Chapter 2555: Tension

Remember there was a period when a clinical fad emerged from somewhere. Some patients were extremely afraid of sutures, insisting before any surgical procedure, big or small, that the doctor must use a good suture—one that can be absorbed by the body. These people were terrified of leaving foreign matter inside their bodies. It’s unclear where they heard the rumor that having these sutures left in the body would be deadly.

It’s easy to see why this assertion is not feasible. Absorbable sutures were invented later. By this logic, wouldn’t previous surgical patients have all been killed by non-absorbable sutures?

In considering which suture to use medically, the first step doctors must consider is certainly not whether the suture can be absorbed by the human body, but the tensile strength of the suture material.

Regarding the tension of human tissue, we discussed this from the first surgery using retractors. Once anesthesia is administered, as long as the tissue is alive, there is always a contracting tension in motion.

The purpose of using sutures in medicine to close wounds is to pull the edges together and allow the wound to heal. If the tensile strength of the suture is insufficient, it cannot withstand the contraction tension of human tissue. Consequently, when the tissues on both sides of the anastomosis repeatedly contract, this tension can easily directly break the suture, causing the wound to reopen, leading to a failed suture.

The fear of a failed suture is significant: the wound reopens—could it result in massive bleeding or fluid leakage? The wound never heals, the anastomosis leaks, repeatedly infects, and the body becomes septic—it’s truly a horrendous ordeal, and these terrifying issues are all a doctor can think about.

If the patients’ fear of the rumor that sutures in the body are deadly refers to suture infections, today’s sutures are all strictly sterilized, and the incidence rate is very low. Moreover, if non-absorbable sutures have an infection risk, absorbable sutures have too. Absorbable sutures are not immediately absorbed by the body upon stitching; otherwise, stitching would be meaningless. One must wait for the wound to heal before it is absorbed by the body, which can take anywhere from a few days to over a month.

These patients should actually be afraid of suture rejection reactions. The problem is, medical technology has developed to the point where there are strict regulations on the use of various surgical materials, clearly specifying what can be left long-term in the body and what cannot. All materials that can stay in the body must undergo compatibility testing with human tissue and be approved before use in clinical practice. This has been discussed in orthopedic materials science. Complex orthopedic materials can achieve this, and small sutures have long since passed this threshold.

At this point, it’s evident that these people’s concerns are groundless.

It’s true that some doctors can be seen in clinical practice asking patients before surgery whether to use absorbable sutures. Where are these sutures the patient can choose typically used? In the skin layer, which is relatively unrelated to the patient’s life and generally acceptable safety-wise. After all, some patients are financially strained and have limited means to pay medical expenses. Previously, these absorbable sutures, called cosmetic sutures, were very costly and fully self-funded.

When it comes to the choice of sutures relevant to the patient’s life and death, a doctor would never hand over the decision on this professional issue to patients who do not understand medicine; that would be equivalent to handing over a knife for someone to commit suicide.

Coming back to polypropylene sutures, the most common use is in blood vessels.

The advantage of this single-filament material is that it is less prone to infection compared to multi-filament sutures. Its smooth properties minimize damage when passing through body tissues, with a low rejection reaction when long-term retained in the body.