China-US Numbering
Absorbable and Non-absorbable
Commonly used non-absorbable sutures in general surgery include silk and Prolene.
① Silk suture, also called raw silk or natural silk suture, is made of silk protein. Because its degradation rate is slow, it is classified as non-absorbable; however, theoretically, its tensile strength will completely disappear in about one year within the human body. (The older generation completed many major surgeries using only silk suture; it’s just that now the materials are improved and better options are available.)
If silk suture is used subcutaneously: sometimes wound suture extrusion and rejection reactions occur.
② Prolene suture material is polypropylene, which is a non-toxic, heat-resistant material that can maintain tensile strength for a long time (plastic food containers made from polypropylene are the only plastic containers that can be directly heated in a microwave).
Monofilament and Braided Sutures
- Braided sutures have good flexibility and knot security, usually requiring 3 knots;
Monofilament sutures are less flexible, knots tend to slip, usually 6 or even 8 knots are tied. - The surface of braided sutures is rougher, causing greater friction with tissue, making ligatures more secure.
Monofilament sutures have a smooth surface and less friction with tissue.
Vascular sutures usually choose Prolene/PDS II.
For thyroid surgery using subcuticular sutures, monofilament Prolene is preferred, and the entire suture is removed after incision healing.
Barbed Sutures and Fishbone Sutures
Fishbone sutures have greater tensile strength.
Common Brands
Commonly Used Suture Locations
Skin closure: recommended silk (size 1 or 4), 2-0 or 3-0 VCRYL;
Midline abdominal closure: 1-0 PDS / 1-0 VCRYL (size 7); barbed sutures / fishbone sutures;
Gastrointestinal anastomosis (stoma): 3-0 / 4-0 VCRYL / PDS;
Biliary-enteric anastomosis: 6-0 Prolene or 6-0 PDS or barbed sutures;
Pancreatic-enteric anastomosis: 6-0 Prolene or 6-0 PDS;
Vascular anastomosis: 2-0 to 10-0 Prolene or PDS II.
