What are Monofilament Sutures?
Walk into any operating room, and you'll find surgeons making crucial decisions about wound closure materials. Among these critical choices, monofilament sutures stand out as versatile, single-strand options that have revolutionized modern surgery.
These specialized sutures offer distinct advantages over their multifilament counterparts, making them indispensable across medical specialties.
This article breaks down what makes monofilament sutures so valuable. We'll explore their key features, material types, and when to use absorbable versus non-absorbable options.
Understanding Monofilament Sutures
Monofilament sutures are made from a single strand of material, unlike multifilament sutures that are braided and may trap bacteria more easily. This smooth structure makes monofilaments ideal for clean, low-risk wounds.
There are several types of monofilament sutures, each suited for different medical needs.
Nylon is strong and skin-friendly, making it a common choice for surface closures. Polypropylene is known for holding its strength over time, making it useful in heart or vascular surgeries.
For procedures where long-term support isn’t needed, synthetic absorbable sutures like PDS (polydioxanone) and Monocryl (poliglecaprone) naturally break down in the body, eliminating the need for suture removal.
In cases requiring maximum tensile strength and long-term durability, stainless steel wire can serve as a monofilament suture option.
What are the Advantages of Monofilament Sutures?
These sutures offer several key benefits that make them ideal for reducing infection risk and promoting cleaner wound healing.
Low Infection Risk / Reduced Bacterial Harboring
Monofilament sutures are less likely to trap bacteria than braided sutures. Their smooth, single-strand design has fewer crevices where bacteria can hide and grow. This makes them a safer choice for wounds at risk of infection.
Minimal Tissue Drag & Trauma
The smooth surface of monofilament sutures allows them to glide through tissue with minimal resistance. This reduces tissue drag—the friction caused when a suture passes through tissue—during both placement and removal.
As a result, there’s less trauma, reduced inflammation, and improved healing with less patient discomfort.
Smooth Passage & Easy Removal
Non-absorbable monofilament sutures are easy to remove when it's time. Their smooth surface prevents them from sticking to tissue, so they slide out with minimal resistance. This makes removal quick and more comfortable, which is especially important for skin closures where patient comfort is a priority.
Biocompatibility and Reduced Inflammation
Most monofilament materials cause only a mild inflammatory response in surrounding tissues. Their biocompatibility supports faster healing and lowers the risk of complications. This makes them a good choice for sensitive areas and patients with delayed or compromised healing.
What are the Disadvantages of Monofilament Sutures?
Despite their benefits, monofilament sutures come with limitations that may affect handling, knot security, and overall surgical efficiency.
Knot Security Issues
The smooth surface of monofilament sutures can lead to knot slippage if not properly secured. Surgeons must use additional knot throws to ensure adequate security, which becomes particularly challenging in confined surgical spaces.
"Memory" and Slippage Risk
The inherent "memory" of monofilament materials causes them to return to their original straight shape. This property creates handling difficulties and requires extra attention to prevent slippage during the critical healing period.
Despite these challenges, proper technique and secure knotting can help maintain suture stability and ensure effective wound closure.
Handling Difficulties, Stiffness, Spring-back
Stiffness in some monofilament sutures makes them challenging to handle, especially in delicate procedures. The material's tendency to kink or bend unpredictably can complicate placement, while the spring-back effect requires surgeons to adapt their technique accordingly.
Not Ideal for High-tension Areas or Where Permanent Strength is Needed
High-tension areas may not be suitable for certain monofilament options due to their handling characteristics. Some applications requiring lifelong strength retention may be better served by alternative suture types, particularly when considering long-term structural integrity.
Ethilon's Tensile Decline
Non-absorbable monofilaments like Ethilon gradually lose tensile strength over time, though they're classified as permanent. This degradation may compromise their effectiveness in applications requiring consistent long-term strength retention.
Different Types of Monofilament Sutures & Their Uses
Monofilament sutures are broadly categorized into two main types based on their absorption characteristics, each serving specific clinical applications with distinct advantages.
Absorbable Monofilament Sutures
Absorbable monofilament sutures are designed to break down naturally in the body through enzymatic or hydrolytic processes. Their single-strand structure provides smooth tissue passage while offering temporary wound support during the critical healing phase.
|
Suture Type |
Characteristics |
Common Uses |
|
Polydioxanone (PDS / PDS II) |
Synthetic, slowly absorbed via hydrolysis (180–238 days). Retains tensile strength for several weeks. Available in clear or violet. Soft, pliable, low tissue drag, strong knot security. Can be used in infected tissues. |
Fascia layers (e.g., abdominal closure), pediatric cardiovascular procedures, ophthalmic surgery, plastic surgery, slow-healing tissues. |
|
Poliglecaprone 25 (Monocryl) |
Synthetic, rapidly absorbed (90–120 days). Loses 50% tensile strength in 7 days. Available in clear or violet. Soft, minimal tissue drag, good handling. |
Subcutaneous and intradermal skin closures (minimal scarring), some dental and urinary bladder procedures. Not recommended for cardiovascular or neurological use. |
|
Plain Gut |
Natural (purified collagen), rapidly absorbed via enzymatic digestion. Retains tensile strength for 7–10 days. Higher tissue reactivity than synthetics. |
Fast-healing tissues, epidermal wound closure, nailbed repairs. |
|
Chromic Gut |
Natural, treated with chromium salts to delay absorption and reduce tissue reaction. Retains tensile strength for 21–28 days. |
Oral mucosa repairs, gynecological procedures, superficial closures needing slightly longer support. |
|
Polyglyconate (Maxon) |
Synthetic, slowly absorbed. Loses 50% strength by 3 weeks, full absorption in 6–7 months. Comparable to PDS in strength. Stiff, requires extra throws for knot security. |
General soft tissue closures where prolonged support is necessary (deep or tension-bearing tissue). |
Non-Absorbable Monofilament Sutures
Non-absorbable monofilament sutures maintain their structural integrity indefinitely, providing permanent wound support. These sutures feature a single-strand construction that combines strength with smooth tissue passage for long-term applications.
|
Suture Type |
Characteristics |
Common Uses |
|
Nylon (Ethilon, Dermalon) |
Synthetic, inert, low tissue reactivity. Technically non-absorbable but gradually loses tensile strength over time. |
Skin closures, general soft tissue repair, cardiovascular, neurological, ophthalmic procedures. |
|
Polypropylene (Prolene, Surgipro) |
Synthetic, retains tensile strength indefinitely. Non-reactive, smooth, strong knot security. Does not adhere to tissues. Often dyed blue. |
Cardiovascular surgery (vessel repair, grafts), hernia repair, abdominal wall closure, cosmetic skin closures, infected or inflamed sites. |
|
Stainless Steel Wire |
Metallic, biologically inert, extremely high tensile strength, excellent knot security. Available in mono- or multifilament. |
Orthopedic applications (e.g., tendon repair), sternal closures, abdominal wall repair, long-term fixation. |
|
Polytetrafluoroethylene (PTFE) |
Synthetic, soft, minimal tissue reaction. |
Dental bone grafting, implant procedures, delicate or sensitive oral tissues. |
Infection Risk & Tissue Reaction
Research consistently demonstrates that monofilament sutures carry lower infection rates than multifilament alternatives. The smooth, single-strand surface provides fewer crevices for bacterial colonization, reducing the risk of surgical site infections.
On the other hand, multifilament sutures have a braided structure that can trap bacteria, creating a protected environment that encourages microbial growth. This can lead to persistent infections, even when antibiotics are properly used. In contrast, monofilament sutures help eliminate this risk through their uniform design.
To enhance infection control further, some monofilament sutures are coated with antimicrobial agents. These specialized options are especially beneficial in high-risk procedures, offering added protection during the critical early stages of healing.
Frequently Asked Questions
What suture is best for lacerations?
Nylon monofilament sutures are typically best for skin lacerations due to their excellent tensile strength, minimal tissue reaction, and smooth removal. For facial lacerations, fine nylon (6-0 or 7-0) provides optimal cosmetic results with minimal scarring.
How many knots are needed for monofilament sutures?
Monofilament sutures require 4-6 knot throws due to their smooth surface and memory characteristics. The exact number depends on the specific material and suture size, with finer sutures typically requiring more throws for adequate security.
How long does it take for monofilament sutures to dissolve?
Absorbable monofilament sutures dissolve at different rates: Monocryl absorbs in 90-120 days, PDS takes 180-238 days, and gut sutures dissolve in 7-10 days (plain) or 21-28 days (chromic). Non-absorbable monofilaments don't dissolve and require removal.
Ready to Purchase High-Quality Monofilament Sutures?
Mastering monofilament suture techniques requires more than theoretical knowledge, it demands consistent, hands-on practice with professional-grade equipment.
If you're committed to excellence in wound closure, investing in quality training materials becomes essential for skill development.
The Advanced Suture Practice Kit from Artagia Med provides comprehensive training solutions with 35 premium components, including lifelike practice materials and medical-grade instruments. This complete system allows you to perfect your monofilament handling techniques in a risk-free environment.
For focused knot-tying practice, our Advanced Surgical Knot Tying Board Kit provides targeted training to help you achieve secure, consistent knots, which are especially important when working with monofilament sutures that require extra throws.
Order your Artagia Med training kit today and train with confidence using trusted, professional tools.