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. Braided (do not use if increased risk of infection)
      1. Polyglactic Acid Suture or Polyglactin-910 (Vicryl, Dexon, Surgicryl, Polysorb)
      2. Vicryl is most commonly used for the deep layer, unless risk of infection (in which case use monofilament)
    2. Non-braided (monofilament)
      1. Polyglecaprone 25 (Monocryl)
        1. Indicated for the deep layer, when wounds are higher risk of infection, and Vicryl is contraindicated
      2. Polydioxanone (PDS)
        1. May be used as an alternative to Monocryl when higher risk of infection, but has a prolonged absorption period
  2. Superficial Sutures
    1. Nonabsorbable Sutures (standard approach)
      1. Nylon (Ethilon)
      2. Polypropylene (Prolene)
    2. Absorbable Sutures
      1. Controversial, but used effectively, and with similar cosmetic results in children to avoid Suture removal
      2. Facial Lacerations: Fast Catgut
      3. Trunk or extremity Lacerations: Plain Catgut or Vicryl Rapide

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: 10 days
  2. Face, Ear, Eyebrow, Nose, Lip: 5 days
    1. Follow with papertape or steristrips
  3. Eyelid: 3 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. Epperson in Pfenninger and Fowler (1994) Procedures for Primary Care Physicians, Mosby, Chicago, p. 3-11
  2. Lin and Lin in Herbert (2014) EM:Rap 14(11): 8-10
  3. Mortiere (1996) Principles of Primary Wound Management
  4. Townsend (2001) Sabiston Textbook Surgery, p. 1552-3
  5. Howell (1997) Emerg Med Clin North Am 15(2):417-25 [PubMed]
  6. Moy (1991) Am Fam Physician 44(6):2123-8 [PubMed]

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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, 337093006, 2760009, 408099007
LNC LA19079-5
English Sutures, Surgical sutures, SUTURES, Surgical suture, device, Surgical Sutures, Sutures, Surgical, suture, sutures (treatment), sutures, surgical suture, surgical sutures, Surgical sutures (physical object), Suture material, device (physical object), Suturing, Suture material, Surgical suture, device (physical object), Surgical suture, Suture - object, Suture, Suture (physical object), Surgical suture, NOS, SUTURE
French Fils de suture, Matériaux de suture
Swedish Stygn
Finnish Ompeleet
Russian SHVY, ШВЫ
Japanese 縫合糸
Croatian ŠAVOVI
Polish Nici chirurgiczne
Czech sešití, sutura, stehy (chirurgie)
Spanish material de sutura (objeto físico), suturas quirúrgicas (objeto físico), material de sutura, suturas quirúrgicas, sutura quirúrgica (objeto físico), sutura quirúrgica, sutura, sutura (objeto físico), Suturas
Norwegian Suturer, Sting
German Nahtmaterial
Italian Suture
Dutch Hechtdraad, Suture, Suturen
Portuguese Suturas