Biocompatibility and mechanisms of aseptic inflammation in the use of suture materials in surgery
DOI:
https://doi.org/10.15574/PS.2025.4(89).93100Keywords:
aseptic inflammation, absorbable suture material, non-absorbable suture materialAbstract
Any suture material intended for medical use must be characterized by a high level of biological compatibility. Biocompatibility is generally considered to be a material's ability to interact harmoniously with living tissue, its "affinity" with the body, which minimizes negative immune and inflammatory reactions.
Aim - to evaluate contemporary suture materials in terms of their physical and mechanical properties, biocompatibility, and effects on body tissues, as well as to determine the advantages of synthetic absorbable materials compared with traditional natural threads.
The analysis was conducted based on contemporary literature sources available in the PubMed, Scopus, Web of Science databases and experimental and clinical data concerning the use of suture materials in surgery. At the current stage of development of surgical practice, suture material must demonstrate a high level of biological activity, and, first of all, demonstrate the ability to resist infectious agents. The best thread should have the following basic properties: have the highest possible tensile strength, have knot stability in dry and wet conditions, have a relative elongation of the thread within 25±10% and a minimally high Young's modulus, be atraumatic, have an optimal thread surface texture, have balanced hydrophilicity, have non-pyrogenic properties, and cause a minimal tissue reaction of the local immune system during absorption.
Conclusion. Synthetic suture materials (both absorbable and non-absorbable) represent an optimal choice for contemporary surgery due to their high biocompatibility, predictable mechanical properties, controlled resorption, and minimal tissue reaction. Their use contributes to improved surgical outcomes and a reduced incidence of postoperative complications.
No conflict of interests was declared by the authors.
References
Ajmeri JR, Ajmeri MCJ. (2006). Surgical sutures: the largest textile implant material. In S.C. Anand, J.F. Kennedy, M. Miraftab, S. Rajendran (Reds.), Medical Textiles and Biomaterials for Healthcare. Woodhead Publishing: 432-440. https://doi.org/10.1533/9781845694104.7.432
Amani H, Alipour M, Shahriari E, Taboas JM. (2024). Immunomodulatory Biomaterials: Tailoring Surface Properties to Mitigate Foreign Body Reaction and Enhance Tissue Regeneration. Advanced Healthcare Materials. 13(29): 2401253. https://doi.org/10.1002/adhm.202401253; PMid:39370571
Balomenos DB, Gοuletsοu PG, Galatos AD. (2023). Comparison of Absorbable and Nonabsorbable Sutures for Intradermal Skin Closure in Dogs. Vet Sci. 10(2): 105. https://doi.org/10.3390/vetsci10020105; PMid:36851409 PMCid:PMC9960444
Bespalova OM. (2021). Biomaterily ta biosumisnistʹ [Elektronnyy resurs] : navchalʹnyy posibnyk dlya zdobuvachiv stupenya bakalavra za osvitnʹoyu prohramoyu «Medychna inzheneriya» «Reheneratyvna ta biofarmatsevtychna inzheneriya» spetsialʹnistʹ 163 «Biomedychna inzheneriya». KPI im. Ihorya Sikorsʹkoho ; uklad. O. YA. Bespalova. Kyyiv: KPI im. Ihorya Sikorsʹkoho: 97.
Bilash S, Pronina O, Ksyonz I, Koptev M, Oliinichenko YO, Kononov B. (2024). Analysis of early morphological and functional perivulnar changes in the mucosa of the cecum after suturing with different surgical threads. Paediatric Surgery (Ukraine). 1(82): 43-49. https://doi.org/10.15574/PS.2024.82.43
Byrne M,Aly A. (2019). The Surgical Suture. Aesthet Surg J. 39; Suppl 2: S67-s72. https://doi.org/10.1093/asj/sjz036; PMid:30869751
Chittoria RK, Reddy BP. (2023). Suture materials - Recent advances. Cosmoderma. 3: 175. https://doi.org/10.25259/CSDM_176_2023
Clark CG, Wyllie JH, Haggie SJ, Renton P. (1977). Comparison of catgut and polyglycolic acid sutures in colonic anastomoses. World Journal of Surgery. 1(4): 501-504. https://doi.org/10.1007/BF01565923; PMid:910457
D'Cunha P, Pande B, Kathalagiri MS, Moharana AK, Deepak T, Pinto CS. (2022). Absorbable sutures: chronicles and applications. International Surgery Journal. 9(7): 1383-1394. https://doi.org/10.18203/2349-2902.isj20221733
Dapunt U, Prior B, Kretzer JP, Hänsch GM, Gaida MM. (2021). The effect of surgical suture material on osteoclast generation and implant-loosening. [Research Paper]. International Journal of Medical Sciences. 18(2): 295-303. https://doi.org/10.7150/ijms.50270; PMid:33390798 PMCid:PMC7757137
Dennis C, Sethu S, Nayak S, Mohan L, Morsi Y,Manivasagam G. (2016). Suture materials - Current and emerging trends. Journal of Biomedical Materials Research Part A. 104(6): 1544-1559. https://doi.org/10.1002/jbm.a.35683; PMid:26860644
Elgohary DH, Saad MA, Salem MM, Sherazy EH, Khalifa TF. (2025). Assessment the properties of various surgical sutures. Scientific Reports. 15(1): 33330. https://doi.org/10.1038/s41598-025-20311-3; PMid:41023094 PMCid:PMC12480881
Faris A, Khalid L, Hashim M, Yaghi S, Magde T, Bouresly W et al. (2022). Characteristics of Suture Materials Used in Oral Surgery: Systematic Review. Int Dent J. 72(3): 278-287. https://doi.org/10.1016/j.identj.2022.02.005; PMid:35305815 PMCid:PMC9275112
Gfroerer S, Baumann P, Schwalbach AK, Smirnoff A. (2019). Prospective international multicenter observational study of Novosyn® Quick for skin closures in adults and children (SKINNOQ). BMC Surg. 19(1): 47. https://doi.org/10.1186/s12893-019-0506-8; PMid:31046730 PMCid:PMC6498545
Gonchar S, Pronina O. (2011). Structural, functional and morphological characteristics of changes in kidney tissues in early period after experimental nephrotomy and application of standard catgut and larginine modified catgut. Bulletin of Problems Biology and Medicine. 11(2): 15-19.
Gorovyi VI. (2018). Features of the use of modern suture material in operations on organs of the genitourinary system. Health of woman. 2(115): 39-45.
Greenberg JA, Clark RM. (2009). Advances in suture material for obstetric and gynecologic surgery. Rev Obstet Gynecol. 2(3): 146-158.
Guarino N, Vallasciani SA,Marrocco G. (2009). A new suture material for hypospadias surgery: a comparative study. J Urol. 181(3): 1318-1322. https://doi.org/10.1016/j.juro.2008.10.056; PMid:19157423
Gupta V. (2025). Potential of Natural Plant-Based Materials in the Development of Biocompatible Drug-Eluting Surgical Sutures: A Review. Biomedical Materials & Devices. 3(2): 1125-1149. https://doi.org/10.1007/s44174-024-00259-0
Hryn V, Kostylenko Y, Maksymenko O. (2023). The greater omentum and similar serous formations of testis in male white rats. Folia Morphologica. 82(4): 854-861. https://doi.org/10.5603/FM.a2022.0095; PMid:36472401
Hryn V, Kostylenko Y, Maksymenko O. (2023). General Morphological Characteristics of the Results of Experimental Modeling of Aseptic Peritonitis. Annals of Anatomy - Anatomischer Anzeiger. 250: 152160. https://doi.org/10.1016/j.aanat.2023.152160; PMid:37739240
Hryn V, Kostylenko Y, Maksymenko O, Svintsytska N, Bilash V, Tykhonova O et al. (2024). Morphology of Catgut Implant Destruction in the Peritoneal Cavity of Male White Rats. Journal of Morphological Sciences. 41: 154-160. doi: 10.51929/jms.41.154.2024.
Hryn V, Maksymenko O. (2024). Morphological Characteristics of the Results of Experimental Modeling of Septic Peritonitis. International Journal of Morphology. 42(2): 446-451. https://doi.org/10.4067/S0717-95022024000200446
Jo Y-Y, Kweon H, Kim D-W, Kim M-K, Kim S-G, Kim J-Y et al. (2017). Accelerated biodegradation of silk sutures through matrix metalloproteinase activation by incorporating 4-hexylresorcinol. Scientific Reports. 7(1): 42441. https://doi.org/10.1038/srep42441; PMid:28205580 PMCid:PMC5304327
Khanuja K, Burd J, Ozcan P, Peleg D, Saccone G, Berghella V. (2022). Suture type for hysterotomy closure: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM. 4(6): 100726. https://doi.org/10.1016/j.ajogmf.2022.100726; PMid:35995367
Kim A, Downer MA, Berry CE, Valencia C, Fazilat AZ, Griffin M. (2023). Investigating Immunomodulatory Biomaterials for Preventing the Foreign Body Response. Bioengineering. 10(12): 1411. https://doi.org/10.3390/bioengineering10121411; PMid:38136002 PMCid:PMC10741225
Kim H, Hwang K, Yun SM. (2020). Catgut and its Use in Plastic Surgery. Journal of Craniofacial Surgery. 31(3): 876-878. https://doi.org/10.1097/SCS.0000000000006149; PMid:32195830
Kuzu T. (2022). Comparison tensile strength of different sutur materials. Cumhuriyet Dental Journal. 24: 355-360. https://doi.org/10.7126/cumudj.978167
Li Y, Meng Q, Chen S, Ling P, Kuss MA, Duan B et al. (2023). Advances, challenges, and prospects for surgical suture materials. Acta Biomater. 168: 78-112. https://doi.org/10.1016/j.actbio.2023.07.041; PMid:37516417
Lovric V, Goldberg MJ, Heuberer PR, Oliver RA, Stone D, Laky B et al. (2018). Suture wear particles cause a significant inflammatory response in a murine synovial airpouch model. J Orthop Surg Res. 13(1): 311. https://doi.org/10.1186/s13018-018-1026-4; PMid:30522505 PMCid:PMC6282382
Maftei G, Mârțu C, Popa C, Geleţu G, Danila V, Jelihovschi I et al. (2019). The Biomechanical Properties of Suture Materials and Their Relationship to Bacterial Adherence. Materiale Plastice. 56: 980-985. https://doi.org/10.37358/MP.19.4.5295
Mariani E, Lisignoli G, Borzì RM, Pulsatelli L. (2019). Biomaterials: Foreign Bodies or Tuners for the Immune Response? International journal of molecular sciences. 20(3): 636. https://doi.org/10.3390/ijms20030636; PMid:30717232 PMCid:PMC6386828
Narasimhan AK, Rahul TS, Krishnan S. (2023). Chapter 9 - Revisiting the properties of suture materials: an overview. In S. Thomas, P. Coates, B. Whiteside, B. JosephK. Nair (Reds.), Advanced Technologies and Polymer Materials for Surgical Sutures. Woodhead Publishing: 199-235. https://doi.org/10.1016/B978-0-12-819750-9.00011-5; PMid:36717878 PMCid:PMC9885388
Pillai CKS, Sharma CP. (2010). Review Paper: Absorbable Polymeric Surgical Sutures: Chemistry, Production, Properties, Biodegradability, and Performance. Journal of Biomaterials Applications. 25(4): 291-366. https://doi.org/10.1177/0885328210384890; PMid:20971780
Prem K, Janoria S, Kumar P. (2018). Secondary stone formation over a suture material after partial nephrectomy. BMJ Case Rep. 2018: bcr2017221569. https://doi.org/10.1136/bcr-2017-221569; PMid:29298785 PMCid:PMC5775761
Pronina OM, Bilash SM, Kobeniak MM, Oliinichenko YO, Koptev MM, Pirog-Zakaznikova AV et al. (2025). Comparative assessment of morphometric parameters of structural elements of crypts of the cecum using surgical threads polyglactin-910 and polycaprolactone modified with l arginine in the experiment. Azerbaijan Medical Journal. 183-189. https://doi.org/10.34921/amj.2025.1.032
Pronina OM, Bilash SM, Ksyonz IV, Kobeniak MM, Oliinichenko YO, Koptev MM et al. (2025). Morphometric features of the structural organisation of rabbit large intestine crypts after colotomy using polycaprolactone thread modified with L-arginine. Paediatric Surgery (Ukraine). 1(86): 33-39. https://doi.org/10.15574/PS.2025.1(86).3339
Quinn J, Panasenko SI, Leshchenko Y, Gumeniuk K, Onderková A, Stewart D et al. (2024). Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2. Mil Med. 189(1-2): 17-29. https://doi.org/10.1093/milmed/usad253; PMid:37647607
Salem EA. (2018). Modified 16-Dot plication technique for correction of penile curvature: prevention of knot-related complications. Int J Impot Res. 30(3): 117-121. https://doi.org/10.1038/s41443-018-0018-6; PMid:29736012
Sarikaya K, Senocak C, Sadioglu FE, Ciftci M, Yordam M, Bozkurt OF et al. (2022). Is there any advantage in the use of absorbable sutures in congenital penile curvature surgery performed in childhood? Rev Int Androl. 20(3): 158-162. https://doi.org/10.1016/j.androl.2020.12.005; PMid:35624015
Selvi F, Cakarer S, Can T, Kirli Topcu S, Palancioglu A, Keskin B et al. (2016). Effects of different suture materials on tissue healing. J Istanb Univ Fac Dent. 50(1): 35-42. https://doi.org/10.17096/jiufd.79438; PMid:28955553 PMCid:PMC5573451
Skoruk R. (2013). Morphological and morphometričal analysis of reaction of liver tissues and skeletal muscle polìfìlamentnogo implantation of surgical suture material of silk. Tavria Medical and Biological Bulletin. 13(2): 178-182.
Snodgrass W, Yucel S. (2007). Tubularized incised plate for mid shaft and proximal hypospadias repair. J Urol. 177(2): 698-702. https://doi.org/10.1016/j.juro.2006.09.104; PMid:17222659
Tagliaferri V, Ruggieri S, Taccaliti C, Gentile C, Didonna T, D'asta M et al. (2021). Comparison of absorbable and permanent sutures for laparoscopic sacrocervicopexy: A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica. 100(2): 347-352. https://doi.org/10.1111/aogs.13997; PMid:32970837
Tatalović V, Marinković M, Perić R, Belopavlović R. (2024). Absorbable vs. non-absorbable suture: which one gives better results? Irish Journal of Medical Science (1971-). 193(5): 2341-2348. https://doi.org/10.1007/s11845-024-03710-9; PMid:38771464
Wahyudi I, Raharja PAR, Situmorang GR, Rodjani A. (2023). Associations between suturing techniques and suture materials with complications of tubularised incised plate urethroplasty: A systematic review and meta-analysis. Journal of Pediatric Surgery Open. 1: 100003. https://doi.org/10.1016/j.yjpso.2023.100003
Xu L, Liu Y, Zhou W, Yu D. (2022). Electrospun Medical Sutures for Wound Healing: A Review. Polymers (Basel). 14(9): 1637. https://doi.org/10.3390/polym14091637; PMid:35566807 PMCid:PMC9105379
Yaltirik M, Dedeoglu K, Bilgic B, Koray M, Ersev H, Issever H et al. (2003). Comparison of four different suture materials in soft tissues of rats. Oral Dis. 9(6): 284-286. https://doi.org/10.1034/j.1601-0825.2003.00954.x; PMid:14629327
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
