Suture Material Basics

Developing Your Skills Equipment and Instruments The Stitch

By: Nechama Brilliant, BSN, RN, CNOR

Published: 2/23/2024

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Suture is a strand of material used to bring two sides of tissue together from an intentional surgical incision or from damaged tissue. It can be used alone to ligate (tie off) blood vessels or to isolate large pieces of tissue for removal. It also can be used with a needle for suturing (ie, stitching two sides of tissue together).  

Suture Selection 

The type and size of suture used for a procedure are based on numerous factors, including the characteristics of the patient’s tissue (and health comorbidities), wound location, size of the wound, desired strength (dependent on pressure exerted on the area of the body), and type of repair being completed. Table 1 provides some key defining characteristics of suture. While surgeons tend to choose the same suture for similar procedures, there is no individual suture that is a good choice for every procedure. Table 2 provides information on different suture types and their uses.  

It should be noted that unnecessary handling of the suture material can decrease its effectiveness. Its integrity should be monitored from the time it is added to the sterile field to the end of the procedure.

Table 1. Key Defining Characteristics of Suture

Suture Characteristic

Description
Configuration
  • The number of fibers that make up the strand.
  • A single strand is referred to as monofilament.
  • Multifilament refers to many strands twisted or braided together to form one strand.
Diameter
  • The diameter of the suture is measured in millimeters.
  • Larger diameter suture ranges in size from 0 to 7.
  • Smaller diameter suture is delineated with the addition of a 0 and ranges in size from 1-0 to 10-0, with the larger number indicating a smaller diameter; for example, 2-0 is larger than 6-0 suture.
  • Larger suture is used for general surgery while smaller, thinner suture is used for specialty procedures, including plastic surgery, cardiac surgery, and neurosurgery.
Tensile strength
  • The malleability of the suture (ie, how much weight the suture material can accommodate).
Memory
  • How well the suture material returns to its original form after being tied.
Material
  • Two main groups are absorbable and nonabsorbable.
  • Absorbable suture is made from collagen derived from mammals or synthetic polymers; it is digested or broken down into the tissue during the healing process.
  • Nonabsorbable suture is made from various materials like silk, nylon, polyester fibers, and stainless-steel wire; it is surrounded by tissue during the healing process and is removed before healing is complete.

 

Table 2. Types of Suture Material and Their Uses

Suture MaterialCommon Needle Size
Uses
Silk8-0, 10-0
Delicate tissue, mucosa, conjunctiva
Nylon0, 1, 3-0, 2-0

On large needle with wide diameter: heavy tissue, such as muscle

Smaller sizes are commonly used in plastic surgery for delicate tissue

Polyester0, 3-0
Tissue, such as fascia (the layer found just beneath the skin that holds all organs, muscles, bone, and nerves in place)
Steel0 to 7
Bone; sternal or large bone fixation

 

Reference

  1. Cromb MM. Sutures, sharps, and instruments. In: Rothrock JC, ed. Alexander’s Care of the Patient in Surgery. 17th ed. St. Louis, MO: Elsevier; 2023:174-198.

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