Different suture materials produce varying degrees of tissue reaction, specifically inflammation. Significant inflammation will reduce the resistance to infection and delay the onset of wound healing. The type of material and size of the suture are thought to be the major factors contributing to this reaction. Natural materials are absorbed by proteolysis, which causes a prominent inflammatory response. Synthetic materials are absorbed by hydrolysis, which produces a minimal reaction.
Multifilamentous sutures have a high degree of capillarity so there is a tendency to absorb and retain both fluid and bacteria. These materials are associated with greater reactivity and may promote infection if bacterial contamination occurs during or shortly after surgery. Tissue reactivity is also affected by the surgical trauma to tissues, so care should be taken in handling the tissues. The amount of suture placed in a wound, particularly with respect to the knot volume, affects inflammation. The suture size contributes more to knot volume than the number of throws. The volume of square knots is less than that of sliding knots, and knots of monofilament sutures are smaller than those of multifilament sutures.
Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon.
Surgical gut suture (Plain and Chromic) is contraindicated in patients with known sensitivities or allergies to collagen or chromium, as gut is a collagen based material, and chromic gut is treated with chromic salt solutions.
MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan).
PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).
VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).
- Allergic Suture Material Contact Dermatitis Induced by Ethylene Oxide: G. Dagregorio, G. Guillet; Allergy Net Article
- Johnson and Johnson Product Information
- Current Issues in the Prevention and Management of Surgical Site Infection - Part 2; MedScape Article
- MECHANICS OF BIOMATERIALS: SUTURES AFTER THE SURGERY; Raúl De Persia, Alberto Guzmán, Lisandra Rivera and Jessika Vazquez
- Materials for Wound Closure by Margaret Terhune, MD; eMedicine Article
- Product Allergy Watch: Triclosan; MedScape Article by Lauren Campbell; Matthew J. Zirwas