Suture Materials
There are a
number of suture materials available, but it is beyond the scope of
this module to cover them in any detail. In selecting a particular
suture, the physician needs to consider the physical and biological
characteristics of the material in relation to the healing process.
Suture materials can be broadly categorized as absorbable and
non-absorbable. Absorbable sutures do not require removal as they are
digested by tissue enzymes. Non-absorbable or permanent sutures need to
be removed at a later date.
Absorbable sutures can be further divided into rapidly absorbing (days)
and slowly absorbing (months). The choice will depend on the rate at
which the particular tissue regains its strength. Fortunately, the
choice is often not an issue in the Emergency Department because most
wounds encountered there require support for a matter of days to weeks.
Sutures available in the Emergency Department will meet this
requirement.
Both absorbable and non-absorbable sutures are graded for size or
diameter of the strand. The grading system uses the letter O and the
number of stated O's indicates the size. The more O's, the smaller the
size. For example, a 6-O is smaller than a 4-O. Accordingly, tensile
strength of a particular suture type increases as the number of O's
decreases.
The needles supplied with sutures also have important features. In
general, for Emergency Department use, needles are either large or
small and either cutting or non-cutting. Large needles have the
advantage of closing a deeper layer of tissue with each "bite". The
concern with small needles is that there will be inadequate closure of
deep subcutaneous tissues, leaving potential space for hematoma
formation. However, small needles create smaller puncture wounds and
may have the advantage of reducing scarring
Cutting needles have at least two opposing cutting edges to facilitate
passage through tough tissue. These needles are used for skin closure.
Non-cutting or tapered needles are used to close subcutaneous tissue,
muscle and fascia. They have sharp points, but do not have cutting
edges.