Suture and Needle choices vary depending on the type of surgery and the patient’s needs. Therefore, knowing the differences between these different types of sutures and when to use them is important to get the best outcome from your surgical procedure. Using the wrong type of suture can lead to undesired surgical outcomes, damage to surrounding tissue or organs, and chronic pain. This can lead to undesired wound healing and complications during recovery, which may require re- suturing for proper wound healing. Suture usage vary on the type of Tissue, patient age as well as the Type of surgical procedure in which suturing needs to be performed. Suturing promotes wound healing by approximating the layers of the tissue and enabling the natural healing process. It also closes the wound thus avoiding the wound to get contaminated by the atmosphere.

What is a suture?

A suture is a surgical device used to close any surgical or traumatic wound requiring skin & tissue closure. A closure is intended to primarily repair skin and deeper layers of the tissue and fascia to fast-track wound healing. Some examples of sutures include monofilament sutures, monofilament polyester sutures, and large absorbable sutures. They are used for repairing cuts and wounds that are deep and open. Sutures are used to close wounds by first suturing the edges together and then using the suture to tie off the wound. After the wound has healed, the suture is either removed or absorbed naturally into the body.

Types of Sutures

Historically, similar to modern sutures, different forms of wound closure mechanisms were employed with needles made of bone and suture materials running from flax, bark, silk, human hair, reeds, etc. Today, there are many options for sutures. Hence, it becomes crucial to make the right suture choice, which means understanding the purpose, attributes, and features of each type of suture. It also means understanding the difference in filament types and the different needle types and under which clinical procedures they have been designed for use. The correct suture helps the surgeon with the right technique and choice of incision to execute and handle the surgical procedure, provide the correct strength, and secure the knots in a manner that can handle and tolerate wound changes during the healing process.

Suture material types are classified as follows:

Absorbable and Non-absorbable Sutures

Absorbable sutures, which get absorbed by the body naturally, are typically employed for deep temporary closure for tissues to heal, and the sutures lose most of their tensile strength over a period of time ranging from weeks to months. Non-absorbable sutures do not get absorbed by the body and hence are required to be removed after a few days of the surgery or may be left in the body permanently. These sutures are used for long-term tissue closures, wounds that take time to heal, like in the case of hernia fascia defects closure. 

Natural and Synthetic Sutures

Sutures are further classified into natural and synthetic sutures. Natural sutures are derived from natural substances. For example Catgut Sutures are usually derived from collagen derived from bovine Guts (used for internal lacerations or wounds). Another Examples of Natural sutures are silk sutures (used in general soft tissue closure and ophthalmic surgery). Catgut degrades by enzymatic reactions (breaking down of proteins partially as peptides or completely as amino acids). They can cause inflammation at the suture site. Synthetic sutures are derived from artificial sources and are made from materials like Nylon sutures (used for general closures and plastic surgery) which is non-absorbable in nature. Synthetic absorbable sutures like Polydioxanone (PDS) sutures (used in abdominal closures or pediatric cardiac procedures) degrade by hydrolysis (the polymer structure of the filaments gets broken down with water penetrating the suture strands) which causes less inflammation at the surgical site. 

Monofilament or Multifilament

Based on the structure, sutures are classified as Monofilament or Multifilament sutures.

Monofilament sutures are single filament sutures with less surface area and higher memory. By memory, we mean the tendency and capacity of a suture to return to its original shape, which makes a suture significantly prone to the knots loosening. They require greater handling and care in the form of more knots to ensure security and less fracture. Monofilament sutures have the capacity to pass through tissues easily, causing less inflammation. 

Whereas Multifilament sutures, as the name suggests, are braided or twisted sutures that are easier to handle by the surgeon as they hold the knots with greater security and less memory. They are prone to inflammation and infection. Multifilament sutures are more expensive than traditional sutures. 

The following are the most commonly used sutures in Surgeries: 

Monofilament sutures, made of a single synthetic strand, are typically used in skin

Closures and Ligation of blood vessels. 

Polypropylene sutures are the synthetic non absorbable sutures; these are typically used in soft tissue closures and are less likely to cause allergic reactions.

Dressings sutures are used to close wounds and stop bleeding. They are typically made of silk, Nylon, or synthetic materials. 

Epithelial sutures are used to close and repair minor wounds. They are made of proteins and are typically used with tissue types such as skin, mucous membranes, and cartilage.

Soft Tissue sutures are used to close wounds in soft tissue such as muscle and tendons. They are also used to support joints and may be made of polyester or polypropylene.

Some sutures are specially used to repair veins and arteries. They are made of polypropylene, Polyester & Nylon.

Needle Types 

The needle is indeed the next most important aspect of sutures after identifying the correct suture type. Needle quality and the appropriate needle choice for a given surgery go a long way to determining the success of the surgery. The surgical needle is mainly built from stainless steel, making it corrosion-resistant. In surgical parlance, the needle has three main parts – the Swage point, the body, and the point. The Swage point is where the surgical suture attaches to the needle by stringing through. The body connects the eye to the point and decides the shape of the needle. In most cases, the needle is curved, but in some cases, it is straight. Curved needles come in different circle lengths like ¼, ½, ⅓, or ⅜ of a circle. The nature of the wound or tissue helps a surgeon choose the needle curve length. The surgeon needs to know where the needle tip is at all times, as it aids in skin closures with minimum trauma. A wrong surgical needle type can lead to tissue injury. The ideal needle is one that is flexible enough to bend yet rigid enough to withstand distortion. It should be sharp to pierce through tough tissues yet thin to cause minimum trauma. Stability of the needle to ensure accurate placement is also equally required. Thus, an appropriate surgical needle must be sterile, corrosion-resistant, and firm enough to prevent any bending or distortion, prevent tissue trauma and injury, and ensure easy penetration. 

Different types of needles are based on the tip, like taper needles or cutting ones. Cutting needles have a tip with three sharp edges. In a typical conventional cutting needle, the cutting surface is inside the needle. In contrast, a reverse cutting needle used most commonly for sewing skin has it on the outside. Whereas taper needles are round and can be either blunt or sharp and are recommended for soft and delicate tissues and tendon repair. They typically pierce the skin without cutting it and spread the tissue as it passes through.

Summary

The right type of suture will prevent issues with excessive bleeding, damage to surrounding tissue or organs, and chronic pain. The thickness of the tissue, the location of the tissue, the risk of infection, and the amount of tension, along with different anesthesia requirements and patient age, play an important role in determining which type of suture to use. There needs to be more than the right type of suture to yield the desired surgical results. The correct choice of needle is equally essential and needed for a wound to be sutured with accuracy, precision, and minimal trauma, ensuring fast healing and preventing tissue reaction and inflammation.

FAQs :

Why is it important to use the correct suture technique?

It is important to use the correct suture technique for precision, minimal trauma to the wound at the surgical site and for faster healing.

Why is knowledge of suture material so important?

The knowledge of the right suture material is very important to the surgeon to maximize tissue healing and ensure scar aesthetics and minimal tissue trauma and inflammation at the surgical site.

What factors influence the surgeon’s choice of suture materials?

The main factors that influence a surgeon’s choice of suture materials are

• Healing time of the wound or tissue
• Wound type and strength
• Properties of the suture material
• Faster attachment of suture and tissue

Wounds can be extremely painful. These wounds can also pose a health risk if they become inflamed or infected. The cause of the suture getting infected could be bacteria, especially those that are naturally found on the skin and Atmosphere. Thus, wound closure may end up promoting bacteria proliferation which can lead to wound complications. As a result, operating doctors, nurses, and other medical professionals have created ways to reduce surgical site infection, speed up healing, and prevent any of these healthcare-associated infections (HCAIs) and surgical site infections (SSIs) from spreading further. One of the ways they have done this is by using antibacterial sutures (ABS) in wound. This closure procedures article explores the advantages of using antibacterial sutures in wound closure procedures. There are various ways and techniques to treat wounds – sutures, staples, non-surgical medications, etc. 

What Is a Suture?

A suture, also known as a stitch, is a very thin, long thread that is twisted together to form a single strand in case of braided structure or comprises of single thread called Monofilament. Suturing is a method of tying off blood vessels to prevent bleeding and hold a wound together till the natural healing process is sufficiently established.

What is an Antibacterial Suture?

Any wound, by and large, are may get contaminated at the time of closure. As a solution to this problem, an antibacterial suture is a surgical innovation which reduces the risk of Surgical Site Infection (SSI). Antibacterial sutures are coated with Antibacterial agents and other agents containing antibacterial properties. They may help in healing wounds faster by significantly reducing the risk of surgical site infections. Why do you need to use an antibacterial suture? We need to use antibacterial suture because bacteria are the leading cause of many types of infections in wounds. You can prevent these infections by covering the wound surfaces with a substance that kills them. An antibacterial suture (Absorbable) is a prosthetic implant into the wound, making it impossible for the bacteria to grow on the surface. You may then cover the wound with a bandage.

Types of Wounds that Can Use Antibacterial Sutures

The first thing you should know about using antibacterial sutures in wound closure procedures is that they can be used on various types of wounds. Antibacterial sutures can be used

• To close the skin tissue after the surgical procedure
• To Ligate blood vessels during the planned surgical procedures

In this case, we are referring to regular cuts and injuries & suturing is done in a sterile atmosphere.

How an Antibacterial Suture works ?

Ordinary sutures may pose a risk of infection if required OT Protocols are not followed. Sometimes, an already sutured wound can rupture and burst open if the healing is not complete – this happens due to bacterial infection. If a wound is not sutured correctly, this is an additional complication and cosmetic loss. The Antibacterial coating on the Antibacterial sutures acts as an additional shield against the bacterial growth.

Advantages of using an Antibacterial suture

The layperson needs to know why a surgeon uses an antibacterial or antimicrobial suture technology in their clinical practice. There is enough evidence and data in surgical studies and peer-reviewed journals that an antibacterial suture is a huge clinical benefit. It has a purpose in its design to add value to risk reduction strategies for any SSIs.

• Prevents Infection – One of the main advantages of using an antibacterial suture is that it prevents infections in a wound. Bacterial infections can be very dangerous. If they go untreated, they can lead to sepsis. Sepsis is an extreme form of blood poisoning that is very dangerous and can quickly lead to death. Preventing these infections means less chance of them spreading throughout your body and causing severe health complications. 
• Patient Safety – Antibacterial sutures contribute significantly to patient safety by reducing microbicidal activity, which can be both internal and external, enhancing clinical effectiveness and being cost-effective. Antibacterial coated sutures create a Zone of Inhibition around the suture site preventing Bacterial colonization. Hence, antibacterial sutures become the need of the hour to reduce bacterial adherence to surgical sutures.

• Effective Results – As an invasive innovative technology, antibacterial sutures have stood the test of time ever since they were introduced in the early 1990s. Since their introduction and usage in wound closures, there has been significantly less wound dehiscence, delayed healing, emergence of resistant organisms, toxicity, or allergic reactions.

• Economically viable – In paediatric and adult surgical procedures, antibacterial suture technology is economically effective and viable. The patient’s Length of Stay may reduce due to the wound being closed with the help of Antibacterial sutures. An added advantage of Antibacterial coating helps in preventing bacterial growth along the line of suture thus preventing unpredicted wound healing.

Conclusion

Globally recognized health authorities like the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the American College of Surgeons & Surgical Infection Society (ACS & SIS) have recommended the use of antibacterial sutures like triclosan-coated sutures to prevent surgical site infection (SSI). Their guidelines on reducing the risk of SSI are general to antibacterial triclosan-coated sutures, not specific to any one brand. Also, using ABS for skin closure in surgical patients displayed a reduced risk of developing surgical site infections and postoperative complications. 

Sutures Used in Dentistry for Periodontal Surgery

Periodontal surgery in dentistry means preventing or correcting anatomical, developmental, traumatic, or plaque-related defects in the teeth and Gums. The periodontal gums are tissues that surround the teeth. These tissues help form the base of the tooth and support it. If the gums get damaged or diseased, you may need periodontal surgery. This involves removing a small portion of gum tissue to relieve pain or correct an issue with your gums. Dental suturing provides strength and integrity to the decayed tissue post-surgery and controls bleeding. It is essential to understand different types of periodontal sutures used in dental surgery as each work differently and has its pros and cons. It is also essential to understand what kind of surgery you are undergoing to know which type of suture is right for you.

What is a Suture?

A suture is a material, primarily a type of thread used extensively and commonly in all kinds of surgery as a tissue closure. When a suture is used in periodontal surgery, it is used to close the gap between two teeth. Sometimes, doctors may use sutures to correct gum disease or relieve pain. The most common sutures used in dental surgery are Polypropylene, Polyglactin 910, Silk and Polyglactin 910 Antibacterial.

Types of Sutures based on the material composition

Polypropylene : These are made from Polypropylene monofilament and are very strong yet soft, making them suitable for various periodontal surgeries.

Polyglactin 910 & Polyglactin 910 with Antibacterial : These are made from Polyglactin 910, a synthetic absorbable material with excellent Histocompatibility with the Gum tissues. These can be also be had with Antibacterial properties

Silk : Non absorbable braided, coated suture made from natural silk filaments widely used across dental surgeries

Properties of good Sutures

Selecting the right suture depends on the anatomical structure and the area where surgery is to be performed, as much as the surgeon’s technique and experience. The properties of an ideal suture are

• Durability – is the quality of a suture’s strength or ability to withstand stress.
• Tensile Strength – is the amount of force needed to stretch a suture. Minimum tension force should be applied to the suture to enable wound closure.
• Elasticity – is the degree to which a suture can be stretched without being torn and the ability to return to its original form and length after the stretch.
• Knot Security – Is related to the suture knot not getting slipped once the surgeon has placed on the tissue
• Minimal Tissue Reaction – A good suture should resist the bacterial growth and cause minimal reaction in the tissue post implantation

Suturing Techniques used in Periodontal Surgery

Simple Interrupted Technique : It is the most common suture technique where the suture passes from one side of the wound and exits on the other, with a knot on top.

Risks in Periodontal Surgery

The risks associated with periodontal surgery are-

• Graft Infection – This is where infection occurs in the grafted area. The chances of this happening are low, but it is still a risk.
• Wound Infection – This happens when an infection occurs in the surgical wound. The chances of this happening are high.
• Bleeding – This happens when the suture tears during surgery or the surgical site ooze blood.
• Pain – This is usually associated with surgery and caused by the cut tissue.

Advantages of Sutures Used in Periodontal Surgery

The advantages of sutures used in periodontal surgery are-

• Quick Recovery – When compared to other types of surgery, oral surgeries have less recovery time because the muscles are not damaged.
• No Reassessment Needed for Wound Care – Most oral surgeries require the patient to be reassessed for wound care, but sutures do not.
• No Oral Surgery for Jaw Fusion – Oral surgeries such as extraction of teeth and periodontal surgery do not require a fusion of the jaw, making a recovery faster as less time is spent in the hospital.
• No Oral Surgery for Orthodontic Treatment – Periodontal surgery can be performed on non-adherent gums, whereas extractions are usually performed on adherent gums. This makes recovery quicker as less time is spent in the hospital.

Conclusion

Periodontal or gum surgery is a surgical procedure in which the inflamed and septic Gums are treated by grafting healthy gums from the oral gum tissues. The most common periodontal surgeries are gum re-habilitation, gingival augmentation, and gum grafting. Due to the risk of infection, gum re- habilitation and gum grafting are the only two gums surgeries that need to be performed in a sterile environment. The patient’s gums are often too damaged to re- habilitate or graft them. In this case, a re-habilitation may be performed to help the patient eat soft foods again.