The Surgical Suture

Surgeons must select the optimal suture materials for tissue approximation to maximize wound healing and scar aesthetics. Thus, knowledge regarding their characteristics is crucial to minimize ischaemia, excess wound tension, and tissue injury. This article describes the selection of various suture materials available today and their intended design. Modern suture material should have predictable tensile strength, good handling, secure knot-tying properties, and could be enhanced with an antibacterial agent to resist infection. Tensile strength is limited by suture size. The smallest suture size that will accomplish the purpose should be chosen to minimize tissue trauma and foreign material within tissues. Monofilament suture has lower resistance when passed through tissues, whereas multifilament sutures possesses higher tensile strength and flexibility but greater tissue friction and pose risks of suture sinus and infection. Natural absorbable sutures derived from mammalian collagen undergo enzymatic degradation whereas synthetic polymers undergo hydrolysis. Collagen or polymer structures in the suture can be modified to control absorption time. In contrast, nonabsorbable sutures typically cause an inflammatory reaction that eventually encapsulates by fibrous tissue formation. Excess reaction leads to chronic inflammation, suboptimal scarring, or suture extrusion. More recently, barbed sutures have transformed the way surgeons approximate wounds by eliminating knots, distributing wound tension, and increasing efficiency of closure. Similarly, modern skin adhesives function both as wound closure devices as well as an occlusive dressing. They eliminate the need for skin sutures, thus improving scar aesthetics while sealing the wound from the external environment.