The world of surgery encompasses countless methods and tools aimed at repairing the human body with the precision of a tailor. One of the foremost of these methods is the use of “surgical sutures” to close wounds and incisions. These sutures bring and hold together tissues in our body—much like threads that join pieces of fabric. By keeping tissues in the correct position, they help them benefit from the natural healing process more quickly and smoothly. Surgical sutures play an important role in preventing wounds from becoming infected and help internal tissues regain their former integrity. Different suture types have been developed to meet various medical needs. Some dissolve on their own inside the body, some stay in place permanently, while others are later removed by a physician.
What Are Surgical Sutures and How Are They Used in Medical Procedures?
Surgical sutures are special medical threads used to hold together injured or cut tissues for a certain period, thereby facilitating healing and reducing the risk of complications. The tip of these threads is usually attached to a surgical needle, and they come in different sizes, levels of flexibility, and durability depending on the type of procedure. Just as the needle and thread we use for sewing fabric vary according to the material’s thickness or purpose, surgical sutures are also available in a wide range of materials and thicknesses.
The fundamental goal of surgical sutures is to bring together bleeding or separated tissues in an orderly fashion, thereby creating better healing conditions. Any incision or injury in the body naturally becomes exposed to bodily fluids and microorganisms. By using sutures, the edges of the wound are approximated, bleeding is better controlled, and the risk of microbial entry decreases. Without sutures, the skin or internal tissues try to heal randomly, which can negatively affect scar aesthetics and tissue integrity, especially in wide or deep wounds.
For example, in orthopedic operations, thicker and more durable sutures are preferred to stabilize bone or tendon structures, whereas in visible areas such as the face, thinner sutures that cause minimal tissue damage are used for aesthetic reasons. In addition, sutures used for internal organs (such as the intestines or uterus) are often preferred to be absorbable by the body. This way, there is no need for a second intervention to remove them; they dissolve on their own. This versatility demonstrates why surgical sutures are indispensable tools in medicine.
How Are Surgical Sutures Classified According to Their Absorbability?
An important classification criterion for sutures is how long they remain in the tissue and whether they are absorbable by the body. Essentially, sutures fall into two main categories: “absorbable” and “non-absorbable.” This classification guides how long the suture will remain in the patient’s body and whether—or when—the physician must intervene.
Absorbable Sutures
This group of sutures is broken down over time by the body’s natural processes and eventually disappears. You can think of it like a piece of fruit that decays or dissolves over time; however, in this case, the process is controlled and medically predictable. Absorbable sutures can be subdivided based on how long they remain in place:
Short-Term Support: For example, “catgut,” a natural suture material derived from animal intestines, falls into this category. These sutures generally provide support for a shorter period, such as 7–14 days. They are frequently preferred in areas that heal quickly, such as subcutaneous tissues or the oral mucosa.
Long-Term Support: Sutures made from synthetic materials such as polyglycolic acid (Vicryl), polyglecaprone (Monocryl), and polydioxanone (PDS) offer more prolonged resistance. Some provide support for weeks or even months and are thus used especially for abdominal fascia (muscular layer) or organ repairs.
The biggest advantage of absorbable sutures is that there is no need for a second surgical procedure to remove them. This increases patient comfort and avoids extra procedures, particularly for internal organ sutures. One disadvantage is that in certain conditions, the absorption rate can be unpredictable. For example, a high risk of infection or an extremely moist environment might cause the sutures to dissolve sooner than expected.
Non-Absorbable Sutures
These sutures retain their strength in the body for a significant amount of time and are not biologically broken down. Much like how plastic materials do not easily decompose in nature, non-absorbable sutures can remain in the body for a long time. However, this does not necessarily mean the body will always react negatively to them; many synthetic non-absorbable sutures can remain stably in tissue or become lightly encapsulated.
Common examples of non-absorbable sutures include silk, nylon (polyamide), polyester, and polypropylene. They are often used in vascular repairs, heart surgeries, or tendon repairs that undergo high levels of tension. If used on the skin surface, they typically need to be removed by a physician after a certain period—usually 7 to 14 days. When used in internal tissues, they may sometimes remain for a lifetime.
The choice between absorbable and non-absorbable sutures depends on the type of operation, the patient’s overall condition, and the desired healing process. The goal is always to achieve the greatest benefit with the least harm to the patient. Therefore, surgeons carefully consider tissue healing dynamics to determine which material and the duration of support needed.
What Are the Differences Between Monofilament and Multifilament Sutures?
Another crucial aspect in the classification of sutures is the structural characteristics of the thread. While some suture threads consist of a single filament (monofilament), others are made up of multiple filaments twisted or braided together (multifilament). You can liken it to the difference between a single wire and several wires braided into a rope. This difference in structure significantly affects how the material behaves and how it is used during surgery.
Monofilament Sutures
- Single-Layer Construction: Monofilaments are composed of a single thread strand, making their surface smoother.
- Less Friction and Reduced Bacterial Adherence: They glide through tissue with minimal friction, which reduces “tissue trauma.” Also, because there are no grooves or indentations, there is less risk of bacterial colonization.
- More Challenging to Tie Knots: The smooth surface can sometimes make it difficult to tie or secure knots. One could say they are a bit “slippery.”
- Examples: Polypropylene (Prolene) and Monocryl are often produced in monofilament form.
Multifilament Sutures
- Multiple Filaments Combined: Several strands of thread are twisted or braided together. Like a rope composed of numerous fibers, multifilament sutures offer enhanced strength.
- Higher Friction and Greater Potential for Bacterial Colonization: The spaces between fibers can provide areas for bacteria to latch onto. They also create more friction when passing through tissue compared to monofilaments.
- Easier Knot Tying and Greater Flexibility: Because of their braided structure, it’s easier to tie knots, and surgeons often find they have “better control” and “better knot security.”
- Examples: Silk and polyglycolic acid (Vicryl) can be found in multifilament form.
A simple real-life analogy would be comparing a satin ribbon (similar to a monofilament’s smoothness) and a cotton thread (similar to a multifilament). A satin ribbon is harder to tie securely due to its slick surface but slides more easily across edges, whereas a cotton thread holds knots well but has higher friction because of its rougher surface.
Which Materials Are Commonly Used for Absorbable Surgical Sutures?
Absorbable sutures are made from materials that will not remain permanently in the body and will dissolve on their own. These materials are chosen to match the tissue’s healing timeline so that the suture remains in place as long as needed, then disappears harmlessly. Let’s take a closer look at some of the most frequently used absorbable materials in the market and clinical practice:
Polyglactin 910 (Vicryl)
- Composition: Generally in a braided (multifilament) form.
- Advantages: It is easy to handle and has good knot security. Absorption typically takes about 2–3 months. Some variants (Vicryl Rapide) dissolve much faster, mostly disappearing within 14–21 days.
- Uses: Preferred for internal suturing, subcutaneous closures, and areas exposed to moderate tension.
Poliglecaprone 25 (Monocryl)
- Composition: Monofilament with a very smooth surface.
- Advantages: It usually elicits minimal tissue reaction and is considered reasonably straightforward to tie. It loses a significant portion of its tensile strength in 2–3 weeks and is fully absorbed by around 3 months.
- Uses: Commonly used for subcuticular closures and rapidly healing soft tissue regions.
Polydioxanone (PDS)
- Composition: Monofilament, and it lasts longer compared to other absorbable sutures.
- Advantages: Maintains high tensile strength for about 4–6 weeks, making it suitable where longer support is needed. Complete absorption may take up to 6 months.
- Uses: Often used in abdominal wall fascia, bowel repair, and various areas of surgery. It is also frequently used in pediatric cardiac surgery, where prolonged support is essential.
Catgut
- Composition: Naturally sourced, mostly from sheep or bovine intestines (despite the name “cat,” it is unrelated to felines).
- Advantages: Has been used historically due to its natural origin. It is broken down enzymatically through interaction with body fluids.
- Disadvantages: Less predictable compared to modern synthetic absorbable sutures. Its absorption rate varies depending on thickness and manufacturing method; it also has a higher risk of tissue reaction.
- Uses: Though less commonly used today, it may still be found in certain traditional settings or for tissues that heal very quickly.
What Are the Applications of Non-Absorbable Surgical Sutures?
Non-absorbable sutures do not dissolve through the body’s natural processes. Therefore, they are ideal when permanent or long-term mechanical support is desired. Like steel beams that support a building, these sutures provide durability and long-term stability. Non-absorbable sutures are generally considered in three main groups: natural (silk), synthetic monofilament (polypropylene, nylon), and synthetic multifilament (polyester, some types of nylon).
Cardiovascular and Vascular Surgery
In procedures where life is directly at stake—such as heart valve repairs or vascular anastomoses—the suture must remain reliably strong for a very long time. Synthetic monofilament sutures like polypropylene (Prolene), known for their smooth surface and resistance to bacteria, excel in this field. For instance, in bypass surgery, it is critical to sew the heart vessels together to restore blood flow, and the permanent support of these sutures is crucial to a successful outcome.
Orthopedic Procedures
Bones and tendons are subjected to high mechanical loads. Tendon repair or the fixation of ligaments around bones often requires permanent support. Strong non-absorbable materials like polyester or nylon maintain the tension needed for a tendon to reattach and adapt to its original position.
Skin and Surface Sutures (Temporary Use)
Non-absorbable sutures can also be used on the skin surface in some cases, but they are typically removed after the wound has healed. Nylon sutures, for example, are commonly used on the skin. Particularly for highly mobile areas like the head and neck or joints, these sutures remain as long as the patient needs that support, after which they are removed. This ensures that the wound edges heal properly and minimizes the risk of early suture failure.
Fixation of Prosthetic Materials
In procedures such as hernia repair using a synthetic mesh, non-absorbable sutures are chosen to secure the mesh. The mesh then remains in place for life, becoming fully integrated with the tissue. The purpose is to minimize the risk of hernia recurrence.
Cosmetic Surgery
Non-absorbable sutures may be used in certain instances in cosmetic surgery. For example, in facelift or eyelid surgery, long-term stability and minimal scarring are often the goals. Some surgeons prefer non-absorbable, fine-caliber sutures because they allow for a controlled removal process.
How Do Continuous and Interrupted Suture Techniques Differ?
The “style” in which a suture is placed is at least as important as the choice of suture material. Much like a sewing machine that uses continuous or single-point stitches for different purposes, surgeons select either a “continuous” or an “interrupted” technique based on the wound characteristics and desired outcome.
Continuous Suture Technique
- Definition: One continuous thread is used to make sequential passes along the wound edges without cutting the thread until the final knot.
- Advantages: Fewer knots are required, making the procedure quicker, thus reducing surgical time and the duration under anesthesia. Tension is more evenly distributed along the wound.
- Disadvantages: If the thread breaks at any point, the entire suture line may loosen. In wounds prone to infection or deformity, there is a risk that a single failure could compromise the entire suture line.
Interrupted Suture Technique
- Definition: Each suture is placed and tied individually. In other words, each stitch is a separate unit.
- Advantages: If one suture breaks, the others remain intact, thus maintaining wound integrity. In the event of infection, removing the affected suture alone can help relieve the infected area.
- Disadvantages: Because each stitch requires its own knot, the procedure takes longer. More threads and knots theoretically mean more foreign material, which can increase tissue irritation.
Example Applications:
Intra-abdominal organ repairs or intestinal anastomoses often use continuous suturing due to its speed and the neat line it provides. Meanwhile, for abdominal wall closure or skin sutures, some surgeons prefer interrupted sutures because if one stitch fails, the entire closure is not compromised. In heavily contaminated wounds, interrupted sutures allow a more controlled approach.
When Are Purse-String Sutures Preferred in Surgical Procedures?
A purse-string suture is a special technique used to cinch tissue in a circular manner, similar to pulling the drawstring on a pouch so that its opening tightens and closes. This method is utilized in various surgical fields, particularly for narrowing or completely closing round or oval defects.
Areas of Application
- Large Skin Defects: Often preferred for closing circular openings created after removing skin cancer or similar lesions. The tissue edges are pulled together, allowing the wound to close not in a single line but in a gathered fashion.
- Colostomy or Ostomy Closures: In bowel surgeries, a purse-string suture may be used to close the area where the ostomy bag was placed. The edges are approximated tightly and evenly, reducing the risk of leakage or residual opening.
- Fistula Closures: When undesired channels (fistulas) form in the body, a purse-string suture can be used to cinch and close off the opening at the end of the channel.
- Endoscopic Applications: In some endoscopic procedures, this technique is used to reduce or secure the opening around a device or tube.
Advantages
- Provides a practical solution for closing circular or oval defects.
- Allows tissue edges to come together evenly without removing excessive tissue.
- In some cases, offers cosmetic benefits by reducing scar size.
Disadvantages and Key Considerations
- It’s important to manage tissue tension properly. Over-tightening can lead to necrosis or undesirable tissue constriction.
- In very large defects, a single purse-string suture may not be sufficient. Sometimes it’s used as a temporary method for narrowing, followed by additional procedures.
- In high-infection-risk environments, rolling tissue edges inward or completely closing the area can sometimes hinder surgical oversight of the site.
Op. Dr. Yunus Kaplan was born in Iskenderun in 1979. He graduated from the Gaziantep University Faculty of Medicine in 2001 and completed his specialization in Otolaryngology in 2009. He has worked at various public and private hospitals. Since 2020, he has been accepting patients in the field of rhinoplasty at his private clinic in Istanbul Nişantaşı.
