Suture Material

Many different suture materials are available. The main classifications
are absorbable or nonabsorbable. A more subtle subclassification is
whether the suture material is braided or nonbraided.
Unless there is a dire emergency, never use regular thread for sutures
because of the risk of infection.
Nonabsorbable Sutures
Nonabsorbable sutures remain in place until they are removed.
Because they are not dissolved by the body, they are less tissue-reactive
and therefore leave less scarring as long as they are removed in a
timely fashion. They are best used on the skin.
Absorbable Sutures
Absorbable sutures are dissolved by the body's tissues. The great advantage
is that the sutures do not need to be removed. However, absorbable
sutures tend to leave a more pronounced scar when used as
skin sutures. Absorbable sutures are primarily used under the skin,
where they are well hidden.
It is sometimes difficult to get patients to return for suture removal. If
this is a concern, use an absorbable suture for skin closure. You should
warn the patient that absorbable sutures probably will result in a more
noticeable scar than nonabsorbable sutures with later removal.
Because it is often difficult to remove stitches from children (because of
their crying and difficulty in staying still), absorbable materials should
be used when suturing their wounds.
Braided Sutures
Braided sutures are made up of several thin strands of the suture material
twisted together. Braided sutures are easier to tie than nonbraided
sutures. However, braided sutures have little interstices in the suture
material, which can be a place for bacteria to hide and grow, resulting
in an increased risk of infection.
Nonbraided Sutures
Nonbraided sutures are simply a monofilament, a single strand. They
are not made up of the little subunits found in a braided suture.
Nonbraided sutures are recommended for most skin closures, especially
wounds that may be at risk for infection.
4 Practical Plastic Surgery for Nonsurgeons

Table 1. Characteristics of the Most Commonly Used Suture Materials

A = absorbable, N = nonabsorbable, 0 = no tissue reaction, +++ = highly reactive.