(a) Silk. Silk has a number of advantages as a suture material. Silk
lies flat when it is tied. It is easy to handle and has the added advantage of forming a
secure knot when tied. But there are also disadvantages. Silk is not the ideal suture
material for routine emergency department use. Silk causes a host reaction since silk is
a foreign protein. This means that there is a high risk of infection if silk is used as
suture material. Therefore, use silk in uncontaminated wounds that are in well-perfused
areas of the body; for example, wounds on the face.
(b) Cotton. Briefly, the advantages of using cotton are the same as the
advantages for using silk as a suture material. Similarly, the disadvantages of using
cotton are the same as the disadvantages of using silk.
(c) Nylon and polypropylene (synthetic materials). Among the
advantages of using these synthetic materials as sutures are that these synthetic
materials pose a lower risk of infection than silk or cotton. Also, these materials are the
suture of choice for skin closure of most lacerations in the emergency room.
Disadvantages include the following:
1 Synthetic materials do not lie flat during the suturing process.
2 These materials are more difficult to use.
3 There is less security of knots.
(d) Dacron. The infection potential of Dacron is greater than that of
nylon or polypropylene but less than that of silk or cotton. Dacron is easier to work with
and holds knots better than nylon or polypropylene.
(3) Metal sutures. Staples are metal sutures. For many years, staples have
been commonly used for surgical wound closure. Staples are used in emergency
rooms for some types of lacerations. The advantages of metal sutures are that they are
easier and quicker than other types of suture repair. The cost is lower, and the wound
healing results are the same as for other types of suturing. The disadvantages are that
an inexperienced person has a difficult time using these sutures. Additionally, metal
sutures can be highly irritating to the patient.
(4) Absorbable sutures. Absorbable suture material is digested and
absorbed by body cells and fluids during and after healing of tissue. There are two
types of regular absorbable suture--plain cat gut and chromic cat gut. Both of these
indicate a surgical gut material that has not been treated to lengthen its absorption time
in the tissue.