Sutures: Past, Present, and Future

Sutures: Past, Present, and Future

They've come a long way, and the future looks bright.

Dean A. Hendrickson
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.

Table 1: Characteristics of Commonly Used Suture Materials
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.

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.

Table 2: Absorbable Sutures and Their Rates of Absorption*
New perspectives 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.

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.
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).

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.

Figure 2a, Maxon suture material after direct removal from the packet.
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 2b, Maxon suture material after stretching to reduce memory.
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.