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