Types of Sutures for Practice
For a medical student to learn about sutures and be able to practice them consistently, they first need to learn the definition of the classifications of sutures used and what exactly they are used for! To that end, we must first discuss the initial classification of sutures based on their ability to be absorbed into the body:
Absorbables vs Non-Absorbables in Suture Placement
An absorbable suture is one that loses tensile strength (basically, becoming stretchy along with that healed part of the body) in 60 days or less of being placed in the tissue. The absorbable suture would need to lose strength only after the tissue regains it! But sometimes it can still be seen in the tissue even without having tensil strength.
By contrast, a non-absorbable suture will need to maintain its original tensile strength for at least 60 days when placed in tissue. Because of this, it cannot be placed in areas like the urinary bladder, which is designed strictly for absorption of materials.
Mono and Multifilaments in Synthetic or Natural Suture Material
As the name implies, a monofilament has only a single thread and can be easily kinked or crushed by the instruments in a surgery, requiring a delicate surgeon's hand. The multifilament’s are braided and can cause something called tissue drag because it doesn't pass smoothly through your tissue when the suture is created. The multifilament’s can cause greater bacteria growth if placed in an already-infected area of the body, so be even more careful looking for signs of inflammation pre-surgery.
These filaments can be made with natural or synthetic materials - keeping in mind that the natural material creates more tissue reaction than the synthetic, which can lose strength be absorbed far more predictably. Both materials can be used in absorbent or nonabsorbent sutures. Examples of natural material include silk and surgical gut (catgut!), and synthetic material is most often referred to as nylon.
Suture Types and Their Uses
- When securing a drain to the skin, use Silk sutures
- When skin sutures are going to removed later on, you can just use Nylon sutures
- Blood vessel repair sutures need to be Prolene
- Mucosa and Eye Wounds use Chromica
- Repairing the Achilles Tendon requires #5 Ethibond or Fiberware
- Dermal or subcutical wounds can have a Polydioxanone suture applied to them, but
- Deeper dermal wounds, like those to the muscle, fascia, or genetalia can only use sutures of the Glycolide/Lactide Polymer
Keep in mind that, while any suture can be absorbent or nonabsorbent, the placement of the suture and how long it needs to remain in the tissue with tensile strength will determine what type of suture you'll need to use in any given procedure. And of course, for any procedure that involves an organ, there will be at least two types of sutures used - one for the organ itself, and one to seal the incision you had to make in the skin in order to reach the organ!
Go over the types of sutures and the places they'll be needed a good few time, and then begin your practice from the head down to find out how well your memory does for you while you create and apply your knowledge of sutures as you move forward in your future from a medical student to a person with a medical career!