The Need for Permanent Silk Sutures When Absorbable Sutures Will Not Do the Job

Stitches are one way of giving strength to a wound until the body's tissues are strong enough to take over. On the whole, the non-absorbable stitches are used where strength is needed for weeks or months for example abdominal wall wounds. Non absorbable sutures are defined by their resistance to eventual breakdown of living tissues. They are most useful in percutaneous closures. Non absorbable sutures are those which are not digested by body enzymes or hydrolyzed in body tissue. They are made from a variety of non biodegradable materials and are ultimately encapsulated or walled off by the body’s fibroblasts. Non absorbable sutures usually stay where they are buried within the tissues. When used for skin closure, they must be removed after the operation. One example of such sutures is the silk suture. It was first widely used as a suture material in the 1890s and was manufactured by Ethicon. Although silk is considered a non absorbable material, it is gradually degraded in tissue over two years.

It is a material formed from the protein fibers produced by silkworm larvae. Silk has excellent handling and knot-tying properties and is the standard to which all other suture materials are compared. It has a high knot security and tissue reactivity and low tensile strength. For many surgeons, surgical silk stands for the standard handling performance by which newer synthetic materials are judged, especially due to its superior handling characteristics. Silk filaments can be twisted or braided, the latter providing the best handling qualities. Raw silk is a continuous filament spun by the silkworm moth larva to make its cocoon. Cream or orange-colored in its raw state, each silk filament is processed to remove natural waxes and gum. It is degummed because it is of no help to the quality of braided surgical silk sutures. This allows for a tighter, more condensed braid which considerably enhances suture quality. After braiding, the strands are dyed, scoured and stretched, and then impregnated and coated with a mixture of waxes or silicone. Each of these steps is critical to the quality of the finished suturing and must be carried out in a precise order. Surgical silk is usually dyed black for easy visibility in tissue.

The silk sutures may be used in a range of applications such as exterior skin closure; to be removed after adequate healing has occurred. It can be used within the body cavity, where they will remain permanently encapsulated in tissue. It can also be applied in prosthetic attachment such as cases of defibrillators, pacemakers, drug delivery mechanisms. Silk also is useful as a transitory suture to raise or pull in tissues for improved visibility while a surgery is going on. Silk is very strong and handles nicely. Silk is unlikely to tear through even delicate tissues.

The choice of a particular suture material should be based on the patient, wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials is important to make an educated selection.  Ethicon, Look, Sharpoint, & Syneture (Covidien) and are amongst the most respected silk suture makers in the world.


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