The general term for the medical device used to hold body tissues together after an injury or surgical procedure is the surgical suture. This device approximates the edges of a wound, bringing separated tissues into close contact. By holding the incision closed, the suture provides the necessary mechanical support for the body’s natural healing processes. The suture minimizes the gap that must be bridged by new tissue growth, helping to ensure the wound closes securely and with less scarring.
The Suture Material Spectrum
Surgical sutures are classified primarily by how the body interacts with the thread material over time, falling into two main categories. Absorbable sutures are designed to gradually lose strength and mass within the body, eventually dissolving completely. This breakdown often occurs through hydrolysis, where water molecules break the polymer chains of the material. These materials are commonly used for deep internal tissues or layers that require temporary support, eliminating the need for a second procedure to remove them.
Common examples of synthetic absorbable materials include polydioxanone (PDS) and polyglactin 910 (Vicryl), which offer different rates of strength retention and absorption time. PDS maintains its tensile strength longer, making it suitable for slow-healing tissues like fascia. In contrast, non-absorbable sutures are composed of materials the body cannot break down. They must either be removed after the wound has healed or remain permanently encapsulated within the tissue.
Non-absorbable sutures are often preferred where long-term tissue support is required, such as in vascular repair or the placement of medical devices. Non-absorbable materials include synthetic options like nylon and polypropylene, often used for closing the skin surface. The thread structure varies: monofilament threads consist of a single strand that passes through tissue with less friction. Braided threads are made of multiple strands twisted together, offering greater flexibility and superior knot security.
Beyond the Thread: Other Wound Closure Methods
While the thread-and-needle suture is the traditional method, modern surgical practice employs several other devices for tissue approximation. Surgical staples offer a faster alternative to traditional hand-suturing, especially for long incisions or areas under high tension, like the scalp or the trunk. These staples are applied using a specialized stapler device and are typically made from stainless steel or titanium. They form a rigid, B-shaped closure that securely holds the wound edges together.
Specialized linear and circular staplers are utilized internally to cut and seal organs like the bowel or lungs during complex procedures. Another non-thread method involves the use of tissue adhesives, commonly referred to as surgical glue. These are typically liquid monomers, such as cyanoacrylate, that polymerize rapidly upon contact with moisture to form a strong, flexible bond. Surgical glues are often used for closing small, low-tension incisions or lacerations, resulting in a more cosmetically appealing scar, particularly on the face.
For superficial wounds and as reinforcement, adhesive wound closure strips, often known as Steri-Strips, are employed. These thin, porous tapes are applied across the wound to gently pull the skin edges together without penetrating the tissue. They are effective for minor cuts or after external stitches or staples have been removed to lend residual support. The choice among these alternatives depends on the wound’s location, size, tension, depth, and the desired cosmetic outcome.
The Fate of the Suture: Removal and Absorption
When non-absorbable sutures or staples are used to close the outer layer of skin, they must be manually removed by a healthcare professional once the wound has achieved sufficient strength. The typical timeline for removal varies significantly based on the area of the body, ranging from 3 to 5 days for wounds on the face to 10 to 14 days for incisions on the limbs or joints.
Conversely, absorbable materials dissolve internally, meaning the patient does not need to return for a removal procedure. The process involves the material gradually losing mass as the body breaks it down and clears the remnants. While this degradation process is generally seamless for the patient, the dissolving material may result in a mild, temporary inflammatory reaction in the surrounding tissue.
Regardless of whether the closure is removed or absorbed, patients must carefully observe the wound site during the healing period. Signs of a complication should prompt immediate medical attention, including:
- Increasing redness.
- Warmth.
- Excessive swelling.
- The presence of pus or foul-smelling discharge.
Proper wound care following the surgeon’s instructions is necessary to support the closure device and ensure the best possible healing outcome.