What are the indications and contraindications for nonabsorbable natural sutures?

Updated: Mar 05, 2020
  • Author: Desiree Ratner, MD; Chief Editor: Dirk M Elston, MD  more...
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Natural nonabsorbable sutures include the following:

  • Surgical silk

  • Surgical cotton

  • Surgical steel

Surgical silk is made of raw silk spun by silkworms. It may be coated with beeswax or silicone. Many surgeons consider silk suture the standard of performance because of its superior handling characteristics. Although classified as nonabsorbable, silk is absorbed by proteolysis and is often undetectable in the wound site by 2 years. Tensile strength decreases with moisture absorption and is lost by 1 year. The main problem with silk suture is the acute inflammatory reaction it triggers. Host reaction leads to encapsulation by fibrous connective tissue.

Surgical cotton is made of twisted, long, staple cotton fibers. Tensile strength is 50% within 6 months and 30-40% by 2 years. Surgical cotton is nonabsorbable and becomes encapsulated within body tissues.

Surgical steel suture is made of stainless steel (iron-chromium-nickel-molybdenum alloy) as a monofilament or a twisted multifilament. This suture can be made with flexibility, fine size, and the absence of toxic elements. Surgical steel demonstrates high tensile strength with little loss over time and low tissue reactivity. The material also holds knots well.

Surgical steel suture is used primarily in orthopedic, neurosurgical, and thoracic applications. This type of suture may also be used in abdominal wall closure, sternum closure, and retention. However, it can be difficult to handle because of kinking, fragmentation, and barbing, which render the wire useless and may present a risk to the surgeon’s safety. [36]

The cutting, tearing, or pulling of other patient tissues is also a risk. In addition, surgical steel in the presence of other metals or alloys may cause electrolytic reactions; therefore, it is not a safe choice in these circumstances. The size of a steel suture is classified according to the Brown and Sharpe gauge –that is, from 18 gauge (largest diameter) to 40 gauge (smallest diameter). The standard USP classification is also used to denote wire diameter.

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