MIAMI BEACH – An antibiotic-coated monofilament suture provides strength, flexibility, and elasticity for dermatologic surgery, but requires an extra throw to prevent knot slippage and comes with an initial learning curve, Dr. Susan H. Weinkle said.

"I’ve been using the same sutures almost 30 years until about 9 months ago," Dr. Weinkle said at this year’s South Beach Symposium.

The Monocryl Plus (poliglecaprone 25, Ethicon) is an absorbable, monofilament suture coated with triclosan antibiotic. The antibiotic "is the plus" and it can lower wound closing costs, Dr. Weinkle said.

The suture can be buried or it can run along the surface of the skin, Dr. Weinkle said. This product is associated with low tissue reactivity, so you get wounds with very little inflammation. "If someone cannot get back to my office quickly enough for suture removal, there [still] is very little reaction."

Absorption of the suture begins in about 12 days and can take considerably longer. "That’s a good thing. It stays underneath for up to 120 days, which is longer than Vicryl would last," Dr. Weinkle said. "However, (the sutures) don’t absorb fast enough on the skin. You still need to see the patient back." She asks patients to return to check wound healing anyway, especially to rule out any hematoma "because everyone I do surgery on is on (a blood thinner)."

"When I sew with Vicryl (polyglactin 910 suture, Ethicon), I tend to only put three knots in the wound. Two throws to start, and then another one on top of that." With this monofilament suture, a fourth throw is generally required to secure the knot, Dr. Weinkle said.

Wound infection risk generally is lower with a monofilament suture. In contrast, although easier to use, braided or twisted multifilament sutures carry a higher infection risk. "In a braided suture you have many more areas for fluid and bacteria to get in – that is very important."

There is an initial learning curve with this monofilament suture and "you are not going to love it in the beginning," said Dr. Weinkle, a private practice dermatologist and Mohs surgeon in Bradenton, Fla. "I sent some of these to a colleague in town and he did not like them." She added: "That is only because he tried one pack. You need at least eight packages until you can actually bond with this suture."

This suture features good elasticity, an imperative for wounds where a lot of local anesthesia was injected and edema results when the wound is closed. The suture stretches, and when that edema dissipates, the suture needs to come back down, she explained.

Using one monofilament suture compared to a two-suture closure can save costs, Dr. Weinkle said. The cost of one monofilament suture to close both deeply and superficially is about $12, compared with almost $18 to use a combination of Vicryl and nylon sutures. "Say you work 48 weeks a year and you do 30 incisions a week." Save $6 on each of these 1,440 annual wound closures "and you're looking at a savings of $8,640."

How you buy this suture is also important, Dr. Weinkle said. "I have a low overhead because I check the prices." Multiple national distributors carry this suture. "Make sure whoever you are buying from knows you’re a surgeon. Otherwise, you may end up paying more money for the same packet of sutures because you’re a dermatologist – you're a different category," Dr. Weinkle said. Also consider joining a group purchasing organization.