The choice of an appropriate suture for any wound closure will make a large contribution to the final functional and cosmetic result. Often, two layers are used:
- Deep sutures below the surface to maintain the closure until the wound has fully healed and can support itself without widening of the scar.
- Surface sutures to closely approximate the epidermal edges providing the best possible cosmetic result.
Characteristics of suture material
The choice of suture is determined by a balance of the various characteristics of suture materials most appropriate for the specific wound closure situation.
|Absorbable vs Non-absorbable||The major subdivision of sutures. Sutures that lose the majority of their tensile strength within 60 days are considered absorbable. They are degraded by tissue enzymes or hydrolysis.
|Tensile Strength||Depends on UPS size (thickness). Surgeons prefer to use the smallest size that will provide adequate strength. The strength increases as the first digit decreases.
|Plasticity and Elasticity||The ability to retain length and strength after stretch, and the ability to regain its original length after stretch, respectively. This is important:
|Ease of handling and Knot security||Determined by a number of related characteristics.
|Multifilament vs Monofilament||
|Tissue reactivity||Refers to the degree of inflammatory response to the suture.
|Polyglactin 910 (Vicryl®, Polysorb®)||
|Poliglecaprone 25 (Monocryl®)||
|Polydioxanone (PDS II®)||
|Polytrimethylene carbonate (Maxon®)||
|Glycomer 631 (Biosyn®)||
|Nylon (Ethilon®, Dermalon®, Surgilon®, Nurolon®, Nylene®)||
|Polypropylene (Prolene®, Surgilene®, Surgipro®)||
|Polyester (Dacron®, Mersilene®, Ethibond®)||
The three major parts of a surgical needle are the tip (or point), the body, and the shank.
- The most common body configuration in dermatological surgery is curved, with a radius of between 1/4 and 5/8 of a circle.
- The tip is usually triangular with either conventional cutting (sharp edge on the inside arc) or reverse cutting (sharp edge on the outside arc). The more the tip is honed, the sharper and more expensive the needle.
- A reverse cutting needle provides less chance of the tissue tearing during suturing. A round needle with tapered tip is the least likely to cause tissue tearing, and is primarily used for suturing fascia, muscle, and aponeuroses.
- The body may be flattened to facilitate needle-holder grasp, and limit twisting during placement.
Alternative skin closure
Staples provide a quick alternative for large scalp and trunk wounds.
Surgical glue may be appropriate where there is little or no wound tension.
Wound closure tapes (e.g. Steristrips®) are often helpful to support the wound following subcuticular closure, use of surgical glue, or after removal of epidermal sutures.
In general the smallest suture that will provide adequate support for the healing wound should be used.
Polyglactin 910 provides a versatile deep suture in most cases, although Poliglecaprone 25 may be preferred in situations where minimal tissue reaction is essential, and Polytrimethylene carbonate in high tension wounds. Monofilament absorbable sutures are preferable in contaminated wounds.
Nylon or Polybutester are considered standard epidermal sutures for most situations. Polypropylene is ideal for running subcuticular sutures, and either Silk or Polyester for mucosal applications.
A 3/8 or 1/2 circle reverse cutting needle is suitable for most wound closures. 5-0 or 6-0 sutures are typically used for facial repairs, while 4-0 or 3-0 are standard for most wounds on the trunk and extremities.