Why sutures are a critical part of a veterinary practice

Distributor reps sell a variety of products ranging from the mundane to the latest technology. This means being a jack of all trades and a master of a few. What often gets unnoticed is the importance of being proficient when it comes to discussing surgical implants, or sutures.

Sutures are an extremely important component of any vet clinic’s surgical practice. Anyone who’s had a suture conversation with their customer knows these implants are an emotional topic. Veterinary surgeons are insistent on their expectations of suture and needle performance. Poor suture handling can be highly frustrating, and suture failure can be catastrophic from both a cost and outcomes standpoint. Any veterinary surgeon will tell you how critical sutures are to uneventful surgical outcomes. Therefore it makes sense to understand sutures and how to be clinically and economically adept at selling these products.

Sutures are a surgical implant. Implants in living tissue will either absorb, encapsulate or be rejected. A surgical implant must work at full performance 100 percent of the time. Further, whenever there is a wound complication, the first potential culprit is the suture.

Reps need to understand the three components of sutures: the suture material itself, the needle and the package.

The material
The suture material is the most obvious component to scrutinize. Because sutures are used in a gloved hand, the feel or handling must be easy, pliable and supple. Kinked or stiff suture material is less than desirable. The knots must be secure to prevent unraveling. The suture material must be very strong to resist breaking. The suture must be inert to guard against reactions or infections.

There are natural and synthetic suture materials. Natural materials include silk, chromic gut and stainless steel. These materials are fading from the scene for a variety of reasons including reactivity, breakage and high cost. Synthetic or man-made materials are manufactured from polymers that are designed specifically for surgical implants. Synthetics include materials such as PDS II, Monocryl, Nylon and Monomend. Sutures are either braided or monofilament. Braided sutures are similar to rope in that there are several filaments braided together to create one strand. Monofilaments are just what the term implies: one filament that creates a smooth, fishing line-like feel. Although most veterinarians prefer monofilaments, there are advantages to braided sutures too. Braided sutures tend to be more limp and supple, while monofilaments glide through tissue smoothly and behave well in the presence of infection. Whether your customer prefers a braided or monofilament depends on their training, experience and handling preference.
Absorbable sutures are designed as a temporary mechanism to hold wound edges together while healing. Once the wound heals, the suture absorbs and is eliminated from the patient’s body. Because sutures are foreign materials, it is often preferable to have them go away once their function is complete. Thus, the veterinary suture market consists mostly of synthetic, absorbable sutures. These materials include PDS II, Monocryl, Maxon, Vicryl, Monomend, etc.
It’s important for everyone to understand the difference between the suture’s tensile strength and its absorption. Tensile strength refers to how long the suture will hold wound edges together. Absorption refers to the time required for the implant to be absorbed or digested by the body and disappear.

Synthetic absorbable sutures are the dominant implant type in veterinary surgery. There are a variety of brands that perform different functions. Some sutures hold wounds together for a short period of time and absorb very quickly. Others hold wounds together for up to six weeks and take over six months to absorb. Here is a general reference chart of synthetic absorbable suture materials:

Brand Name Tensile Strength Construction
PDS II 6-weeks Monofilament
Monocryl 3-weeks Monofilament
Vicryl 4-weeks Braided
Maxon 6-weeks Monofilament
Biosyn 3-weeks Monofilament
Monomend Max 6-weeks Monofilament
Monomend MT 3-weeks Monofilament
Monosorb 6-weeks Monofilament
Sorbacryl 3-weeks Monofilament
Polysorb 4-weeks Braided

The needle
Precise placement of sutures in tissue is very important for wound healing. The role of the suture needle is to make precise placement happen. Therefore, strong and sharp needles are extremely important. Dull needles can not only impede suture placement, they may cause additional tissue trauma. When selling a suture line, make sure you are comfortable with the sharpness and strength of the needles they come with.

The package
Finally, the packaging can make using a suture material pleasant or frustrating. When removing the suture from the package, the surgeon will grasp the needle in their needle-driver and pull the suture out. The package must allow the surgeon easy access to the needle. Remember that the package is being opened with the gloved hand. A cumbersome package can cause frustration, waste time and money. A good idea is to practice opening suture packages and placing the needle in the needle holder before making that sales call. Be prepared to demonstrate to your customer expertise in handling your suture lines. This will give you credibility in the eyes of your surgeon customer.

Pitfalls
There are numerous issues a customer will encounter when using sutures. As a distributor representative, it’s important to understand what frustrates your customer. Issues include:
Sutures that are stiff or kinked, which is a result of high memory
Sutures that break while tying
Knots which become unraveled
Inconsistent suture diameter, which can cause tissue trauma
Tissue reactions or infections
Dull needles
Bending needles
Broken needles
Needles that become detached from the suture
Needles that twist or rock in the needle holder
Packaging that is difficult to open and access the needle.

Some reps have found that promoting the lowest cost sutures doesn’t always save the customer money in the long run. If a suture breaks or the needle becomes unusable, the surgeon will have to open additional packages. At best, this mitigates any cost savings and often leads to increased costs. Tissue reactions and infections will also significantly drive up the cost to your clinic. It’s always a good idea to encourage the surgeon to use a quality surgical implant and find cost savings in less critical areas. Most surgeons are loyal to the most expensive suture brands because of their concerns about the costs associated with wound complications. Distributor reps who take advantage of suture manufacturer training programs will lend value by being informed and credible in the eyes of the surgeon.