or multifilament
• Provides indefinite tensile strength retention
• Available in sizes 10-0 to 7
• Has silver metallic color

Benefits of stainless steel sutures include:

• Free of toxins
• Biologically inert
• Easy to sterilize
• Flexible
• Exceptionally high tensile strength
• Extreme knot security
• Minimal tissue reactivity
• Compatible with stainless steel implants and prostheses

Contact Mercedes Scientific for More Information

Medical professionals must consider many different elements when selecting sutures, such as personal preference, patient factors and the location of the wound. They must also think about quality and choose sutures that offer high tensile strength, knot security and ease of handling, regardless of material. When you visit Mercedes Scientific, you'll find an array of absorbable and non-absorbable sutures from names you can trust.

Mercedes Scientific is a medical supply and equipment distributor with nearly 30 years of experience and a passion for customer service. If you have any questions about our products, pricing or availability, our sales team will be happy to assist you. If one of our products is out of stock, we encourage you to fill out our Special Order Form, and we'll respond to you as soon as we can. For any other questions you might have or for more information, please feel free to contact us or check our FAQ page. If you're ready to shop, browse our suture selection today!