What are the advantages of absorbable natural sutures?

Updated: Mar 05, 2020
  • Author: Desiree Ratner, MD; Chief Editor: Dirk M Elston, MD  more...
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Absorbable natural suture materials include the following:

  • Collagen

  • Plain surgical gut

  • Fast-absorbing surgical gut

  • Chromic surgical gut

Collagen sutures are derived from the submucosal layer of ovine small intestine or the serosal layer of the bovine small intestine. This collagenous tissue is treated with an aldehyde solution, which crosslinks and strengthens the suture and makes it more resistant to enzymatic degradation. Suture materials treated in this way are called plain gut.

The tensile strength of plain surgical gut is maintained for 7-10 days after implantation (this varies with individual patient characteristics), and absorption is complete within 70 days. This type of suture is used for (1) repair of rapidly healing tissues that require minimal support and (2) ligation of superficial blood vessels.

Fast-absorbing surgical gut is indicated for epidermal use (it is required only for 5-7 days) and is not recommended for internal use. A 2019 randomized evaluator-blinded split-wound comparative effectiveness trial found that for linear repair of cutaneous wounds, use of 6-0 fast-absorbing gut did not produce statistically significant differences in cosmetic outcomes, scar width, or incidence of complications. [31]

Chromic surgical gut is treated with chromium salt, which slows down the absorption rate (reaching complete absorption at 90 days). Tensile strength is maintained for 10-14 days. Tissue reaction is due to the noncollagenous material present in these sutures. In addition, patient factors affect absorption rates and make tensile strength somewhat unpredictable. Salthouse et al demonstrated that the mechanism by which chromic surgical gut reabsorbs is the result of sequential attacks by lysosomal enzymes. [32]

Natural-fiber absorbable sutures have several distinct disadvantages. First, they tend to fray during knot construction. Second, there is considerably more variability in their retention of tensile strength than is found with the synthetic absorbable sutures. A search for a synthetic substitute for collagen sutures began in the 1960s. Soon, procedures were perfected for the synthesis of high-molecular-weight polyglycolic acid, which led to the development of the polyglycolic acid sutures. [32]

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