Absorbable synthetic sutures are composed of chemical polymers that are absorbed by hydrolysis and cause a lesser degree of tissue reaction after placement. Depending on the anatomic site, surgeon’s preference, and the required suture characteristics, the following types of synthetic absorbable suture may be considered including (but not limited to) the following:
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Polyglactin 910 (Vicryl)
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Polycaprolate (Dexon II)
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Poliglecaprone 25 (Monocryl)
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Polysorb
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Polydioxanone (PDS II)
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Polytrimethylene carbonate (Maxon)
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V-Loc
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Polyglytone 621 (Caprosyn)
Polyglactin 910 suture is a braided multifilament suture coated with a copolymer of lactide and glycolide (polyglactin 370). The water-repelling quality of lactide slows loss of tensile strength, and the bulkiness of lactide leads to rapid absorption of suture mass once tensile strength is lost. The suture is also coated with calcium stearate, which permits easy tissue passage, precise knot placement, and smooth tiedown.
The tensile strength pf polyglactin 910 suture is approximately 65% at day 14 after implantation. Absorption is minimal for 40 days and complete in 56-70 days. These sutures cause only minimal tissue reaction. These sutures are used in general soft-tissue approximation and vessel ligation.
A similar suture material is made from polyglycolic acid and coated with polycaprolate (Dexon II). This material is comparable to polyglactin 910 with respect to tensile strength and absorption profile.
Poliglecaprone 25 suture is a monofilament suture that is a copolymer of glycolide and ε-caprolactone. The suture has superior pliability, leading to ease in handling and tying. Tensile strength is high initially, 50-60% at day 7 after implantation, and is lost at day 21. Absorption is complete at 91-119 days. Poliglecaprone 25 sutures are used for subcuticular closure and soft-tissue approximations and ligations. A recent study by Regan et al reported that poliglecaprone 25 sutures caused significantly less suture extrusion than polyglactin 910. [33]
Polysorb is a braided absorbable suture produced from a Lactomer copolymer formed via synthesis of copolymers of glycolide and lactide (in a ratio of 9 to 1). The glycolide and lactide behave differently when exposed to tissue hydrolysis. Glycolide provides for high initial tensile strength but hydrolyzes rapidly in tissue. [23] Lactide has a slower and controlled rate of hydrolysis, or tensile strength loss, and provides for prolonged tensile strength in tissue.
To decrease their friction coefficient, the surfaces of Polysorb sutures are coated with an absorbable mixture of caprolactone-glycolide copolymer and calcium stearyl lactylate. [34] At day 14 after implantation, nearly 80% of the USP tensile strength of these braided sutures remains. Approximately 30% of their USP tensile strength is retained at day 21. Absorption is essentially complete between days 56 and 70.
Polydioxanone, a polyester monofilament suture, provides extended wound support and elicits only a slight tissue reaction. Tensile strength is 70% at day 14 and 25% at day 42. Wound support remains for up to 6 weeks. Absorption is minimal for the first 90 days and essentially complete within 6 months. Like other monofilament sutures, polydioxanone has a low affinity for microorganisms. It is used for soft-tissue approximation, especially in pediatric, cardiovascular, gynecologic, ophthalmic, plastic, and digestive (colonic) situations.
Polytrimethylene carbonate is similar to polydioxanone with regard to tensile strength and absorption profile.
V-Loc is a barbed suture manufactured from 0 polydioxanone that is self-anchoring, with no knots required for wound closure. The elimination of knot tying may reduce many of the challenges of knot construction. This suture consists of axially barbed segments on each side of a midpoint, at which the barbs change direction. The tensile strength of the barbed suture decreases over time. Each suture is attached to a premium cutting and taper-point needle with NuCoat coating technology. [35]
Caprosyn is rapidly absorbing and represents the most recent innovation in the development of monofilament absorbable synthetic sutures. Caprosyn sutures are prepared from polyglytone 621, which is composed of glycolide, caprolactone, trimethylene carbonate, and lactide. Implantation studies in animals indicate that Caprosyn suture retains a minimum of 50-60% USP knot strength at day 5 after implantation and a minimum of 20-30% of knot strength at day 10 days. All of its tensile strength is essentially lost by day 21.
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Diagram of a needle.
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Needle is placed vertically and longitudinally perpendicular to needle holder.
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Needle holder is held through loops between thumb and fourth finger, and index finger rests on fulcrum of instrument.
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Needle holder is held in palm, allowing greater dexterity.
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Knot tying.
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Simple interrupted suture placement. Bottom right image shows a flask-shaped stitch, which maximizes eversion.
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Line of interrupted sutures.
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Running suture line.
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Running locked suture.
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Vertical mattress suture.
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Pulley stitch, type 1.
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Far-near near-far modification of vertical mattress suture, creating pulley effect.
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Horizontal mattress suture.
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Half-buried horizontal suture (tip stitch, three-point corner stitch).
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Subcuticular stitch. Skin surface remains intact along length of suture line.
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Anatomy of needle.
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Commonly used suture needles, with cross-sections of needles shown at point, body, and swage. (A) Taper-point needle. (B) Conventional cutting needle. (C) Reverse cutting needle.
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Interaction between needle holder and suture needle. (A) Needle holder of appropriate size for needle. (B) Needle holder that is too large for needle—pressure applied by needle holder leads to inadvertent straightening of suture needle. (C) Needle holder that is too small for needle—needle rotates around long axis of needle holder.
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Poster for Biogel Puncture Indication System.
