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Types of Sutures

 

You are working in urgent care and you see a patient with a laceration pop up on your board.  You start going through the files in your mind.  I wonder what type of suture I will use; how long should these sutures stay in for, what type of suture will I tie?

 

Today we are going to discuss several of the many type of sutures as well as when they are indicated for use, suture material, and finally suture patterns that can be used.

 

 

Suture Types and Indication

 

There are several types of sutures that can be used depending on the location of the wound.  Suture types include:

  • Chromic
  • Nylon
  • glycolide/lactide polymer
  • polypropylene
  • poliglecaprone
  • silk
  •  

 

Indications

 

Depending on what type of tissue that you are suturing will depend on what type of suture that you would want to use.  Some examples of these include:

 

  • Interrupted skin suturing when sutures will be removed later
    • 4-0 Nylon
  • Securing drains to the skin
    • 2-0 Silk
  • Repairing sutures for blood vessels
    • 6-0 Prolene
  • Vessel graft sutures for AAA, Femoral-Popliteal graft, or Carotid Artery grafts
    • 5-0, 6-0 Prolene or Gortex
  • Bowel repair sutures and for hemostasis in ligation of vessels or for tying over bolsters
    • 3-0 Silk
  • Achilles tendon repair
    • #5 Ethibond or Fiberwire
  • Mucosa, eye wounds
    • Chromic
  • Deep dermal, muscle, fascia, oral mucosa, genitalia wounds
    • Glycolide/lactide polymer (Vicryl)
  • Dermal, subcuticular wounds
    • Polydioxanone

 

Indications for Tissue Adhesive

 

As opposed to sutures, there are some instances where tissue adhesive can be used instead.  These include a wound that is:

  • less than twelve hours old
  • the patient must have no chronic conditions that might impair wound healing
  • the wound must be linear
  • not a result of mammalian bite
  • no crossing a joint
  • no devitalized tissue
  • not crossing a mucocutaneous junction
  • not infected
  • not in a hair-bearing area unless hair opposition technique is being used
  • and the wound must not be under significant tension.

 

Suture Material

 

Next, lets discuss suture materials.  The big determining factor regarding which suture material to use will be dependent upon if you plan to leave the sutures in the skin and not remove them, or if want the patient to return to their primary care provider for suture removal

 

Dissolvable Sutures

 

The material in which the suture is comprised matters regarding if the suture will dissolve or not.  Some dissolvable sutures include:

 

  • Vicryl Rapide
    • 2 weeks
  • Undyed Monocryl
    • 3 weeks
  • Dyed Monocryl
    • 4 weeks
  • Coated Vicryl
    • 5 weeks
  • PDS
    • 9 weeks
  • Panacryl
    • 70 weeks

 

Rate Suture Dissolves

 

The rate in which a suture dissolves is dependent upon the suture type, size, and location in the body where the suture is placed.  Additionally, some characteristic within the patient can affect how fast the suture will dissolve as well.  If a patient is:

  • Febrile
  • has an infection
  • protein deficiency
  • if the suture is under high tension

The suture may dissolve faster.

 

Non-absorbable Sutures

 

Additionally, there are non-absorbable sutures as well, these lie on the skin and must be removed.  If they are within the body, “buried”, they will be retained in the tissue.  Non-absorbable suture materials include:

  • Nylon
  • Polypropylene
  • Silk

 

 

Types of Suture Patterns

 

Lastly, we will go over different suture pattern that can be used when repairing a wound.  Classically, single layer, simple interrupted sutures have similar cosmetic results for facial and general skin lacerations. 

 

Simple Interrupted

 

Simple interrupted sutures are commonly used for general tissue approximation and can be used for most wound repair.  To see a simple interrupted suture completion, see this video

 

Running Sutures

 

Next for running sutures.  When looking at the data regarding running sutures, these types of sutures have less dehiscence than simple interrupted sutures in wound repair.  Simple running sutures are fast and effective for long lacerations.  However, if one suture is cut by mistake or removed, then all sutures are lost, therefore, caution and attention must be used when completing this suture type.

 

Mattress Sutures

 

Next horizontal and vertical mattress patterns.  Mattress sutures are used for everting wound edges.  Additionally, half-buried mattress sutures are beneficial for everting triangular edges in flap repair.

 

Running Subcuticular Sutures

 

Lastly running subcuticular sutures are fast and effected in accurate skin edge apposition.  This type of suture pattern is best used for closing clean wounds especially for surgical wound in the procedure labs or operating room.

 

Vertical and Horizontal Mattress Sutures
Am Fam Physician. 2017;95(10):628-636. Copyright © 2017 American Academy of Family Physicians.

 

 

Additionally, here is a nice algorithm for the management, evaluation, and repair of laceration!

Management, Evaluation and Repair of Laceration

Am Fam Physician. 2017;95(10):628-636. Copyright © 2017 American Academy of Family Physicians.

 

In conclusion

 

I hope this article has provided information on suture types and the indication and reasons why you would use a certain suture type or patter in specific clinical situations.  Additionally, view this article on Medgeeks for a summary of how to suture!  Lastly, if you are interested in learning more about suturing, as well as one on one direction, and practice, keep an eye open for the next intimate suturing workshop with Medgeeks (https://www.medgeek.co/suture)!  Until next time!

 

Sources

  • Am Fam Physician. 2017;95(10):628-636. Copyright © 2017 American Academy of Family Physicians
  • Pfenninger and Fowler’s Procedures for Primary Care
  • Family Practice Notebook
  • Surgical Instruments and Suture Material Lecture. Southern Illinois University School of Medicine Physician Assistant Program

 

This article or blog post should not be used in any legal capacity whatsoever, including but not limited to establishing standard of care in a legal sense or as a basis of expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog