The wide variety of materials that may be used to close a superficial wound was addressed previously. However, there are times when only a real suture will work. The plethora of options makes it difficult for the regular Joe or Jane to figure out what is really wanted for the TEOTWAWKI home medical supply.
By way of review, a suture is needed if the wound being closed is over a joint or beneath the superficial layer of skin. It is best if you do not improvise here. You really do not want to use a regular needle and thread if you don't have to.
So let's review the most commonly available suture options to determine what will be best for potential future needs.
Needle: A reverse cutting needle is usually preferred as it reduces the potential for weakening and tearing the skin. Conventional cutting is what was first invented, but it was observed that it was more likely to weaken and tear tissue. Tapered needles are round, like sewing needles, and cause more tissue damage, and increase the pain and scarring.
Needle shape: The most commonly used shapes are 1/2 and 3/8 circle, with the latter being the more common of the two. Other shapes are for specialties that aren't really of concern in a post-apocalyptic world.
Suture material: Suture material is classed in several different ways. Factors to consider include the patient and location where the suture is to be placed, as well as the supplies you actually have available. You aren't a hospital pharmacy; unless you are really wealthy, you can't possibly stock every possible option. The choices to make with each suture include:
- Absorbable or non-absorbable
- Absorbable sutures are usually reserved for use inside the body. But they are ideal in someone where the sutures may not be able to be removed due to challenging circumstances or a young child who will remember the trauma of having stitches placed and may not be so cooperative having them removed. Absorbable sutures are broken down and removed by the body.
- Non-absorbable sutures usually used outside for skin closure, as well as in patients with a history of reaction to absorbable sutures.
- Monofilament (single ply) or braided (three plies)
- Monofilament sutures (like fishing line) are less likely to harbor organisms and do not wick any fluid (and possibly bacteria) into the wound. They are less irritating to the skin than many others. Monofilament sutures tie down easily. However, the knots slip more readily and may become weakened if compromised (crushed, crimped, or nicked).
- Braided sutures are more likely to harbor organisms. They are also stronger and more flexible, and thus are easier to work with for some individuals.
- Needle size. The picture on the suture package indicates the exact shape and size of the needle. The more zeros, the smaller the diameter of the needle and suture material. The size indicates the diameter. 3-0 = 000, 6-0 = 000000, so a 3-0 is larger than a 6-0. The strength of the suture should never be greater than the strength of the tissue. This is because if something is going to give, it should be the suture, not the tissue. Otherwise, you are causing more trauma to the tissue. Example: You would not want to use 1-0 suture, a large diameter suture, on young child or elderly person's skin. In these situations, you'd use 4-0 to 6-0, depending on the location. Fascia, the sheath covering muscles (like on a cut of beef--the very thin, cream-colored sheath covering the meat), is stronger than the muscle it covers and will tolerate a 2-0 to 3-0 suture. Muscle itself will usually tear before 4-0 breaks, but because fascia is usually sutured as well, the 2-0 to 3-0 can be used.
- Coated or non-coated. Coated, which usually goes with braided, makes it easier to pull the suture through the tissue. The knots also hold better.
- Material. There is a considerable variety in the choices of materials for a suture.
- Nylon (Ethilon) is the most common non-absorbable, monofilament, less expensive.
- Polyester (Ethibond) is easier to use than nylon because it is braided and coated and thus holds knots better than nylon.
- Polypropylene (Prolene) is another non-absorbable monofilament that is easier to use than nylon and less likely to cause a tissue reaction than nylon.
- Polyglactin (Vicryl) is an absorbable, braided suture suitable for general use.
- Polydiaxone is another common absorbable suture that is monofilament and retains its strength better and longer than Vicryl.
- Chromic gut is also absorbable but is more likely to cause inflammation than other absorbables.
- Silk is probably the easiest to work with, but because it is braided and not coated, it has a higher chance of harboring organisms. It acts as a very slowly absorbing suture, so it can be used internally and is preferred for ligating blood vessels. Silk is tough, and even silk sewing thread will tolerate autoclaving or other sterilization methods.
There is no one-size-fits-all here. Physicians all have their favorite materials to work with, just like the rest of us. As far as what's most commonly used? Needle sizes 2-0, 3-0, and 4-0. Non-absorbable. (Think about it--you're more likely to need stitches for a flesh wound than internal surgery.) Prolene, Vicryl, and Ethilon seem to be the most popular overall. Silk and chromic gut have been around forever, so they've stood the test of time. Get a variety if you can.
Wound Closure Supply Options
Cosmetic Travel Bag for Organizing Medical Supplies in Kit
Review of OnPoint Tactical's Off Grid Medicine Course
Duct Tape Suture in a Straw
Suturing the Skin
For further reading:
http://surgsoc.org.au/wp-content/uploads/2014/03/Ethicon-Knot-Tying-Manual.pdf (pages 36-41 address suture materials and options) Accessed on 15 April 2019.
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