Are there different types of surgical sutures?
There are many types of sutures used in plastic surgery. There are also many sutures used in plastic surgery. I often say that when the surgeon is closing the wound, it’s the end of the case. Except in plastic surgery, where it’s only the beginning. Plastic surgeons use many types, strengths, and layers of sutures to create optimal closures that last, heal, and end up looking as good as possible. But everything has its issues.
What are the main types of sutures?
The list of types of sutures is long and complex, but as a general rule, there are a few types of dissolving sutures that are commonly used. One type, Vicryl, is soft and strong, and lasts a long time. These sutures are a common favorite because of their durability and general success. The problem with them is that, for some patients, breaking down the knots can be difficult. If the suture is deep in the body, this often yields few issues. But if it is just below the skin, then the knot, which has now become a ball of inflamed scar tissue, will ultimately try to find its way out. In this case, it will become a small pimple, as the ball works itself to the surface, irritates the skin, and eventually breaks through to be free. The resultant opening can be tiny or not so tiny, painful, warm, and can take hours to days to close back up. This is the “spit” of the suture, and it is enjoyable neither for the patient nor for the surgeon.
Other types of sutures, namely Monocryl, do not usually have this same problem. They are less soft, but still easy to work with. They are easier to break down, therefore rarely spit; but they also are not quite as strong and do not last as long. In patients who take longer to heal (which is sometimes completely unpredictable before performing the surgery and watching the recovery), this can lead to areas of the wound opening up prematurely, which is often worse than a few little pimples here and there.
Why would surgeons use one type of suture over another?
Most surgeons have their preferred recipe of what to use, and in what combination. I have found that the secret sauce is a combination, adjusted depending on procedure and body area. But, as with everything in medicine, they call it a “practice” for a reason. One must always imagine that things could be improved, and be open to change. Given that, and the speed of technology, there are also always new types of sutures which promise fewer issues. But nothing comes without its drawbacks, so this must all be weighed and balanced.
Does the type of suture used make a big difference?
The good news is that the great majority of patients who undergo surgery have no problems at all with their sutures. Spitting sutures is a fairly rare occurrence. But for those in whom it becomes significant, this can really put a damper on their enjoyment of the result. The other good news is that, in almost all cases, even the open or pimply wounds completely resolve in the end. While they may be frustrating while they last, those tiny mounds eventually become just that: small bumps in the postoperative road.
Take Home Messages About Sutures in Surgery
- There are different types of sutures, and they all behave differently
- Some are stronger than others, and some break down more easily than others
- Everyone has their own way and level of difficulty with breaking down or “absorbing” sutures
- Suture type and tolerance can affect the entire outcome of the result
What I have learned about surgical sutures:
- It is very important to choose the right type for the right patient and the right body location
- In many cases, I have found that using a mixture of sutures optimizes the benefits of each
- I always take a personal history of my patients and their experiences with previous procedures and sutures before making my final plan
Most important rule in closing surgical wounds:
Know your patient and choose well, both in terms of the type of suture and the method of closure.
