INTRODUCTION
In dermatologic surgery, the two main configurations of suture are monofilament and multifilament. Suture selection is based on various biologic factors but also personal experience, mentor preferences, availability, as well as cost effectiveness. There are few comparative studies evaluating suture choice, especially in terms of cost.
There is a perception that monofilament sutures are significantly more expensive than multifilament, possibly influencing some to avoid monofilament sutures. In 2006, Adams et al reported that 73% of surgeons choose polyglactin-910 (multifilament suture) followed distantly by poliglecaprone-25 (11%) and polydioxanone (5.5%) (monofilament sutures).1 While there was no direct explanation, we surmise it was due to previous experience and cost. In recent years, there has been a price decrease in monofilament sutures, making this option more accessible.
Some theoretical advantages to monofilament sutures com-pared with multifilament sutures include a lower coefficient of friction and decreased risk for postoperative infection or inflammatory response due to their decreased capillarity when compared with braided multifilament.2 Regan and Lawrence demonstrated that poliglecaprone-25 had a significantly decreased risk of suture extrusion when compared with poly-glactin-910 and that the appearance of extruded polyglactin-910 sutures was more inflammatory and noticeable to the patient.3
Another benefit of monofilament sutures includes their ability to be employed as the sole suture material in closing defects that require both a subcutaneous and epidermal repair. Yag-Howard and Lavelle reported their experience with using poliglecaprone-25 alone and demonstrated excellent cosmetic outcomes, increased patient convenience, and cost savings of between $4 and $12 per surgery when using one package of poliglecaprone-25 compared with using one absorbable and one nonabsorbable suture.4
While more comparison studies need to be done between monofilament and multifilament sutures, we hypothesize that dermatologists are unaware of the nearly negligible cost differences between monofilament and multifilament sutures.
