Suturing is a fundamental surgical skill used to close wounds and promote healing. The choice of suture material and technique is crucial for optimal wound closure and cosmetic outcomes.

Types of Sutures

Sutures can be classified into two main categories:

Absorbable Sutures

• Lose most of their tensile strength within 60 days
• Used primarily for deep tissue closure
• Examples:
• Natural: surgical gut (catgut)
• Synthetic: polyglycolic acid (Dexon), polyglactin 910 (Vicryl), polydioxanone (PDS)

Non-absorbable Sutures

• Maintain tensile strength for longer periods
• Used for skin closure or when prolonged wound support is needed
• Examples: nylon, polypropylene, silk, polyester

Suture Properties

Important characteristics of suture materials include:

• Tensile strength
• Plasticity and elasticity
• Ease of handling and knot security
• Tissue reactivity
• Monofilament vs. multifilament structure

Common Suturing Techniques

1. Simple Interrupted Suture

• Most basic and versatile technique
• Suitable for many wound types

1. Continuous (Running) Suture

• Faster to place than interrupted sutures
• Distributes tension evenly along the wound

1. Vertical Mattress Suture

• Promotes wound edge eversion
• Useful for poorly supported or mobile skin

1. Horizontal Mattress Suture

• Distributes tension across the wound
• Useful in high-tension areas or glabrous skin

1. Subcuticular Suture

• Provides excellent cosmetic results
• Placed within the dermis, leaving no visible suture marks

Suture Selection

The choice of suture material depends on various factors:

• Wound location and tension
• Required duration of wound support
• Risk of infection
• Cosmetic considerations

For most cutaneous procedures, synthetic non-absorbable monofilament sutures like nylon or polypropylene are commonly used. For deep tissue closure, absorbable sutures such as polyglactin 910 (Vicryl) are often preferred.

Surgical Needles

Suture needles are typically curved and come in various sizes and shapes. The most common types for skin closure are:

• 3/8 circle reverse cutting needle
• 1/2 circle reverse cutting needle

Needle size is matched to the suture size and tissue type being closed.