What are indications for nonabsorbable synthetic sutures?

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

  • Nylon (Ethilon/Monosof [monofilament] and Nurolon/Surgilon [braided])

  • Polyester fiber (Mersilene/Surgidac [uncoated] and Ethibond/Ti-cron [coated])

  • Polybutester (Novafil)

  • Coated polybutester (Vascufil)

  • Polypropylene (Prolene)

  • Surgipro II

Nylon is a polyamide polymer suture material available in monofilament and braided forms. Its elasticity makes it useful in retention and skin closure. Nylon is quite pliable, especially when moist. (A premoistened form is available for cosmetic plastic surgery.) The braided forms are coated with silicone. Nylon suture has good handling characteristics, though its memory tends to return the material to its original straight form.

Nylon has 81% tensile strength at 1 year after implantation, 72% at 2 years, and 66% at 11 years. It is stronger than silk and, unlike silk, elicits only a minimal acute inflammatory reaction. Nylon is hydrolyzed slowly, but the remaining suture material is stable at 2 years, as a consequence of gradual encapsulation by fibrous connective tissue.

Polyester fiber (Mersilene/Surgidac [uncoated] and Ethibond/Ti-cron [coated]) suture material, formed from a polymer of polyethylene terephthalate, is available either uncoated or coated with polybutilate or silicone. The coating reduces friction for ease of tissue passage and improved suture pliability and tiedown.

Polyester fiber sutures elicit minimal tissue reaction and last indefinitely in the body. they are stronger than natural-fiber sutures and do not weaken with moistening. The material provides precise, consistent suture tension and retains tensile strength. This suture is commonly used for vessel anastomosis and the placement of prosthetic materials.

Polybutester suture, composed of a block copolymer containing butylene terephthalate and polytetramethylene ether glycol, is a monofilament suture with unique performance characteristics that may be advantageous for wound closure. [37] With a polybutester suture, low forces yield significantly greater elongation than is seen in the other sutures. In addition, the elasticity of polybutester suture is superior to that of the other sutures, allowing the suture to return to its original length once the load is removed.

Coated polybutester suture is a unique absorbable polymer that enhances the clinical performance of polybutester suture by virtue of its coating, a polytribolate polymer composed of glycolide, ε-caprolactone, and poloxamer 188. [38] Coating the polybutester suture markedly reduces its drag force in musculoaponeurotic, colonic, and vascular tissue.

Polypropylene is a monofilament suture that is an isostatic crystalline stereoisomer of a linear propylene polymer, permitting little or no saturation. It does not adhere to tissues and is useful as a pullout suture (eg, in subcuticular closure). It also holds knots better than other monofilament synthetic materials do.

Polypropylene is biologically inert and elicits minimal tissue reaction. It is not subject to degradation or weakening and maintains tensile strength for up to 2 years. This material is useful in contaminated and infected wounds, minimizing later sinus formation and suture extrusion. Interestingly, a recent study compared poliglecaprone 25 with polypropylene for superficial closures and did not find a statistically significant difference in cosmetic results. [39]

Surgipro II is a polypropylene suture that was developed to have increased resistance to fraying during knot rundown, especially with smaller-diameter sutures. This material is extremely inert in tissue and has been found to retain tensile strength in tissues for as long as 2 years. Surgipro II is widely used in plastic, cardiovascular, general, and orthopedic surgery. It exhibits a lower drag coefficient in tissue than nylon does, making it ideal for use in continuous suture closure. [28]

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