Monocryl is a synthetic, absorbable monofilament suture material. It is available in dyed and undyed forms. Undyed Monocryl 4-0 suture is advantageous when subcuticular stitches are taken in a patient with light coloured skin, in order that the suture does not show through. Monocryl 4-0 suture is especially suited for the closure of skin after adequate closure of subcutaneous tissue and that forms a platform for the subcuticular skin closure with this particular suture size.
As compared to Vicryl, which is a multifilament suture, 4-0 Monocryl is a monofilament suture. Though this feature makes knotting a little more difficult, it also means that it can be used in tissues likely to be harbouring infection. The problem with multifilament sutures (braided) like Vicryl is that bacteria lodges into the crevices created by multifilament knots and have the potential to infect a wound.
As compared to a suture material like Catgut, 4-0 Monocryl incites a tissue reaction of much lower intensity. This allows for it to be used in the closure of skin. Suture materials causing significant tissue reactions, if used in the closure of skin, would have a high incidence of causing wound inflammation and tissue granulomas. Ultimately these would lead to a worse cosmetic outcome, and poor wound healing, along with increased risk of infection.
The tensile strength of Monocryl 4-0 suture is at fifty to sixty percent at one week and twenty to thirty percent at two weeks after suture placement. This is slightly lower than Vicryl which maintains a tensile strength of approximately sixty percent at two weeks. Therefore; Monocryl 4-0 is absorbed completely by ninety to one hundred and twenty days. The properties of Monocryl coincide well with the closure of skin and the time required for skin wounds to heal.
A good tip to keep in mind when using Monocryl 4-0 sutures is that this suture has considerable memory. It is more pliable than synthetic non absorbable (permanent) sutures, but needs to have the memory removed prior to initiation of closure of skin. The techniques of using 4-0 Monocryl to close skin include options to leave the terminal knots inside the dermis for a seamless closure, or creating the knots outside, requiring removal after a period of ten to fourteen days. The most important thing to get a good closure of skin when selecting a 4-0 strand in size; is to have an entry perpendicular to the plane of the dermis and to try and go as deep in the dermis as possible to keep the tissue reaction furthest away from the skin surface.
Monocryl 4-0 absorbable sutures on a nineteen millimetre PS-2 reverse cutting needle which is three eights of a circle is used a lot in plastic and cosmetic surgery. Usually most absorbable sutures come in different lengths, although not all of the suture material available comes in every suture size and every suture needle combination. The Ethicon item code on this particular suture/needle combo is Y426H and it is twenty seven inches long (seventy centimetres).
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