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An Overview Of Nonabsorbable Sutures
New developments in materials that can be used in the treatment of patients have lead to increasing choices for physicians. This is true in highly technical types of equipment as well as in the basics. Different options now exist in both absorbable and nonabsorbable suture materials that give surgeons, emergency room doctors, nurses and medical staff a wide range of different suture options to choose from.
Like absorbable sutures, nonabsorbable sutures are available in both natural materials as well as synthetic materials. The natural long lasting suture materials include surgical silk, surgical steel and surgical cotton. These products have a long track record as very effective permanent options for wound closure and tissue repair. The synthetic types of sutures include nylon, polyester fibers, and a variety of poly materials that are marketed under different brand names.
Nonabsorbable sutures are designed to provide the maximum duration of the suture in the body without any tension reduction. This allows the wound to heal without any stress that can lead to tearing and subsequent scarring of the tissue. Like all types of sutures they have to be sterile and cause a minimum amount of tissue reaction. They also have to be uniform in diameter and size, resistant to fraying, and have the flexibility needed to remain knotted and in place. In the case of nonabsorbable sutures the material also has to be highly resistant to the natural biological response of the body to a foreign material. Instead of being absorbed by the body these sutures are encapsulated by fibroblasts to help retain the sutures in place for optimum wound healing.
There are three different classifications of nonabsorbable sutures. Class l includes the silk and synthetic fibers that can be braided, monofilament or twisted. Class ll nonabsorbable sutures are natural or synthetic fibers which are coated or cotton or linen fibers. Class lll are the metal sutures which can be multi or monofilament in structure and design.
Not all nonabsorbable sutures will stay in the body indefinitely. The natural fibers such as silk, even when treated with a coating to reduce the breakdown of the fiber, will be absorbed by the body over time. Most of the silk nonabsorbables will not be detectable after approximately two years in the body. Cotton fibers, when coated, tend to last much longer in the body but it will lose tensile strength by approximately 60-70% within two years. Unlike silk it is not fully absorbed by encapsulated, providing gradual reduction in tensile strength over the wound.
Surgical steel nonabsorbable sutures are the most permanent but can be difficult to work with in specific locations. Surgical steel is considered to have excellent retention of tensile strength and also holds knots very well making it a good choice for abdominal, orthopedic, and thoracic types of procedures and applications.
Nylon and poly types of sutures are reported to be an ideal compromise between natural fibers and stainless steel. They retain tensile strength well and also are slower to dissolve in the body, providing additional support to the wound over the two year mark post procedure.