Suture Selection by Procedure
Principles of Suture Selection :

Among the many decisions that face the surgeon in the operating room, suture selection for the procedure at hand may be one of the most critical. Personal Preference will ofcourse play a role. But the final choice will depend upon various patient factors that influence the healing process, the characteristics of the tissues involved and potential post-operative complications

The wide variety of suturing materials available can make it difficult to choose the most appropriate suture for a given task
 
The following principles (guide) for selecting a suture material :
 
A. When a wound reaches maximal strength, sutures are no longer needed. Therefore:

    a. Close slow-healing tissues (skin, fascia, tendons) with non-absorbable sutures or a           
        long-lasting absorbable sutures
    b. Close fast healing tissues (stomach, colon, bladder) with absorbable sutures
 
B. Foreign bodies in potentially contaminated tissues may convert contamination into infection.
    Therefore:
    a. Avoid multifilament sutures which may convert contaminated wound into an infected one
    b. Use monofilament sutures or absorbable sutures which resist harboring infection
 
C. Where cosmetic results are important, close and prolonged apposition of tissues and avoidance
    of irritants will produce the best results. Therefore:
    a. Use the smallest inert monofilament suture materials (Nylon, Polypropylene)
    b. Avoid using skin sutures alone. Close subcuticularly whenever possible
 
D. Foreign bodies in the presence of fluids containing high crystalloid concentrations may cause
    precipitation and stone formation. Hence :
    a. Use absorbable sutures in the urinary and biliary tracts
 
E. Regarding suture size :
    a. Use the finest sized suture commensurate with the natural strength of the tissue to be sutured
    b. Use retention sutures to reinforce appropriately sized primary sutures if the patient is at risk
        of producing sudden strains on the suture line post-operatively. Remove the retention sutures
        as soon as that risk is reduced
 
 


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