Classification of Sutures

Sutures are normally classified in three different ways.

Structure:

Monofilament - Multifilament

Composition:

Synthetic - Biological

Degradation:

Absorbable - Non-Absorbable 

Monofilament sutures

Monofilament sutures are made out of one single strand. 

Advantages:
Smooth surface
Less tissue trauma
No bacterial harbours
No capillarity 

Disadvantages:
Handling & knot tying
Ends/knot burial
Stretch

Examples:
Monocryl* (absorbable, synthetic, monofilament)
Mersilene* (non-absorbable, synthetic, monofilament)
Ethilon* (non-absorbable, synthetic, monofilament)
Prolene* (non-absorbable, synthetic, monofilament)

Multifilament (braided) sutures

Multifilament sutures are made of several strands that are braided together.

Advantages:  
Strength
Soft and pliable
Good handling
Good knot tying 

Disadvantages:
Bacterial harbours
Capillary action
Tissue trauma

Examples:
Vicryl* (absorbable, synthetic, mulifilament) 
Vicryl Plus* (absorbable, synthetic, multifilament)
Vicryl Rapid* (absorbable, synthetic, multifilament)
Silk suture* (non-absorbable, biological, multifilament)
Ethibond* (non-absorbable, synthetic, multifilament)

Synthetic sutures

Advantages:
Non-absorbables are inert
Absorbables resemble natural substances
Absorption by hydrolysis
Predictable absorption
Strength

Disadvantages:
Monofilament handling

Examples:
Monocryl* (absorbable, synthetic, monofilament)
Mersilene* (non-absorbable, synthetic, monofilament)
Ethilon* (non-absorbable, synthetic, monofilament)
Vicryl* (absorbable, synthetic, mulifilament)
Vicryl Plus* (absorbable, synthetic, multifilament)
Vicryl Rapid* (absorbable, synthetic, multifilament)
Ethibond* (non-absorbable, synthetic, multifilament)
Prolene* (non-absorbable, synthetic, monofilament)

Biological sutures

Advantages:
Handling & knot tying
Economy

Disadvantages:
Tissue reactions

Example:
Silk suture* (non-absorbable, biological, multifilament)

Absorbable sutures

Absorbable sutures are broken down in the body by hydrolysis. 

Advantages:
Broken down by body
No foreign body left

Disadvantages:
Consideration of wound support time

Examples:
Monocryl* (absorbable, synthetic, monofilament)
Vicryl* (absorbable, synthetic, mulifilament)
Vicryl Plus* (absorbable, synthetic, multifilament)
Vicryl Rapid* (absorbable, synthetic, multifilament)

Non-absorbable sutures

Non-absorbable sutures are permanent and have to be removed manually.

Advantages:
Permanent wound support

Disadvantages:
Foreign body left
Suture removal can be costly and inconvenient
Sinus & extrusion if left in place

Examples:
Mersilene* (non-absorbable, synthetic, monofilament)
Ethilon* (non-absorbable, synthetic, monofilament)
Silk suture* (non-absorbable, biological, multifilament)
Ethibond* (non-absorbable, synthetic, multifilament)
Prolene* (non-absorbable, synthetic, monofilament)

Absorption guide absorbable sutures

Vicryl rapid*



Wound support: 10 days
Mass absorption: 42 days

Monocryl*

 

Wound support: 20 days
Mass absorption: 90-120 days

Vicryl*

 

Wound support: 30 days
Mass absorption: 56-70 days

Vicryl Plus*



Wound support: 30 days
Mass absorption: 56-70 days

The anatomy of the surgical needle 

 

Ethicon knot tying manual

Ethicon has produced a very good knot tying manual that runs through the basic steps of knot tying when working with surgical sutures. It contains all the common knots used in the different kinds of surgery.

The Ethicon knot tying manual can be viewed or downloaded here 

Ethicon wound closure manual

Ethicon has also produced a very comprahensive manual for wound closing techniques. This is not only for dental surgery but contains very good basics.

The Ethicon wound closure manual can be viewed or downloaded here 

 
* all trademarks courtesy of Johnson & Johnson