What are the differences between absorbable and nonabsorbable sutures?

Updated: Mar 05, 2020
  • Author: Desiree Ratner, MD; Chief Editor: Dirk M Elston, MD  more...
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Absorbable sutures provide temporary wound support until the wound heals well enough to withstand normal stress. Absorption occurs by enzymatic degradation in natural materials and by hydrolysis in synthetic materials. Hydrolysis causes less tissue reaction than enzymatic degradation.

The first stage of absorption has a linear rate, lasting for several days to weeks. The second stage is characterized by loss of suture mass and overlaps the first stage. Loss of suture mass occurs as a result of leukocytic cellular responses that remove cellular debris and suture material from the line of tissue approximation. Chemical treatments, such as chromic salts, lengthen the absorption time.

It is important to note that loss of tensile strength and the rate of absorption are separate phenomena. The surgeon must recognize that accelerated absorption may occur in patients with fever, infection, or protein deficiency, and this may lead to an excessively rapid decline in tensile strength. Accelerated absorption may also occur in a body cavity that is moist or filled with fluid or if sutures become wet or moist during handling before implantation.

Nonabsorbable sutures elicit a tissue reaction that results in encapsulation of the suture material by fibroblasts. The United States Pharmacopeia (USP) classification of nonabsorbable sutures is as follows:

  • Class I - Silk or synthetic fibers of monofilament, twisted, or braided construction

  • Class II - Cotton or linen fibers or coated natural or synthetic fibers in which the coating contributes to suture thickness without adding strength

  • Class III - Metal wire of monofilament or multifilament construction

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