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Different types of sutures

Classification of Sutures / How Do I Choose the Right Suture?

Sutures are typically classified according to these three criteria:

Suture structure:   

Monofilament suture or braided suture

Suture composition:

Synthetic suture or biological (natural) suture

Suture degradation:

Absorbable suture or Non-absorbable suture


Structure: Monofilament sutures

Monofilament sutures are made from a single strand. These sutures are recommended for skin suturing, especially in areas or cases where the risk of infection is higher. 

Advantages:
  • Smooth surface 
  • Minimal tissue trauma
  • No site for bacterial accumulation
  • No capillary action
Disadvantages:
  • Sensitive to rough handling and tying
  • May bury knots/ends
  • Stretch
Examples:

Structure: Braided sutures

Braided sutures are made of many threads that are braided together. These sutures are easier to tie but have small voids in the suture material that may be filled with bacteria. 

Advantages:   
  • Strength 
  • Soft and flexible 
  • Good tactile feedback 
  • Good feel when tying 
Disadvantages:
  • Can harbor bacteria
  • Capillarity
  • Effect on tissue
Examples:



Composition: Synthetic sutures

Today, the vast majority of sutures are synthetically produced. This enables modern, predictable treatment.

Advantages:
  • Non-absorbable sutures are inert
  • Absorbable sutures resemble natural substances
  • Resorption via hydrolysis
  • Predictable resorption time
  • Strength
Disadvantages:
  • Monofilament sutures are sensitive to rough handling
Examples:

Composition: Biological (natural) sutures

Biological/natural sutures are primarily silk sutures and catgut sutures. Silk sutures are made from silkworm cocoons. These are used for small, clean skin sutures, primarily on the eyelids. Catgut sutures are made from animal intestines. 

Advantages:
  • Good feel when handling and tying
  • Lower cost
Disadvantages:
  • Tissue reactions
Examples:



Degradation: Absorbable sutures

Absorbable sutures degrade in the body through hydrolysis. This has the advantage that the sutures do not need to be removed manually. However, absorbable sutures tend to leave larger scars when used as skin sutures. For this reason, absorbable sutures are primarily used for subcutaneous suturing. 

Advantages:
  • Break down completely in the body
  • No foreign material remains in the body
Disadvantages:
  • Considerations regarding how long the wound needs active support from the suture
Examples:

Absorbable sutures

Degradation: Non-absorbable sutures

Non-absorbable sutures are permanent and must be removed manually. Since they are not broken down by the body, they do not cause as much tissue reaction as absorbable sutures, resulting in less scarring. These work best as skin sutures. 

Advantages:
  • Permanent wound support
Disadvantages:
  • A foreign substance remains in the body if not removed
  • Removal of sutures can be costly and inconvenient
  • Problems may arise if left in place
Examples:
Non-absorbable sutures

Suture classification and selectionEthicon

Sutures are normally classified in three different ways.

Structure:

Monofilament or MultifilamentEthibond

Composition:

Synthetic or Biological

Degradation:

Absorbable or Non-Absorbable 

Structure: Monofilament suturesEthilon

Monofilament sutures are made out of one single strand. These sutures are recommended for most skin closures, especially those that stand the risk of infection.  

Advantages: 
Smooth surface 
Less tissue trauma 
No bacterial harbours 
No capillarity 

Disadvantages:
Handling & knot tying
Ends/knot burial
StretchMonocryl

Examples:
Monocryl, Ethilon, Prolene, PDS II

Structure: Multifilament sutures

Multifilament sutures are made of several strands that are braided together. These sutures are easier to tye than monofilament sutures but have small interstices in the suture material that eventually can harbour bacteria. 

Advantages:   Prolene
Strength 
Soft and pliable 
Good handling 
Good knot tying 

Disadvantages:
Bacterial harbours
Capillary action
Tissue trauma

Examples:
Vicryl, Silk sutureVicryl Plus, Vicryl Rapide, Silk suture, Ethibond, Mersilene

Composition: Synthetic sutures

The vast majority of sutures nowadays are synthetic. This is a modern way to ensure predictability in treatments. 

Advantages:
Non-absorbables are inert
Absorbables resemble natural substances
Absorption by hydrolysis
Predictable absorption
Strength

Disadvantages:
Monofilament handling

Examples:
Monocryl, Mersilene, Ethilon, Vicryl, Vicryl Plus, Vicryl plus
Vicryl Rapide, Ethibond, Prolene, PDS II

Structure: Biological sutures

Biological/natural sutures are mainly made out of silk. (cocoons from the silk worm). Silk sutures are manly used in clean skin wounds especially eyelids.  

Advantages:
Handling & knot tying
Economy

Disadvantages:
Tissue reactionsVicryl Rapid

Example:
Silk suture

Degradation: Absorbable sutures

Absorbable sutures are broken down in the body by hydrolysis. This gives the advantage that the sutures do not have to be revmoved. However, absorbable sutures tend to leave a more pronounced scar when they are used as skin sutures. Therefore absorable sutures are mainly used under the skin.  

Advantages:
Broken down by body
No foreign body left

Disadvantages:
Consideration of wound support time

Examples:
Monocryl, Vicryl, Vicryl Plus, Vicryl Rapide, PDS II, 

Degradation: Non-absorbable sutures

Non-absorbable sutures are permanent and have to be removed manually. As they are not broken down by the body, they are not as tissue reactive as absorbable sutures and leave less scars. They work best on the skin. 

Advantages:
Permanent wound support

Disadvantages:
Foreign body left
Suture removal can be costly and inconvenient
Sinus & extrusion if left in place

Examples:
Mersilene, Ethilon, Silk suture, Ethibond, Prolene
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