Suture Material

1. 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
2. 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)
3. Background: Suture types recommended for skin closure
   1. Deep (dermal or buried) Absorbable Sutures
      1. Polyglecaprone 25 (Monocryl)
      2. Polydioxanone (PDS)
      3. Polyglactin-910 (Vicryl)
      4. Polyglycolic acid (Dexon)
   2. Superficial, monofilament Nonabsorbable Sutures
      1. Nylon (Ethilon)
      2. Polypropylene (Prolene)
4. 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
5. 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
6. Background: Suture Removal Timing
   1. Scalp: 6-8 days
   2. Face, Eyelid, Eyebrow, Nose, Lip: 3-5 days
      1. Follow with papertape or steristrips
   3. Ear: 10-14 days
   4. Chest and Abdomen: 8-10 days
   5. Back: 12-14 days
   6. Extremities: 12-14 days
   7. Hand: 10-14 days
   8. Foot and sole: 12-14 days
   9. Penis: 8-10 days
   10. Condition delaying Wound Healing: 14 to 21 days
       1. Chronic Corticosteroid use
       2. Diabetes Mellitus
7. References
   1. Howell (1997) Emerg Med Clin North Am 15(2):417-25
   2. Moy (1991) Am Fam Physician 44(6):2123-8
   3. Phenninger (1994) Procedures, p. P3-6
   4. Townsend (2001) Sabiston Textbook Surgery, p. 1552-3