DOI: https://dx.doi.org/10.18203/2349-2902.isj20221733
Published: 2022-06-27

Absorbable sutures: chronicles and applications

Prema D’Cunha, Benudhar Pande, Muralidhar S. Kathalagiri, Ashok Kumar Moharana, Deepak T. S., Cismitha Sharol Pinto

Abstract


Surgical sutures are used to bind tissues together to help in wound closure and healing after surgery or trauma. Surgical suture materials for medical purposes are available in a variety of forms, the most common of which are absorbable and non-absorbable. Absorbable sutures were traditionally exclusively utilised for approximating internal tissues. However, using absorbable sutures in percutaneous wound closure has recently gained popularity. Absorbable sutures provide many advantages, including eliminating the need for another clinic visit to remove the sutures as well as low risk of infections and minimal scarring. One of the recent advances in absorbable sutures: barb sutures, by removing knots, dispersing wound tension, and increasing closure efficiency, have changed the way doctors work on them. Suture material classes have recently been developed based on their qualities and abilities to promote tissue approximation and wound healing. Surgeons should choose an appropriate suture material for tissue approximation which enhances the healing effect and minimises scaring possibilities. To avoid ischemia, excessive wound tension, and tissue damage, it is necessary to understand their properties. Antibacterial agents have also been added to the absorbable suture materials to provide an extra layer of protection by making it more resistant to infection while still maintaining its high tensile strength and good handling. The present article attempts to describe different absorbable suture materials available along with their respective applications.


Keywords


Absorbable sutures, Tissue approximation, Tensile strength, Wound closure

Full Text:

PDF

References


Ethicon Inc., Wound Closure Manual; 2005. Available at: http://www.uphs.upenn.edu/surgery /Education/facilities/measey/Wound_Closure_ Manual.pdf. Accessed on December 12, 2014.

Dennis C, Sethu S, Nayak S, Mohan L, Morsi YY, Manivasagam G. Suture materials-Current and emerging trends. J Biomed Mater Res A. 2016;104(6):1544-59.

Chellamani KP, Veerasubramanian D. Barbed Bi-directional sutures. Asian Textile J. 2010;73(8):73-4.

Pillai CK, Sharma CP. Review paper: absorbable polymeric surgical sutures: chemistry, production, properties, biodegradability, and performance. J Biomater Appl. 2010;25(4):291-366.

Mackenzie D. The history of sutures. Med Hist. 1973;17(2):158-68.

Types of Sutures/Suture materials. Available at: https://www.dolphinsutures.com/types-of-sutures/. Accessed on December 12, 2014.

Alan Barber F, Boothby MH, Richards DP. New sutures and suture anchors in sports medicine. Sports Med Arthrosc Rev. 2006;14(3):177-84.

Lloyd JD, Marque MJ 3rd, Kacprowicz RF. Closure techniques. Emerg Med Clin North Am. 2007;25(1):73-81.

Bloom BS, Goldberg DJ. Suture material in cosmetic cutaneous surgery. J Cosmet Laser Ther. 2007;9(1):41-5.

Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am. 2009;89(3):627-41.

Ratner BD, Hoffman AS, Schoen FJ, Lemons JE. Biomaterials science: An introduction to materials in medicine. Appl Materials Med Dentistry. 1996;8:356-9.

Tan RH, Bell RJ, Dowling BA, Dart AJ. Suture materials: composition and applications in veternary wound repair. Aust Vet J. 2003;81(3):140-5.

Tajirian AL, Goldberg DJ. A review of sutures and other skin closure materials. J Cosmet Laser Ther. 2010;12(6):296-302.

Edlich RF. Surgical Knot tying manual, 3rd ed. In: Covidien. Surgi cal Knot tying manual. 2008. Available at: http://www.covidien.com/image Server.aspx?contentID=11850&contenttype=application/pdf. Accessed on February 13, 2014.

Dart AJ, Dart CM. 7.38 Suture Material: Conventional and Stimuli Responsive, Editor(s): Paul Ducheyne, Comprehensive Biomaterials II, Elsevier. 2017;746-71.

Venkataram M. Acs (I) Textbook on Cutaneous and Aesthetic Surgery. Jaypee Brothers Medical Publishers Pvt. Ltd. Mysore. 2012;125-6.

Vivian N. Ancient Medicine. Taylor and Francis US. 2005.

Anne R. The Story of Medicine. Arcturus Publishing. 2009.

David R, Robert E. Textbook of Family Medicine E-Book. Elsevier Health Sciences. 2011.

Wikipedia. Surgical sutures. Available at: https://en.wikipedia.org/wiki/Surgical_suture. Accessed on April 12, 2022.

Bloom BS, Goldberg DJ. Suture material in cosmetic cutaneous surgery. J Cosmet Laser Ther. 2007;9(1):41-5.

Ammirati CT. Advances in wound closure materials. Adv Dermatol. 2002;18:313-38.

Regula CG, Yag-Howard C. Suture Products and Techniques: What to Use, Where, and Why. Dermatol Surg. 2015;41(10):S187-200.

Kowalsky MS, Dellenbaugh SG, Erlichman DB, Gardner TR, Levine WN, Ahmad CS. Evaluation of suture abrasion against rotator cuff tendon and proximal humerus bone. Arthroscopy. 2008;24(3):329-34.

Trimbos JB, Brohim R, van Rijssel EJ. Factors relating to the volume of surgical knots. Int J Gynaecol Obstet. 1989;30(4):355-9.

Molokova OA, Kecherukov AI, Aliev FSh, Chernov IA, Bychkov VG, Kononov VP. Tissue reactions to modern suturing material in colorectal surgery. Bull Exp Biol Med. 2007;143(6):767-70.

Khan MS, Bann SD, Darzi A, Butler PE. Suturing: a lost art. Ann R Coll Surg Engl. 2002;84(4):278-9.

Bucknall TE. Factors influencing wound complications: a clinical and experimental study. Ann R Coll Surg Engl. 1983;65(2):71-7.

Geiger D, Debus ES, Ziegler UE, Larena-Avellaneda A, Frosch M, Thiede A et al. Capillary activity of surgical sutures and suture-dependent bacterial transport: a qualitative study. Surg Infect (Larchmt). 2005;6(4):377-83.

Moy RL, Waldman B, Hein DW. A review of sutures and suturing techniques. J Dermatol Surg Oncol. 1992;18(9):785-95.

Tera H, Aberg C. Tensile strengths of twelve types of knots employed in surgery, using different suture materials. Acta Chir Scand. 1976;142(1):1-7.

Tera H, Aberg C. Strength of knots in surgery in relation to type of knot, type of suture material and dimension of suture thread. Acta Chir Scand. 1977;143(2):75-83.

Kim JC, Lee YK, Lim BS, Rhee SH, Yang HC. Comparison of tensile and knot security properties of surgical sutures. J Mater Sci Mater Med. 2007;18(12):2363-9.

Stone IK, von Fraunhofer JA, Masterson BJ. The biomechanical effects of tight suture closure upon fascia. Surg Gynecol Obstet. 1986;163(5):448-52.

Van Rijssel EJ, Brand R, Admiraal C, Smit I, Trimbos JB. Tissue reaction and surgical knots: the effect of suture size, knot configuration, and knot volume. Obstet Gynecol. 1989;74(1):64-8.

Berguer R, Smith WD, Chung YH. Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc. 2001;15(10):1204-7.

Berguer R, Chen J, Smith WD. A comparison of the physical effort required for laparoscopic and open surgical techniques. Arch Surg. 2003;138(9):967-70.

Kadirkamanathan SS, Shelton JC, Hepworth CC, Laufer JG, Swain CP. A comparison of the strength of knots tied by hand and at laparoscopy. J Am Coll Surg. 1996;182(1):46-54.

Dattilo PP Jr, King MW, Cassill NL, Leung JC. Medical textiles: Application of an absorbable barbed bi-directional surgical suture. J Textile Apparel Technol Manag. 2002;2:1-5.

Leung JC. Barbed suture technology: Recent advances. Adv Biomed Textiles Healthc Prod. 2004;165-83.

Bartlett LC. Pressure necrosis is the primary cause of wound dehiscence. Can J Surg. 1985;28(1):27-30.

Högström H, Haglund U, Zederfeldt B. Tension leads to increased neutrophil accumulation and decreased laparotomy wound strength. Surgery. 1990;107(2):215-9.

Seitz JM, Durisin M, Goldman J, Drelich JW. Recent advances in biodegradable metals for medical sutures: a critical review. Adv Healthc Mater. 2015;4(13):1915-36.

Seitz JM, Utermöhlen D, Wulf E, Klose C and Bach FW. The Manufacture of Resorbable Suture Material from Magnesium-Drawing and Stranding of Thin Wires. Adv. Eng. Mater. 2011;13:1087-95.

Miller G, Luke JC. Silk technique: its role in wound healing. Can Med Assoc J. 1938;38(4):358-62.

Najibi S, Banglmeier R, Matta J, Tannast M. Material properties of common suture materials in orthopaedic surgery. Iowa Orthop J. 2010;30:84-8.

McDonald E, Gordon JA, Buckley JM, Gordon L. Comparison of a multifilament stainless steel suture with Fiber wire for flexor tendon repairs--an in vitro biomechanical study. J Hand Surg Eur. 2013;38(4):418-23.

Bothina P. Comparison between absorbable and non-absorbable sutures in skin closure in ENT surgery. Available at: https://www.researchgate.net/ publication/354598795_Comparison_Between_Absorbable_Nonabsorbable_Sutures_In_Skin_Closure_In_ENT_Surgery. Accessed on January 28, 2021.

Byrne M, Aly A. The Surgical Suture. Aesthet Surg J. 2019;39(2):S67-72.

Stashak TS, Theoret CL. Equine wound management, Second edition, Blackwell publishing, USA. 2008;194-7.

Desiree R, Dirk ME, Julian MW, Divya RS. Medscape Available at: https://www.medscape.com/ answers/1824895-32110/what-are-the-types-of-absorbable-synthetic-sutures. Accessed on 05 March 2020.

Chellamani KP, Veerasubramanian D, Balaji RSV. Surgical Sutures: An overview. J Acad Indus Res. 2013;1(12):778-81.

Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350(14):1422-9.

Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284(5418):1318-22.

Anitha A, Sowmya S and Kumar PTS. Chitin and chitosan in selected biomedical applications. Prog Polym Sci. 2012;39(9):1644-67.

Shao K, Han B, Gao J, Jiang Z, Liu W, Liu W. Fabrication and feasibility study of an absorbable diacetyl chitin surgical suture for wound healing. J Biomed Mater Res B Appl Biomater. 2016;104(1):116-25.

Serrano C, García-Fernández L, Fernández-Blázquez JP, Barbeck M, Ghanaati S, Unger R et al. Nanostructured medical sutures with antibacterial properties. Biomaterials. 2015;52:291-300.

Angiotech Pharmaceuticals, QuillTM SRS materials guide. 2009. Available at: http://www.mana-tech.com/factsheets/quillproductcat. pdf. Accessed on January 5, 2014.

Kirsch D, Marczyk S. Multifilament barbed suture. US Patent No. 8414612 B2, 2013.

Murtha AP, Kaplan AL, Paglia MJ, Mills BB, Feldstein ML, Ruff GL. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg. 2006;117(6):1769-80.

Villa MT, White LE, Alam M, Yoo SS, Walton RL. Barbed sutures: a review of the literature. Plast Reconstr Surg. 2008;121(3):102e-8.

Greenberg JA, Goldman RH. Barbed suture: a review of the technology and clinical uses in obstetrics and gynecology. Rev Obstet Gynecol. 2013;6(3-4):107-15.

Olga S, James S. The Use of Barbed Suture for Wound Closure in Hip and Knee Arthroplasty. Biomed J Sci and Tech Res. 2017;1(5).

Kaul S, Sammon J, Bhandari A, Peabody J, Rogers CG, Menon M. A novel method of urethrovesical anastomosis during robot-assisted radical prostatectomy using a unidirectional barbed wound closure device: feasibility study and early outcomes in 51 patients. J Endourol. 2010;24(11):1789-93.

Zaruby J, Gingras K, Taylor J, Maul D. An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: biomechanical wound strength and histology. Aesthet Surg J. 2011;31(2):232-40.

Schwarzkopf R, Hadley S, Weatherall JM, Gross SC, Marvin SE. Barbed sutures for arthroplasty closure--does it decrease the risk of glove perforation? Bull NYU Hosp Jt Dis. 2012;70(4):250-3.

Tsugawa AJ, Verstraete FJM. In Ch. 7, Suture materials and biomaterials, Editor(s): Verstraete FJM, Lommer MJ, Oral and Maxillofacial Surgery in Dogs and Cats, W.B. Saunders. 2012;69-78.

Robinson JK, Hanke W, Siegel D, Fratila A, Bhatia A, Rohrer-Surgery of the Skin: Procedural Dermatology, Third Edition. 2015;195-7.

Astete CE, Sabliov CM. Synthesis and characterization of PLGA nanoparticles. J Biomater Sci Polym Ed. 2006;17(3):247-89.

Venkataram M. ACSI Textbook on Cutaneus and Aesthetic Surgery. P Medical Ltd. 2012.

Boland ED, Coleman BD, Barnes CP, Simpson DG, Wnek GE, Bowlin GL. Electrospinning polydioxanone for biomedical applications. Acta Biomater. 2005;1(1):115-23.

Goel A. Surgical Sutures-A Review. DJO. 2016;26:159-162.

Chu CC. Materials for absorbable and nonabsorbable surgical sutures. Biotextiles as Medical Implants. 2013.

SJ Langley-Hobbs. In Ch. 10, Sutures and general surgical implants, Editor(s): Langley-Hobbs SJ, Demetriou JL, Ladlow JF. Feline Soft Tissue and General Surgery, W.B. Saunders. 2014;105-16.

Lober CW, Fenske NA. Suture materials for closing the skin and subcutaneous tissues. Aesthetic Plast Surg. 1986;10(4):245-8.

Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database Syst Rev. 2017;11(11):CD005661.

Swanson NA, Tromovitch TA. Suture materials, 1980s: properties, uses, and abuses. Int J Dermatol. 1982;21(7):373-8.

Alexander TT. In Ch. 8-Instruments, Suture Materials, and Closure Choices, Editor(s): Trott AT. Wounds and Lacerations (Fourth Edition), W.B. Saunders, 2012;82-94.

Chu CC. In Ch. 11, Materials for absorbable and nonabsorbable surgical sutures, Editor(s): King MW, Gupta BS, Guidoin R. In Woodhead Publishing Series in Textiles, Biotextiles as Medical Implants, Woodhead Publishing. 2013;275-334.

Ingle NP, King MW. Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues. J Biomech. 2010;43(2):302-9.

Al-Mubarak L, Al-Haddab M. Cutaneous wound closure materials: an overview and update. J Cutan Aesthet Surg. 2013;6(4):178-88.

Kudur MH, Pai SB, Sripathi H, Prabhu S. Sutures and suturing techniques in skin closure. Indian J Dermatol Venereol Leprol. 2009;75(4):425-34.