Absorbable Suture

1. Definitions
   1. Absorbable Suture
      1. Suture that loses its tensile strength by 60 days under skin (typically in much shorter time)
2. Indications
   1. Buried Suture in dermal layer to reduce wound edge tension
      1. Polyglactic Acid Suture (e.g. Vicryl)
      2. Poliglecaprone 25 (Monocryl) if risk of infection
   2. Superficial skin layer closure in pediatric patients (requires no removal)
      1. Controversial, but typically results in similar cosmetic results as Nonabsorbable Suture
      2. Use Fast Catgut for facial Lacerations
      3. Usev plain Catgut or Vicryl Rapide for trunk or extremity Lacerations
3. Precautions
   1. Suture absorption depends on a moist environment
      1. Exposed Sutures (e.g. those used for superficial closure) will absorb at a slower rate
      2. Residual nonabsorbed Suture results in inflammation and worse cosmetic results
      3. Remove residual Suture
   2. Infection risk
      1. Avoid using braided Suture (e.g. Vicryl) when there is an increased risk of infection
4. Preparations: Catgut Absorbable Sutures
   1. See Catgut Suture
   2. Rarely used for deep, dermal Suture and replaced by synthetic Absorbable Sutures (see below)
   3. May be preferred of the Absorbable Sutures for superficial skin closure (least inflammation)
   4. Regular, plain catgut Suture (Plain Catgut)
      1. Effective wound support for 8-9 days
      2. Used for superficial skin closure of chest or extremity Lacerations
   5. Fast-absorbing plain catgut Suture (Fast Gut)
      1. Heat-treated Suture for faster absorption
      2. Effective wound support for 5 days
      3. Used for superficial skin closure of facial Lacerations
   6. Chromic catgut Suture (Mild Chromic Gut)
      1. Chromic treated catgut Suture doubles the wound support duration
      2. Effective wound support for >18 days
      3. Increased inflammatory response
5. Preparations: Synthetic abosrbable Sutures
   1. Polyglactic Acid Suture (Vicryl, Dexon, Surgicryl, Polysorb)
      1. Braided Suture (higher risk of infection)
      2. Effective wound support for 14-21 days
      3. Dexon was the first synthetic Absorbable Suture (1962)
   2. Polyglactic Acid Suture treated with Gamma irradiation (Vicryl Rapide)
      1. Braided Suture (higher risk of infection)
      2. Effective wound support for 10 days
   3. Poliglecaprone 25 (Monocryl)
      1. Non-braided Suture (monofilament)
      2. Primarily used for high tension areas such as the fascial layer
      3. Effective wound support for 7-14 days
   4. Polydioxanone (PDS)
      1. Non-braided Suture (monofilament)
      2. Effective wound support for 30 days
   5. Polyglyconate (Maxon)
      1. Non-braided Suture (monofilament)
6. References
   1. Epperson in Pfenninger and Fowler (1994) Procedures for Primary Care Physicians, Mosby, Chicago, p. 3-11
   2. Lin and Lin in Herbert (2014) EM:Rap 14(11): 8-10
   3. Mortiere (1996) Principles of Primary Wound Management
   4. Townsend (2001) Sabiston Textbook Surgery, p. 1552-3
   5. Howell (1997) Emerg Med Clin North Am 15(2):417-25 [PubMed]
   6. Moy (1991) Am Fam Physician 44(6):2123-8 [PubMed]