Absorbable vs Non-Absorbable Sutures

What Are Absorbable Sutures?

Absorbable sutures are wound closure materials designed to be degraded and eliminated by the body over a defined period. They provide temporary mechanical support to healing tissue and are progressively broken down, eliminating the need for a second procedure to remove them.

Modern synthetic absorbable sutures are degraded by hydrolysis — a chemical process in which water molecules cleave the ester bonds in the polymer backbone. This process is predictable and consistent across patients and tissue types. The rate of hydrolysis is determined by the polymer's chemical structure, crystallinity, and molecular weight. Highly crystalline polymers like PGA degrade faster than amorphous polymers like PDO.

The hydrolysis process occurs in two phases. In the first phase, water penetrates the amorphous (disordered) regions of the polymer, cleaving chains and causing a progressive loss of tensile strength — this is when the suture loses its load-bearing capacity. In the second phase, the crystalline regions are attacked, the polymer fragments into small molecules, and these are metabolized (primarily to glycolic acid or lactic acid) and excreted by the body. The mass loss phase is when the suture material physically disappears from tissue.

This two-phase process explains why a suture can lose all useful tensile strength (first phase) well before the material is fully absorbed (second phase). For example, DesmoNex (PGA) retains 75% strength at 2 weeks and 40% at 3 weeks, but complete mass absorption takes 60-90 days. Understanding this distinction is critical for suture selection: the clinician must match the strength retention profile — not the absorption time — to the tissue healing rate.

What Are Non-Absorbable Sutures?

Non-absorbable sutures are not broken down by the body and remain at the implantation site indefinitely. They maintain their tensile strength permanently (or near-permanently — silk gradually loses strength over 6-12 months but is still classified as non-absorbable because the material is not fully eliminated).

Non-absorbable sutures serve two distinct clinical roles. First, as permanent implants: in cardiovascular anastomoses, hernia mesh fixation, tendon reattachment, and sternal closure, the suture provides lifelong mechanical support because the repaired tissue cannot sustain physiological loads independently. Second, as temporary external closures: in percutaneous skin closure, the suture holds wound edges together during initial healing and is then removed at a follow-up visit (typically 5-14 days).

The major classes of non-absorbable suture materials include synthetic polymers (polypropylene, polyamide, polyester), natural fibers (silk, linen), and metals (stainless steel). Each offers a distinct combination of strength, inertness, and handling characteristics. Desmo Care manufactures four non-absorbable suture products: DesmoMid (polypropylene), DesmoSilk (silk), DesmoSter (stainless steel), and DesmoLen (linen).

Side-by-Side Comparison

The following table compares the fundamental characteristics of absorbable and non-absorbable sutures across key clinical parameters.

When to Use Each Type: Indications by Surgical Specialty

General Surgery

Both types are used extensively. Absorbable sutures (PGA, PDO) are standard for fascial closure, peritoneal closure, bowel anastomosis, and subcutaneous tissue approximation. DesmoNex (PGA) and Absorbex (high-strength PGA) are commonly selected for fascial closure due to their 28-35 day tissue support duration and high initial tensile strength. Non-absorbable sutures are used for skin closure (subsequently removed) and for hernia mesh fixation where permanent attachment is needed.

Cardiovascular Surgery

Non-absorbable polypropylene sutures are the standard for vascular anastomoses. DesmoMid provides permanent tensile strength, minimal tissue reaction, and its monofilament structure resists thrombogenicity. Stainless steel sutures (DesmoSter) are used for sternal closure after median sternotomy. Absorbable sutures, particularly DesmoPol (PDO) and DesmoCapro (PLLA-PCL), are used in pediatric cardiovascular surgery where tissue growth must be accommodated and permanent suture material could restrict development.

Orthopedic Surgery

Both categories are used depending on the tissue. Non-absorbable sutures are used for tendon and ligament repair where permanent fixation strength is needed. Absorbable sutures with extended strength retention — DesmoCapro (80% strength at 90 days) or DesmoPol (50% strength at 6 weeks) — are used for periosteal closure, joint capsule repair, and soft tissue approximation around fracture sites.

Plastic and Reconstructive Surgery

Absorbable monofilament sutures dominate in this specialty. Subcuticular closure with DesmoCryl (PGCL) or DesmoPol (PDO) eliminates suture marks and avoids the need for removal. Deep dermal closure with medium- to long-term absorbable sutures supports the wound while the dermis regains strength. Non- absorbable nylon or polypropylene may be used for percutaneous interrupted closure on the face, removed at 5-7 days to minimize scarring.

Ophthalmic Surgery

Very fine absorbable sutures (8/0 to 10/0) are used for conjunctival and corneal closure. DesmoNex (PGA) in fine gauges provides adequate strength with predictable absorption. Non-absorbable DesmoSilk is valued in ophthalmic surgery for its exceptional handling characteristics at fine diameters.

Obstetrics and Gynecology

Absorbable sutures are almost exclusively used. Fast-absorbing DesmoNex Rapid is the standard for episiotomy repair and perineal laceration closure — the rapid absorption (42 days) eliminates the need for suture removal in a sensitive area. Standard PGA sutures are used for uterine closure during cesarean section. PDO sutures provide extended support for cervical cerclage.

Pediatric Surgery

Absorbable sutures are strongly preferred in pediatric patients to avoid the distress of suture removal. Fast-absorbing products like DesmoNex Rapid and DesmoCryl Rapid are particularly useful for skin closure in children. For internal procedures, standard absorbable sutures are used. In pediatric cardiovascular surgery, absorbable sutures like DesmoPol are preferred to allow for tissue growth.

Desmo Care Absorbable and Non-Absorbable Product Range

Absorbable Sutures

Non-Absorbable Sutures

Frequently Asked Questions