All you need to know about sutures: Types, uses and selection

In the complex world of surgery, suture plays an indispensable role. This small, often underestimated component is in fact a cornerstone of successful surgery, enabling patients to heal and recover. The art of suturing, which dates back thousands of years, has evolved with medical science, offering today a variety of threads adapted to every type of tissue and every surgical procedure. In this article, we delve into the heart of this fascinating universe to explore the different types of suture, understand their specific uses, and discover how to choose the right suture to optimize surgical results. By highlighting these aspects, we aim not only to educate, but also to ensure that suture selection at Peters Surgical best meets the needs of healthcare professionals, guaranteeing safety and efficacy in every surgical procedure.

I. Suture fundamentals

1. Definition and Role

A suture, consisting of a thread and a needle, is a medical device used to bring together and hold together tissues cut or pierced during surgery. Its main purpose is to enable the natural healing of tissues by holding them in position until the healing process is sufficiently advanced. It therefore plays a crucial role not only in the immediacy of surgery, but also in the long-term success of the patient’s recovery. 

In medical use, the ligature, consisting of a needleless thread, is also used to achieve hemostasis.

2. History in brief 

The use of sutures dates back to antiquity, with historical references suggesting their use as early as 3000 B.C. Initially, sutures were made from natural materials such as animal sinew, linen or silk. With time and technological advances, materials diversified and evolved towards more sterile, resistant solutions adapted to modern surgical needs.

3. Materials evolution

The evolution of suture materials has been marked by the constant quest for biocompatibility, tensile strength and minimization of tissue reactions. Today, sutures come in a wide range, including absorbable materials that degrade and disappear over time, and non-absorbable materials designed for permanent tissue retention. Advances in polymer synthesis have also led to the development of synthetic sutures, offering improved properties in terms of workability, strength and minimized risk of infection.

In short, the suture, though small in size, is immense in its importance to the surgical field. Its proper selection and use are essential to ensure the success of procedures and the safety of patients. In the following sections, we explore in detail the types of sutures and needles available, their specific features, and how to make the best choice for each surgical situation.

II. The different types of suture

1. Suture classification

Sutures are classified according to several criteria, including their ability to be resorbed by the body, their origin (natural or synthetic), and their structure (braid or monofilament). This classification helps surgeons choose the most suitable suture for each operation.

2. Absorbable vs. non-absorbable threads

• Absorbable: These threads are designed to degrade and hydrolyze over time, eliminating the need for a second procedure to remove them. Commonly used materials include polyglycolic acid, caprolactone or polydioxanone. However, their strength diminishes over time, which is not recommended for tissues requiring long-term support.
• Non-resorbable: Made from materials that do not degrade in the body, these sutures remain in place indefinitely unless surgically removed. Offer long-lasting strength, ideal for tissue under tension, skin sutures or long-term applications such as prosthesis fixation or vascular anastomosis. Materials include polypropylene, polyester, polyamide and silk. Their main drawback lies in the potential risk of long-term tissue irritation and the need for removal for certain applications.

3. Natural threads vs. synthetic threads

• Natural threads: Made from natural fibers such as silk or catgut (manufactured from sheep or beef intestine), these were the first suture types used in surgery. Although still in use, their popularity has waned in favor of synthetic options due to their potential to induce allergic reactions and less predictable resorption.
• Synthetic threads: These threads are made from artificial polymers. They offer several advantages, including uniform strength, less risk of infection, and a wide range of resorption times. Examples include polyglycolide, polydioxanone and polyglactin. Their controlled composition allows a variety of properties tailored to specific needs, reducing allergic risks and providing predictable resistance.

4. Braids vs Monofilament vs Braided Sutures

Suture material can be made up of a single filament (monofilament) or several filaments (multifilaments, braided or notched).

• Braids: yarns made up of several strands braided together around a core. Multifilament sutures (braided or twisted) have greater tensile strength, are more flexible and easier to handle than monofilament sutures. They have a rough surface, which hinders passage through the tissue, but allows the knot to hold much better. To reduce the effects, braids are coated. Coating facilitates passage through tissue and reduces the risk of infection, making multifilament sutures the choice of many intestinal surgeons. Because of their high knot security, multifilament sutures are often used in cases where discontinuous sutures or ligatures are required. This type of suture is used when high levels of tension are applied to the tissue, or when the tissue is quite fragile. For example, braided multifilament sutures are the standard in cardiac surgery and for the fixation of prosthetic material, due to their high tensile strength.
• Monofilament: Extruded, single-strand sutures. Monofilament sutures are an attractive option due to their strength, gliding properties, fixation, low tissue resistance and low propensity to spread infection. It is accepted that the incidence of infection with a monofilament suture is significantly lower than with a braided suture. Monofilament sutures represent a surgical advance, as their structure facilitates passage through tissue and prevents capillarity. However, monofilament sutures are not as easy to handle as braided sutures due to the memory effect and increased rigidity. They have poor knot security and are less flexible. Monofilaments are mainly used for continuous sutures, e.g. skin sutures, tendon sutures, microsurgery, and are also popular in vascular and microvascular surgery due to their slipperiness and ease of tying sutures.
• Barbed sutures: Sutures can also be braided, i.e. essentially a monofilament suture whose surface is provided with micromechanically machined serrations, or serrations added to the suture core. These notches enable the sutures to be held in tissue without mechanical knotting. Recognized as innovative sutures, barbed sutures reduce suturing time by minimizing the need for knots, reinforce the suture line and adapt to laparoscopic or robotic procedures. 

› Discover our range of barbed sutures: https://peters-surgical.com/our-products/barbed-sutures/

5. Needle types

The needle is an essential element, as it is the first to pass through the tissue, and to some extent determines the success of the suture. The needle is made up of three parts: the point, the body and the curvature. Each of these characteristics must be carefully identified in order to make the best choice, i.e. to select the most appropriate needle for the patient and the type of surgical procedure. Surgical needles are made from stainless steel alloys, which offer excellent corrosion resistance. To improve gliding and penetration properties, needles are silicone-coated, except for ophthalmological indications. 

› Discover our needles: https://peters-surgical.fr/nos-produit/aiguilles/  

III. Suture selection criteria

Selecting the ideal suture for a specific surgical procedure is crucial to ensuring patient safety and optimizing healing results. This decision must take into account several key factors, which will influence the surgeon’s choice.

Factors to consider

• Tissue type: The nature of the tissue to be sutured is one of the most important criteria. Delicate tissues, such as those found in internal organs, require finer, absorbable sutures that minimize tissue reactions. Conversely, external tissues or those under high stress, such as skin or tendons, may require stronger, non-absorbable threads.
• Healing time: The time required for tissue to heal completely influences the choice between absorbable and non-absorbable threads. Absorbable sutures are preferred when tissue heals quickly and long-term support is not required.
• Tensile strength: The force the wire must withstand without breaking is also a determining factor. It must be strong enough to hold the wound edges together until healing is sufficiently advanced.
• Tissue reaction: A thread’s ability to minimize inflammation and tissue reaction is essential for optimal healing. Synthetic absorbable sutures are often chosen for their low tissue reaction potential.
• Surgeon’s preference and experience: Finally, wire selection can also depend on the surgeon’s personal preferences, based on experience and familiarity with different wire types.

In conclusion

Appropriate suture selection is crucial to the success of surgical procedures, significantly impacting healing, post-operative risk reduction and overall patient comfort. 

Peters Surgical offers a diverse range of sutures to meet the specific needs of every surgical procedure. By choosing high-quality suture products, healthcare professionals can not only optimize the healing process, but also contribute to a better quality of life for their patients after surgery.

› Discover our complete range of sutures: https://peters-surgical.fr/type-nos-product/sutures/