SutureEdit

A suture is a strand used to hold body tissues together after injury or surgery. It is one of the oldest and most essential tools in surgical practice, enabling surgeons to reapproximate tissue planes, control bleeding, and create stable conditions for healing. Sutures come in many forms, from natural threads to advanced synthetic polymers, and their selection depends on the tissue involved, the desired healing time, and the risk profile of the patient. A modern operating room usually contains a diverse range of sutures and needle types to handle everything from delicate mucosal closures to sturdy fascial approximation. surgery wound closure

The practice of suturing has evolved from ancient techniques using natural fibers to today's highly engineered materials designed to balance strength, pliability, and biocompatibility. Early materials such as silk and gut were supplanted in many contexts by synthetic polymers that offer more predictable behavior and fewer inflammatory reactions. The development and regulation of suture materials reflect broader trends in medical innovation, including emphasis on sterility, sterility assurance, and proven performance across diverse patient populations. silk catgut polyglycolic acid polypropylene sterilization

## History Suturing dates back thousands of years, with evidence of stitched wounds in ancient civilizations. The move from natural fibers such as silk and gut toward synthetic polymers began in the 20th century, driven by a need for more consistent tensile strength, predictable resorption, and reduced tissue reaction. Innovations such as monofilament and braided structures, as well as barbed designs, expanded the surgeon’s toolbox. Modern suture development continues to emphasize durability, handling characteristics, radiopacity when needed, and compatibility with imaging modalities. catgut silk polypropylene barbed suture antibiotic-coated suture

## Types of suture Sutures are categorized along several axes, each with practical implications for surgical decision-making.

### Natural versus synthetic - Natural sutures include materials derived from animal or plant sources, such as silk or, historically, catgut. They tend to be supple but may provoke greater tissue reaction and variable strength over time. silk catgut - Synthetic sutures are manufactured from polymers and can be tailored for specific performance characteristics, including strength, elasticity, and absorbability. Common synthetic families include polymers such as polypropylene, nylon, and polyglycolic acid. polypropylene nylon polyglycolic acid

### Absorbable versus non-absorbable - Absorbable sutures are designed to be degraded and absorbed by the body over time, reducing the need for suture removal and supporting internal healing. They are favored for internal tissues where a later intervention would be undesirable. Examples include polyglycolic acid and polydioxanone. absorbable suture polyglycolic acid polydioxanone - Non-absorbable sutures remain in the body indefinitely (unless removed) and are often used where long-term support is needed, such as some fascial closures or skin closures in contexts where removal is feasible. Examples include polypropylene and nylon. non-absorbable suture polypropylene nylon

### Monofilament versus braided (multifilament) - Monofilament sutures consist of a single filament, offering smooth tissue passage and reduced bacterial harboring. They are often preferred for vascular or delicate closures where minimal tissue drag is important. monofilament - Braided or multifilament sutures are created by intertwining multiple strands, which can improve handling and knot security but may harbor bacteria in the interstices and require careful sterilization. Examples include silk (natural braided) and various synthetic braids. multifilament silk

### Barbed sutures and other innovations - Barbed sutures incorporate tiny hooks along their length to distribute tension without knots, potentially speeding closure but raising considerations about tissue interaction and cost. barbed suture - Antibiotic-coated sutures are designed to reduce surgical-site infection risk in high-risk procedures, balancing potential benefits against material costs and regulatory considerations. antibiotic-coated suture

## Materials and design Suture performance hinges on material science as well as mechanical design. Key properties include tensile strength, elasticity, knot security, tissue reactivity, and absorption profile. Modern sutures use a mix of natural and synthetic polymers and may be coated to alter handling or reduce friction. Some commonly encountered materials and their typical uses include: - Polypropylene: a strong, non-absorbable monofilament widely used for skin and fascia closures. polypropylene - Nylon: another non-absorbable option with good strength and versatility. nylon - Polyglycolic acid (PGA) and polydioxanone (PDS): absorbable synthetic polymers used for internal tissues with varying absorption timelines. polyglycolic acid polydioxanone - Silk: a natural, braided suture with excellent handling but greater tissue reaction in some patients. silk - Catgut: historically common for internal uses but largely superseded by more predictable synthetic materials. catgut

Subspecialty design considerations include needle geometry, coating technologies, and compatibility with imaging or radiopacity requirements. The needle itself is a separate instrument, and its size, curvature, and point type (e.g., straight, curved) affect tissue penetration and precision. suture needle surgical instrument

## Surgical uses and techniques Sutures close wounds by opposing tissue edges and maintaining apposition during the healing process. Choices about technique depend on tissue type, location, tension, and cosmetic or functional priorities. - Skin closures commonly use subcuticular or interrupted patterns, often with non-absorbable or rapidly absorbable materials depending on cosmetic goals and patient factors. subcuticular interrupted suture continuous suture - Deep closures (muscle, fascia, or mucosa) favor materials and techniques that provide durable support during the healing window, with absorbable sutures in many internal layers. fascia closure mucosa - Barbed sutures have gained popularity in some settings for faster closure and reduced knot burden, though adoption varies by procedure and surgeon preference. barbed suture

Techniques also emphasize sterile technique and proper handling to minimize infection and suture-related complications. The goal is to balance secure tissue approximation with minimizing inflammatory response and the need for subsequent removal. sterilization asepsis infection prevention

## Complications and safety While suturing is routine, complications can arise. Common concerns include infection at the wound edge, excessive tissue reaction or granuloma formation, suture breakage, knot slippage, and wound dehiscence (reopening of a wound). The risk of complications is influenced by tissue type, patient factors (e.g., diabetes, smoking), the suture material, and the surgeon’s technique. Preventive measures include proper antisepsis, appropriate material selection, meticulous technique, and, when appropriate, the use of advanced materials such as antibiotic-coated sutures in high-risk settings. infection prevention wound dehiscence granuloma sterilization

## See also - surgical suture technique - suture needle - barbed suture - antibiotic-coated suture - absorbable suture - non-absorbable suture - monofilament - multifilament - suture material - wound closure - sterilization - infection prevention