Suture choice

Hochherg J, Meyer KM, Marion MD. Suture choice and other methods on skin closure. Surg Clin North Am 2009 89(3) 627—41. 

Effective interventions for treating a minor surgical suture site infection should definitely include one of the following choices ... 

A study from 1989 looked at the viability of dorsal skin flaps (on guinea pigs) subjected in vivo to transposition and suture immediately followed by a single application of phenol (Baker s solution) and 24-hour occlusive tape dressing. Thirty-six skin flaps were raised and sutured back into place, and only 18 were treated with phenol. Analysis of the results clearly shows that combining a surgical lift and phenol at the same time of operation is not a wise choice, as the average necrosed surface area without phenol was 3.1 cm, compared with 6.3 cm for the peeled flaps. 

For use in implants, polypropylene is the fiber of choice for hernia and prolapsed repair meshes and monofilament sutures. Gel-spun polyethylene, on the other hand, with ultra-high strength and stiffness but stretch of the order of only 2%, has been considered mostly for use as very fine suture materials. 

Monofilament sutures are considered to be a better choice than multifilament ones in closing contaminated wounds. Multifilament sutures elicit more tissue reactions which may lessen tissue ability to deal with wound infections. They also have a capillary effect which could transport microorganisms from one region of the wound to another. The reason that multifilament sutures generally elicit more tissue reactions than their monofilament counterparts is because inflammatory cells are able to penetrate into the interstitial space within a multifilament suture and invade each filament. Multifilament sutures also have a larger surface area in contact with tissues which should be expected to elicit more tissue reaction. 

PLGA (Cutright and Hunsuck, 1971 Athanasiou et al., 1996), which was employed as suture by taking advantage of its biodegradation ability. So far, the medical applications have not changed drastically and the main polymer choices are still the classical types of copolymers based on polylactic acid (PLA) and polyglycolic acid (PGA) as shown in Table 7.6. 

Wound dehiscence can be due to mechanical stresses. When a foreign body (i.e., the port) is present, its contamination quickly leads to infection, which is very difficult to treat without device removal. Insufficient suture strength, improper suture techniques, improper choice of stitch, premature removal of sutures, or excessive tension of the suture line may all contribute to dehiscence (Lyon et al. 1999 Hunt and Zederfeldt 1990). 

Currently, the Cantwell-Ranswell urethroplasty is the method of choice (Kelly 1998 Ben-Chaim et al. 1996 Canning 1996 Husmann et al. 1993). Briefly, the urethra is tubularized over a catheter. The corporal bodies are freed completely from the glans and the proximal urethra, then rotated inward and sutured together. The procedure is finished by reconstruction of the glans and moving the distal end of the urethra to the ventral side of the penis. Penile ischemia can lead to an asymmetric appearance of the penis afterwards. 

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