Everything You Need to Know About Surgical Sutures

The different types of sutures can be classified in many ways.

First, suture material can be classified as either absorbable or nonabsorbable.

Absorbable sutures don’t require your doctor to remove them. This is because enzymes found in the tissues of your body naturally digest them.

Nonabsorbable sutures will need to be removed by your doctor at a later date or in some cases left in permanently.

Second, the suture material can be classified according to the actual structure of the material. Monofilament sutures consist of a single thread. This allows the suture to more easily pass through tissues. Braided sutures consist of several small threads braided together. This can lead to better security, but at the cost of increased potential for infection.

Third, sutures can be classified as either being made from natural or synthetic material. However, since all suture material is sterilized, this distinction is not particularly useful.

Types of absorbable sutures

• Gut. This natural monofilament suture is used for repairing internal soft tissue wounds or lacerations. Gut shouldn’t be used for cardiovascular or neurological procedures. The body has the strongest reaction to this suture and will often scar over. It’s not commonly used outside of gynecological surgery.
• Polydioxanone (PDS). This synthetic monofilament suture can be used for many types of soft tissue wound repair (such as abdominal closures) as well as for pediatric cardiac procedures.
• Poliglecaprone (MONOCRYL). This synthetic monofilament suture is used for general use in soft tissue repair. This material shouldn’t be used for cardiovascular or neurological procedures. This suture is most commonly used to close skin in an invisible manner.
• Polyglactin (Vicryl). This synthetic braided suture is good for repairing hand or facial lacerations. It shouldn’t be used for cardiovascular or neurological procedures.

Types of nonabsorbable sutures

Some examples of nonabsorbable sutures can be found below. These types of sutures can all be used generally for soft tissue repair, including for both cardiovascular and neurological procedures.

• Nylon. A natural monofilament suture.
• Polypropylene (Prolene). A synthetic monofilament suture.
• Silk. A braided natural suture.
• Polyester (Ethibond). A braided synthetic suture.

You’ll often see sutures and stitches referred to interchangeably. It’s important to note that “suture” is the name for the actual medical device used to repair the wound. The stitching is the technique used by your doctor to close the wound.

Suture material is graded according to the diameter of the suture strand. The grading system uses the letter “O” preceded by a number to indicate material diameter. The higher the number, the smaller the diameter of the suture strand.

Suture material is also attached to a needle. The needle can have many different features. It can be of various sizes and also have a cutting or noncutting edge. Larger needles can close more tissue with each stitch while smaller needles are more likely to reduce scarring.

Just like there are many different types of sutures, there are many different suture techniques. Some of them are:

Continuous sutures

This technique involves a series of stitches that use a single strand of suture material. This type of suture can be placed rapidly and is also strong, since tension is distributed evenly throughout the continuous suture strand.

Interrupted sutures

This suture technique uses several strands of suture material to close the wound. After a stitch is made, the material is cut and tied off. This technique leads to a securely closed wound. If one of the stitches breaks, the remainder of the stitches will still hold the wound together.

Deep sutures

This type of suture is placed under the layers of tissue below (deep) to the skin. They may either be continuous or interrupted. This stitch is often used to close fascial layers.

Buried sutures

This type of suture is applied so that the suture knot is found inside (that is, under or within the area that is to be closed off). This type of suture is typically not removed and is useful when large sutures are used deeper in the body.

Purse-string sutures

This is a type of continuous suture that is placed around an area and tightened much like the drawstring on a bag. For example, this type of suture would be used in your intestines in order to secure an intestinal stapling device.

Subcutaneous sutures

These sutures are placed in your dermis, the layer of tissue that lies below the upper layer of your skin. Short stitches are placed in a line that is parallel to your wound. The stitches are then anchored at either end of the wound.

When your sutures are removed will depend on where they are on your body. According to American Family Physician, some general guidelines are as follows:

• scalp: 7 to 10 days
• face: 3 to 5 days
• chest or trunk: 10 to 14 days
• arms: 7 to 10 days
• legs: 10 to 14 days
• hands or feet: 10 to 14 days
• palms of hands or soles of feet: 14 to 21 days

To remove your sutures, your doctor will first sterilize the area. They’ll pick up one end of your suture and cut it, trying to stay as close to your skin as possible. Then, they’ll gently pull out the suture strand.

You may have heard the word “sutures” in reference to a bone or bones. This is because the area where the bones of your skull meet is called a suture. Your skull has many of them. They allow the skull to increase in size throughout development and then fuse together when growth is complete. This is not related to the sutures that a physician or surgeon may place to close a wound.

Sutures are used by your doctor to stitch shut wounds or lacerations. There are many different types of suture materials available. Additionally, there are many suture techniques that can be used. Your doctor will choose both the correct suture material and technique to use for your condition. Talk to your doctor about any concerns you have about sutures before your procedure.