How To Choose Sutures

When selecting sutures, there are a variety of options to choose from. Knowing the difference between suture materials is key to ensuring you purchase the right product for your practice. Below we have briefly outlined the different types of sutures available and why you would choose one over the other depending on its application.

There are a couple of key features to know before choosing a suture. Knowing the material that your suture is made from and the absorbency of the suture will help you to make an informed decision. And if you are looking for even more in depth information, take a look at the magnificent reference guide that we use daily, Healing Passage: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth, 6th Edition, by Anne Frye!

Nonabsorbable sutures maintain tensile strength - also known as the amount of weight a suture can withstand before snapping - for over 60 days. Nonabsorbable sutures are often used for wounds that have longer healing periods and because they do not naturally break down, they must be removed after the healing process is complete. These sutures aren't ideal for perineal repair.

Absorbable sutures will gradually break down within a shorter period of time, making them an ideal option for suturing perineal tissue. It is important that the suture selected loses its tensile strength within a similar time frame of the healing process, so that it is completely absorbed by the time the healing process is complete.

TYPES OF SUTURES

 

 

Chromic Gut is a natural, absorbable suture made from plain gut that has been treated using chromium trioxide. The treatment process also provides greater resistance to absorption than plain gut. According to Frye, chromic gut is a preferred choice for perineal suturing because it creates less tissue reaction than untreated plain gut.

 

Vicryl Rapide is a rapidly absorbing, braided polyglactin synthetic suture. This particular multifilament suture has been irradiated to alter its molecular structure for an increased rate of absorption. Vicryl Rapide has a better tensile tension than Chromic Gut, except that the strength of the tensile tension breaks down between 7 and 10 days, which is much faster than Chromic Gut. It also has a faster absorbency rate than regular Vicryl making it less likely that removal of sutures will be required after healing is complete. Vicryl Rapide is ideal to use when healthy women without a history of complications during healing, sustain lacerations.

 

Vicryl is a synthetic multifilament suture that is made from Polyglactin 910 and known for keeping its tensile strength for longer than Chromic Gut. It has a longer absorbency time-frame than both Chromic Gut and Vicryl Rapide of 56 to 90 days. Coated Vicryl is normally used for general soft tissue approximation and/or ligation, including use in ophthalmic procedures, but not for use in cardiovascular and neurological tissues.

 

NEEDLE TYPES AND SIZES

Below is a useful reference for suture sizes and types.

 

Click the image below for a Printable Needle Chart.

SIZE/STRENGTH GUIDE

    1-0 and 2-0: Used for high stress areas requiring strong retention
    3-0: Used in areas requiring good retention
    4-0: Used in areas requiring minimal retention. Most commonly used for superficial wound closure.

As always, if you have questions about the sutures we carry, let us know! Don't forget to take a look at our Suturing Kits, specially designed to include all of the instruments you need for suturing from brands like Vantage, König andMiltex. We strongly recommend looking at Anne Frye's Healing Passage book, no matter what level of experience you have. It is extremely in depth and an invaluable resource for referencing instruments, materials and applications for tissue repair required after birth.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Why Do We Use Fetoscopes?', 'How to Choose the Right Doppler', and 'Entering the New Age of Midwifery'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products

 

Resources

Healing Passage: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth, 6th Ed, Anne Frye.

Wound Closure, Ethicon Inc.

Sutures and Suturing Kits, Cascade HealthCare Products Inc.