I. Background: Suture Characteristics

  1. Tensile Strength
    1. Related to Suture size (see below)
    2. Related to weight required to break a Suture
  2. Knot strength
    1. Force required for a knot to slip
  3. Configuration
    1. Monofilament (less risk of infection)
    2. Braided multifilament (easier to handle and tie)
  4. Elasticity
    1. Degree Suture stretches and return to original length
  5. Memory or Suture stiffness
    1. High memory: Suture stiff, difficult handling, unties
  6. Tissue reactivity (inflammatory response to Suture)
    1. Reaction peaks in first 2 to 7 days

II. Background: Needles

  1. Curvature
    1. Straight needle
    2. Curved 2/8 of circle
    3. Curved 3/8 of circle (preferred needle in most cases)
    4. Curved 4/8 of circle
    5. Curved 5/8 of circle
  2. Needle Tip
    1. Tapered (used in vascular Sutures)
    2. Conventional cutting needle
    3. Reverse cutting needle (preferred in most cases)

III. Background: Suture types recommended for skin closure

  1. Deep (dermal or buried) Absorbable Sutures
    1. Polyglecaprone 25 (Monocryl)
    2. Polydioxanone (PDS)
    3. Polyglactin-910 (Vicryl)
    4. Polyglycolic acid (Dexon)
  2. Superficial, monofilament Nonabsorbable Sutures
    1. Nylon (Ethilon)
    2. Polypropylene (Prolene)

IV. Background: Suture Size (See Suture types above)

  1. General
    1. Superficial facial lesions: 6-0 nylon
    2. Other superficial skin lesions
      1. Low skin tension areas: 5-0 nylon
      2. Higher skin tension areas: 4-0 nylon
  2. Annotation for Suture size indications below
    1. Skin: Superficial monofilament Nonabsorbable Suture
    2. Deep: Dermal Absorbable Sutures
  3. Size O: Largest Suture
  4. Size 2-O
  5. Size 3-O
    1. Skin: Foot
    2. Deep: Chest, Abdomen, Back
  6. Size 4-O
    1. Skin: Scalp, Chest, Abdomen, Foot, Extremity
    2. Deep: Scalp, Extremity, Foot
  7. Size 5-O
    1. Skin: Scalp, Brow, Oral, Chest, Abdomen, Hand, Penis
    2. Deep: Brow, Nose, Lip, Face, Hand
  8. Size 6-O
    1. Skin: Ear, Lid, Brow, Nose, Lip, Face, Penis
  9. Size 7-O: Smallest Suture
    1. Skin: Eyelid, Lip, Face

V. Background: Suture indications by location (see Suture types above)

  1. Mucosal Lacerations (mouth, Tongue or genitalia)
    1. Absorbable Suture: 3-0 or 4-0
  2. Scalp, Torso (chest, back, Abdomen), Extremities
    1. Superficial Nonabsorbable Suture: 4-O or 5-O
    2. Deep Absorbable Suture: 3-O or 4-O
  3. Face, Eyebrow, Nose, Lip
    1. Superficial Nonabsorbable Suture: 6-O
    2. Deep Absorbable Suture: 5-O
  4. Ear, Eyelid
    1. Superficial Nonabsorbable Suture: 6-O
  5. Hand
    1. Superficial Nonabsorbable Suture: 5-O
    2. Deep Absorbable Suture: 5-O
  6. Foot or sole
    1. Superficial Nonabsorbable Suture: 3-O or 4-O
    2. Deep Absorbable Suture: 4-O
  7. Penis
    1. Superficial Nonabsorbable Suture: 5-O or 6-O

VI. Background: Suture Removal Timing

  1. Scalp: 6-8 days
  2. Face, Eyelid, Eyebrow, Nose, Lip: 3-5 days
    1. Follow with papertape or steristrips
  3. Ear, Lip: 4-5 days
  4. Chest and Abdomen: 8-10 days
  5. Back: 12-14 days (10-12 days in children)
  6. Extremities: 10-14 days (8-10 days in children)
  7. Hand: 10-14 days
  8. Foot and sole: 12-14 days (8-10 days in children)
  9. Penis: 8-10 days
  10. Condition delaying Wound Healing: 14 to 21 days
    1. Chronic Corticosteroid use
    2. Diabetes Mellitus

VII. References

  1. Howell (1997) Emerg Med Clin North Am 15(2):417-25
  2. Moy (1991) Am Fam Physician 44(6):2123-8
  3. Phenninger (1994) Procedures, p. P3-6
  4. Townsend (2001) Sabiston Textbook Surgery, p. 1552-3

Images: Related links to external sites (from Google)

Ontology: Surgical sutures (C0038969)

Definition (UMD) Threads of natural, synthetic, or metallic material intended to sew a wound or incision together (i.e., approximate the edges and provide a method for wound closure). Sutures are either absorbable (e.g., surgical gut, polyglicolic acid) or nonabsorbable (e.g., silk, nylon, polypropylene, stainless steel). A suture may consist of only one thread (i.e., monofilament) or several threads (i.e., multifilament) that are frequently twisted or braided. The type of suture used depends on the size and location of the wound, the strength and period of use required, cosmetic effect desired, and/or other clinical or physical needs. Sutures are typically available in sterile sections (e.g., 18, 30 inches/45, 76 cm long) attached to a single-use needle as an integral device; they are frequently colored for easy identification during surgery.
Definition (MSH) Materials used in closing a surgical or traumatic wound. (From Dorland, 28th ed)
Concepts Medical Device (T074)
MSH D013537
SnomedCT 27065002, 408099007, 337093006, 2760009
English Sutures, Surgical suture, NOS, Surgical sutures, Suture, surgical, SUTURES, Surgical suture, device, Surgical Sutures, Sutures, Surgical, suture, sutures (treatment), sutures, surgical suture, surgical sutures, Suture material, Surgical suture, device (physical object), Surgical suture, Suture - object, Suture, Suture (physical object), Surgical sutures (physical object), Suture material, device (physical object), SUTURE
French Fils de suture, Matériaux de suture
Swedish Stygn
Czech šicí materiály
Finnish Ompeleet
Russian SHVY, ШВЫ
German Naehfaden, Nahtmaterial
Japanese 縫合糸
Croatian ŠAVOVI
Polish Nici chirurgiczne
Spanish material de sutura (objeto físico), material de sutura, sutura quirúrgica (objeto físico), sutura quirúrgica, suturas quirúrgicas (objeto físico), suturas quirúrgicas, sutura, sutura (objeto físico), Suturas
Italian Suture
Dutch Hechtdraad, Suture, Suturen
Portuguese Suturas