We live in a time when polymer chemists work magic with different suture materials to give them specific properties that benefit
surgeons. Today's sutures absorb within a consistent time frame every time veterinarians use them, possess specific handling
characteristics, demonstrate good knot security, and cause minimal tissue inflammation.
Dean A. Hendrickson
In a perfect world, suture material would be effective in any surgical procedure, possess excellent handling characteristics,
display great strength with a small diameter, and exhibit excellent knot security with minimal suture throw. It would also
inhibit bacterial growth, cause no tissue inflammation, be absorbed precisely when tissue no longer needs it, and be economical.
Table 1: Characteristics of Commonly Used Suture Materials
While this material doesn't exist yet, the sutures currently available have far surpassed the first silk, cotton, and gut
materials to give surgeons many of the desired characteristics just described.
While surgeons have had the option of choosing absorbable or nonabsorbable sutures for some time, they now have the ability
to consider other characteristics that can improve the surgical environment for their patients.
Table 2: Absorbable Sutures and Their Rates of Absorption*
For example, suture materials are available for use in rapidly healing tissues, such as the bladder and uterus (Biosyn–Tyco
Healthcare/–Kendall Animal Health) and Monocryl–Ethicon). Other sutures are designed with elasticity for better closure of
the linea alba (Novafil–Tyco Healthcare/ Kendall Animal Health). There is even suture material available that is impregnated
with an antimicrobial agent to help prevent incisional infection (Vicryl Plus with Triclosan–Ethicon).
Figure 1, A ruptured bladder after surgical repair with 2-0 Biosyn suture material, which will be absorbed faster than Maxon
or PDS in the rapidly healing bladder wall.
Keep in mind, however, that antimicrobial-impregnated sutures will never take the place of excellent surgical technique, including
hemostasis, gentle tissue handling, minimal contamination, and reduced tension on the incision line.
So why are these options important? Because the suture that is easiest for the surgeon to use is not always the best choice
for the patient. And that calls for changing your perspective and considering patients first and sutures second.
Figure 2a, Maxon suture material after direct removal from the packet.
The basics of suture materials
In most cases, sutures can be divided into four categories: absorbable, nonabsorbable, monofilament, and multifilament (also
known as braided). The different characteristics of each allow practitioners to choose the best suture for a particular application
instead of using whatever suture they have on hand. Table 1 lists the more common suture materials available today.
Figure 2b, Maxon suture material after stretching to reduce memory.