What are the principles of suturing technique selection?

Updated: Mar 05, 2020
  • Author: Desiree Ratner, MD; Chief Editor: Dirk M Elston, MD  more...
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Much of the process surrounding suture selection depends on surgeon training and preference. A wide variety of suture materials are available for each surgical location and surgical requirement. Generally, the surgeon selects the smallest suture that adequately holds the healing wound edges. The tensile strength of the suture should never exceed the tensile strength of the tissue. As the wound heals, the relative loss of suture strength over time should be slower than the gain of tissue tensile strength.

Certain general principles can be applied to suture selection. Sutures are no longer needed when a wound has reached maximum strength. Therefore, nonabsorbable suture should be considered in skin, fascia, and tendons (slowly healing tissues), whereas mucosal wounds (rapidly healing tissues) may be closed with absorbable sutures.

Aesthetic concerns are at a premium in regions of the head and neck such as the eyelid, periorbital area, nose, pinna, lip, and vermillion. In these areas, tensile strength requirements tend to be less, and smaller suture sizes are preferred. However, the mobility of the lip and vermillion requires a relatively higher suture tensile strength.

The activity and mobility of the face, anterior and posterior neck, scalp, superior trunk, and nasal and oral mucosa demand higher tensile strength requirements in suture selection. Additionally, major musculocutaneous flaps tend to be closed under significant tension, requiring maximal long-term tensile strength.

Because the presence of foreign bodies in contaminated tissues may facilitate infection, special consideration of suture selection in these locations (eg, a contaminated posttraumatic wound) is imperative. Multifilament sutures are more likely to harbor contaminants than monofilament sutures are; accordingly, monofilament sutures are generally preferable in potentially contaminated tissues. The smallest inert monofilament suture materials (eg, nylon or polypropylene) should be sued in this setting.

The optimal suture size is generally the smallest size that can still effectively achieve the desired tension-free closure. If wound tension is high, smaller-diameter sutures may actually injure tissues by cutting through them. Therefore, the tensile strength of the suture and that of the tissue should be closely matched.

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