Understanding Surgical Sutures
In medicine, sutures, or stitches, are used to hold body tissues together after an injury or surgery, facilitating proper healing. Surgical sutures are broadly classified into two main types: absorbable and non-absorbable. Absorbable sutures are designed to be broken down and assimilated by the body over time, while non-absorbable sutures remain in place permanently or until a healthcare professional removes them. The selection of which type of suture to use is a complex decision, relying heavily on the location of the repair, the tissue's healing rate, and the level of mechanical stress on the wound.
Tendon Repair: Absorbable vs. Non-Absorbable Sutures
When repairing a torn or damaged tendon, a surgeon's choice of suture is critical to ensure a strong, stable repair that allows for a guided, effective rehabilitation. Tendons are unique connective tissues that heal slowly, often requiring long-term structural support, which is why non-absorbable sutures have been the traditional choice. However, advancements in materials and surgical techniques have expanded the use of absorbable sutures in specific scenarios.
The Role of Non-Absorbable Sutures
Non-absorbable sutures are made from materials that are not broken down by the body's natural processes, offering a durable, long-lasting solution for repairs under high tension. These materials include synthetics like nylon (polyamide), polypropylene, and polyester. They provide permanent support, which is essential for slower-healing tissues like tendons. For example, during an Achilles tendon repair, a strong, non-absorbable core suture may be used to provide robust fixation during the initial critical healing period. The long-term presence of this material, however, carries some risks, such as chronic inflammation or foreign body reactions.
The Emerging Use of Absorbable Sutures
In contrast, absorbable sutures are made from synthetic polymers like polydioxanone (PDS) or polyglactin (Vicryl), which break down via hydrolysis. They are absorbed by the body over weeks or months, eliminating the need for removal. Historically, their use in high-tension repairs like tendons was limited due to concerns about strength and the possibility of re-rupture. However, modern studies, including one comparing absorbable polyglactin with non-absorbable sutures for Achilles tendon repair, have shown comparable outcomes in terms of strength and complication rates, making them a viable alternative in certain cases. The dissolving nature of these sutures may reduce the risk of long-term foreign body reaction and minimize scarring.
Factors Influencing the Surgeon's Choice
- Location and Size of the Tendon: Larger tendons under high stress, such as the Achilles, may still favor non-absorbable core sutures for maximum strength. In smaller, lower-tension tendons, absorbable sutures may be sufficient. Some repairs use a combination, such as a strong non-absorbable core with absorbable circumferential stitches.
- Risk of Complications: Non-absorbable sutures, while strong, can sometimes lead to complications like stitch granuloma, fibrosis, or triggering, where the body's reaction to the permanent foreign material can impede function. Absorbable sutures mitigate this risk by disappearing over time.
- Tissue Response: The body's inflammatory response to suture material is an important consideration. While absorbable sutures trigger a temporary inflammatory response as they dissolve, non-absorbable sutures can cause long-term inflammation due to their permanent presence.
- Technique and Patient Factors: The specific surgical technique (e.g., grasping or locking loops), patient's health status, and the risk of infection can all play a role in the final decision.
Comparison of Absorbable vs. Non-Absorbable Tendon Sutures
| Feature | Absorbable Sutures | Non-Absorbable Sutures |
|---|---|---|
| Longevity | Dissolves over weeks to months, depending on material (e.g., PDS: 6-12 months absorption). | Permanent unless surgically removed. |
| Tensile Strength | Gradually decreases as the suture is absorbed, providing temporary support during healing. | Maintains strength indefinitely, offering permanent structural support. |
| Removal | Not required for internal sutures, as they break down naturally. | Required for superficial external sutures; internal ones remain. |
| Tissue Reaction | Can cause a temporary inflammatory response during the absorption process. | Typically causes minimal long-term reaction but can lead to granulomas or fibrosis. |
| Use Case | Internal layers, low-tension tendon repairs, situations where long-term foreign material is undesirable. | High-tension tendon repairs (e.g., Achilles), areas requiring long-term, robust fixation. |
| Cosmetic Outcome | May promote better cosmetic results due to less scarring from long-term sutures. | May cause more potential for scarring or visible suture knots in some cases. |
Conclusion
In summary, the question of whether tendon sutures dissolve depends entirely on the material a surgeon chooses for the repair. While traditional non-absorbable sutures offer permanent strength, modern absorbable sutures have proven to be a reliable and increasingly used alternative, particularly in Achilles tendon repair. The decision balances the need for robust, long-term support with minimizing the risk of complications from foreign material. Ultimately, a patient with a tendon repair should always consult their surgeon to understand the specifics of their procedure and the type of suture used. The right choice ensures optimal healing and a successful recovery.
Common Absorbable Suture Materials for Tendons
- Polydioxanone (PDS): A synthetic monofilament suture with an extended absorption profile, often used for slow-healing tissues. Studies on flexor tendon repair have shown safe and effective use.
- Polyglactin 910 (Vicryl): A braided absorbable suture that is widely used, though its application in tendon repair has been more cautiously considered, with some comparative studies finding it comparable to non-absorbable options for certain repairs.
- Barbed Sutures (e.g., V-Loc): These newer absorbable sutures feature barbs that allow for knotless repair, reducing bulk and suture knots. They have shown promise in biomechanical studies for flexor tendon repair.
