The role of sutures and fibrin sealant in wound healing

Sutures and fibrin sealant are important surgical aids for facilitating wound closure and creating an optimal setting for wound healing. Most commonly, sutures are used to close wounds because suture material provides the mechanical support necessary to sustain closure. A wide variety of suturing material is available, and the surgeon can choose among sutures with a range of attributes to find the one best suited to his or her needs. Considerations when choosing an appropriate suture for wound closure and healing include strength of suture, holding power of tissue, absorbability, risk of infection, and inflammatory reaction associated with the suture material. Other factors to be considered include type of incision, suturing technique, and appearance of wound site. Fibrin sealant, in contrast, is a biologic tissue adhesive that can function as a useful adjunct to sutures. Fibrin sealant can be used in conjunction with sutures or tape to promote optimal wound integrity, or it can be used independently to seal wound sites where sutures cannot control bleeding or would aggravate bleeding. This adhesive can effectively seal tissue planes and eliminate potential spaces. Fibrin sealant has been used clinically in many surgical applications, although an FDA-approved commercially available product does not yet exist in the United States. Clinically, fibrin sealant has resulted in a low rate of infection and has promoted healing. Further study is needed to determine the best fibrin sealant mixtures both to achieve hemostasis and to encourage healing. It may even be desirable to use different sealant formulations for particular clinical situations.