Introduction
Monocryl and Vicryl are two of the most commonly used absorbable suture materials in surgical skin closure. Yet many surgeons struggle with selecting the optimal material for specific surgical contexts—a decision that significantly impacts wound healing outcomes, cosmetic results, and patient comfort.
Wound complications occur in 5-10% of surgical closures, with suture material selection playing a critical role in these outcomes.
These selection challenges stem from fundamental differences between the two materials. Both are synthetic absorbable sutures, but they differ in composition, absorption rates, and clinical performance characteristics.
Monocryl is a monofilament suture that loses 70-80% of its tensile strength within 1-2 weeks. Vicryl maintains approximately 50% strength at 2-3 weeks due to its braided multifilament structure. Understanding these differences allows surgeons to select the best closure technique for each surgical scenario.
TL;DR
- Monocryl delivers superior cosmetic outcomes with minimal tissue drag—ideal for subcuticular closure
- Vicryl maintains 50% strength at 2-3 weeks with excellent knot security for deeper layers
- Complete absorption within 56-120 days eliminates follow-up removal appointments
- Choose Monocryl for clean wounds prioritizing cosmesis; Vicryl for deeper layers needing extended support
- Selection factors: tissue depth, healing timeline, infection risk, and cosmetic priority
Monocryl vs Vicryl: Quick Comparison
Composition and Structure
Monocryl:
- Composed of poliglecaprone 25
- Monofilament copolymer of glycolide and ε-caprolactone
- Smooth, single-strand structure minimizes tissue drag and bacterial adherence
Vicryl:
- Composed of polyglactin 910
- Braided multifilament copolymer (90% glycolide, 10% L-lactide)
- Coated with calcium stearate and polyglactin 370 for improved handling
Absorption Timeline
Monocryl:
- Retains 60-70% tensile strength at 1 week (dyed version)
- Retains 30-40% strength at 2 weeks
- Complete absorption in 91-119 days
Vicryl:
- Retains 75% tensile strength at 2 weeks
- Retains 50% strength at 3 weeks
- Complete absorption in 56-70 days (standard) or 42 days (Vicryl Rapide)
Tensile Strength and Knot Security
Monocryl:
- High initial breaking strength comparable to PDS
- Moderate knot security requires up to 6 throws
- Monofilament memory affects knot retention
Vicryl:
- Moderate initial tensile strength (size 3-0: ~3.90 kgf or 38 N)
- Superior knot security with only 4 throws needed
- Braided structure provides excellent knot retention
Tissue Reaction and Handling
Monocryl:
- Minimal tissue drag and lower bacterial adherence
- Higher memory affects handling
- Causes only slight tissue reaction
Vicryl:
- Higher tissue drag and capillarity (wicking) from braided structure
- Excellent flexibility with low memory
- Mild tissue reaction during absorption
Clinical Applications
Monocryl: Ideal for subcuticular skin closure, cosmetic procedures, pediatric surgery, and contaminated wounds where bacterial wicking is a concern.
Vicryl: Preferred for fascia, muscle, subcutaneous layers, mucosal closure, and applications requiring sustained strength beyond 2 weeks.
What is Monocryl?
Monocryl is a synthetic absorbable monofilament suture made from poliglecaprone 25, designed specifically for surgical applications where cosmetic outcomes are paramount.
Its monofilament structure provides smooth passage through tissue with minimal trauma, making it the preferred choice for subcuticular skin closure in plastic surgery, obstetrics, and pediatric procedures.
The monofilament design significantly reduces bacterial adherence compared to braided sutures. Studies show that monofilament surfaces have substantially lower microbial colony counts, making Monocryl preferable for contaminated sites or high-risk closures.
The smooth surface eliminates capillary action (wicking), which decreases infection risk in potentially contaminated wounds. These infection-resistance properties make Monocryl particularly valuable across surgical specialties.
Core Benefits in Surgical Practice
Rapid Absorption Profile
Monocryl's absorption timeline aligns with tissues that heal quickly—skin and subcutaneous tissue—without prolonged foreign body presence. This rapid profile minimizes the inflammatory response during the critical healing phase.
Superior Cosmetic Outcomes
The monofilament structure causes minimal tissue trauma during passage. In a randomized trial comparing Monocryl to nylon for carpal tunnel release, Monocryl resulted in significantly better early scar quality scores (POSAS) and reduced pillar pain at 6 weeks, demonstrating its cosmetic advantages.
Clinical advantages also include:
- Reduced infection risk through monofilament design that prevents bacterial wicking
- High initial tensile strength (60-70% at one week) during critical healing phase
- Lower bacterial adherence compared to braided alternatives in contaminated wounds
Variations and Product Line
Monocryl is available in:
- Sizes: USP 2 through 6-0 (4-0 commonly used for skin closure)
- Colors: Violet (dyed) for better visibility and Undyed (natural/beige)
- Needles: Various configurations including Taperpoint and Reverse Cutting
- Monocryl Plus: Contains triclosan (Irgacare MP) to inhibit colonization by Staphylococcus aureus and E. coli
Use Cases of Monocryl
Primary applications include:
- Subcuticular (intradermal) skin closure for surgical incisions
- Plastic surgery and facial procedures
- Cesarean sections
- Pediatric surgery where cosmesis is priority
Clinical Scenario Example: A 35-year-old patient undergoing elective cosmetic abdominoplasty received subcuticular closure with 4-0 Monocryl. At 3-month follow-up, the incision showed minimal visible scarring with excellent wound approximation.
Contraindications: Not recommended for tissues requiring support beyond 2 weeks (fascia, tendon) or high-tension closures where extended strength retention is critical.
What is Vicryl?
Vicryl is a synthetic absorbable braided multifilament suture composed of polyglactin 910, widely used across surgical specialties for both superficial and deep tissue closure.
Its braided structure, coated with calcium stearate and polyglactin 370, provides excellent handling characteristics and knot security that many surgeons prefer over monofilament alternatives.
The braided multifilament construction creates superior knot security compared to monofilaments.
However, this structure increases tissue drag and creates capillarity, which can allow bacterial transport along the suture material—a consideration in contaminated wound environments.
Core Benefits in Surgical Practice
- Retains approximately 75% of original tensile strength at 2 weeks and 50% at 3 weeks, making it suitable for fascia and muscle requiring longer support periods
- Reduces knot slippage risk—braided sutures achieve security with 4 throws, while monofilaments may require up to 6 throws for comparable security
- Pliability and low memory make it easier to work with, especially for less experienced surgeons or challenging anatomical locations
- Functions as a workhorse suture suitable for skin, subcutaneous tissue, muscle, and fascial layers—offering surgeons a single material for multilayer closures
Variations and Product Line
Standard Vicryl: For general applications with absorption over 56-70 days
Vicryl Rapide: Irradiated version with accelerated absorption—loses 50% strength by 5 days, completely absorbed by 42 days. Specifically designed for superficial closures and mucosal repairs.
Coated vs. Uncoated: Coating improves tissue passage and handling but may slightly reduce knot security.
Use Cases of Vicryl
Widely Used For:
- Deeper tissue layer closure (muscle, fascia, subcutaneous tissue)
- Abdominal, thoracic, orthopedic, and gynecologic surgery
- Mucosal repairs and bowel anastomoses
- Applications requiring sustained strength beyond 2 weeks
Clinical Example: In multilayer closure for open abdominal surgery, a surgeon uses 2-0 Vicryl for the fascial layer and 3-0 Vicryl for subcutaneous tissue. This approach demonstrates versatility across tissue depths while using a single suture type.
Vicryl remains one of the most commonly used absorbable sutures globally, with widespread adoption across surgical specialties due to its reliable performance and familiar handling characteristics.
Monocryl vs Vicryl: Which is Better?
Surgeons frequently debate this choice in the OR. The answer isn't straightforward—optimal selection depends on surgical context, tissue characteristics, healing timeline requirements, and desired outcomes.
Key Decision Factors
| Factor | Monocryl | Vicryl |
|---|---|---|
| Structure | Monofilament | Braided multifilament |
| Absorption | 90-120 days | 56-70 days |
| Tensile Strength | 50-60% at 1 week | 75% at 2 weeks |
| Ideal Applications | Subcuticular skin closure | Fascia, muscle, mucosal layers |
| Infection Risk | Lower (smooth surface) | Higher (wicking potential) |
| Cosmetic Outcome | Superior for visible areas | Functional priority |
Tissue Type and Depth:
- Skin/subcuticular closure: Monocryl's smooth monofilament structure minimizes scarring
- Fascia and muscle layers: Vicryl provides extended strength retention for structural support
Healing Timeline:
- Rapid healing tissues (under 2 weeks): Monocryl or Vicryl Rapide
- Medium healing tissues (3-4 weeks): Standard Vicryl
Cosmetic Priority:
- High cosmetic concern: Monocryl produces better aesthetic outcomes
- Functional closure priority: Vicryl offers easier handling and knot security
Infection Risk:
- Contaminated wounds: Monocryl's smooth surface reduces bacterial wicking potential
- Clean wounds: Either material works well
Situational Recommendations
Choose Monocryl When:
- Cosmetic outcome is paramount (face, neck, visible areas)
- Infection risk exists in clean-contaminated wounds
- Rapidly healing tissues require closure (skin, subcutaneous fat)
- Follow-up for suture removal is impractical or difficult
Choose Vicryl When:
- Deeper layers need extended strength retention (fascia, muscle)
- Knot security and ease of handling are priorities
- Less experienced team members will perform closure
- Mucosal surfaces or bowel anastomoses require closure
Beyond Traditional Sutures
Both Monocryl and Vicryl require manual placement and knot tying, which extends OR time. For skin closure specifically, bioabsorbable stapling systems like SubQ It! combine subcuticular placement with mechanical speed.
These devices deliver fasteners beneath the skin surface, eliminating surface punctures while achieving closure speeds comparable to metal staplers. The bioabsorbable fasteners absorb naturally, removing the need for follow-up removal appointments.
Real-World Applications and Emerging Alternatives
Clinical evidence provides important guidance for suture selection in specific surgical contexts.
Comparative Clinical Evidence
Research from multiple surgical specialties reveals performance differences between these materials.
- Cesarean Section Outcomes: A prospective cohort study (n=1,082) comparing 4-0 Monocryl and 4-0 Vicryl for subcuticular skin closure found no significant difference in surgical site infection rates01722-6/fulltext) (5.1% vs 6.1%, p=0.58), supporting the use of either material based on surgeon preference
- Episiotomy Repair: The randomized MOVE trial (n=250) comparing Monocryl vs Vicryl Rapide for intracutaneous episiotomy repair found that Monocryl resulted in significantly less dehiscence (10% vs 25%, p=0.016), suggesting superior performance for perineal skin closure
- Cosmetic Outcomes: Research demonstrates Monocryl's cosmetic advantages in procedures where scarring is a primary concern, though surgeons can achieve comparable results with both materials when proper subcuticular technique is employed
Practical Considerations
Time Efficiency: Vicryl's easier handling may be faster for some surgeons despite Monocryl's theoretical advantages. The braided structure provides better tactile feedback and knot security with fewer throws.
Learning Curve: Less experienced surgeons often find Vicryl easier to work with due to superior handling characteristics and lower memory.
Material Costs: Hospital price data indicates Monocryl 4-0 costs approximately $23.00 per unit compared to $16.00 for Vicryl 4-0, though total cost-of-care analyses suggest reduced complication rates may offset higher unit prices.
Evolution of Skin Closure Technology
Beyond comparing Monocryl and Vicryl, surgical teams increasingly evaluate alternatives that address inherent limitations of manual suturing.
Traditional suturing with these materials, while effective, still requires significant time and technical skill. Manual sutures take approximately 9 minutes for average procedures, with each subcuticular stitch requiring 42 seconds to complete.
Bioabsorbable Subcuticular Systems: Newer closure technologies like SubQ It! combine the speed advantages of traditional staplers (7X faster than manual sutures) with the cosmetic benefits of absorbable materials. These FDA-cleared systems place bioabsorbable fasteners subcutaneously rather than through the skin surface, eliminating train track scarring while maintaining closure strength. Suitable for incisions in abdominal, thoracic, gynecologic, orthopedic, and plastic/reconstructive surgery, these systems offer an alternative for teams prioritizing both OR efficiency and cosmetic outcomes.
Conclusion
The choice between Monocryl and Vicryl depends on specific surgical context, tissue characteristics, healing timeline requirements, and desired outcomes—neither is universally superior.
Practical Decision Framework:
- Use Monocryl for subcuticular skin closure prioritizing cosmesis and rapid healing tissues
- Use Vicryl for deeper layers, longer strength retention needs, and situations where handling ease is critical
- Consider bioabsorbable stapling systems like SubQ It! for faster closure times (7X faster than manual sutures) with superior cosmetic results
Surgical closure technology continues to advance beyond traditional suture materials. New bioabsorbable stapling options now complement suture selection, giving surgeons additional tools for optimizing efficiency and outcomes.
Understanding the fundamental differences between Monocryl and Vicryl—absorption profiles, structural characteristics, and clinical performance—helps you make evidence-based decisions for better patient outcomes.
Frequently Asked Questions
How long does Monocryl take to absorb compared to Vicryl?
Monocryl loses 70-80% strength within 1-2 weeks and absorbs completely in 91-119 days. Vicryl loses 50% strength at 2-3 weeks and absorbs in 56-70 days, while Vicryl Rapide absorbs faster (42 days).
Which suture material is better for cosmetic outcomes?
Monocryl generally produces superior cosmetic outcomes due to its monofilament structure causing less tissue trauma. This makes it preferred for subcuticular closure in plastic surgery and areas where scarring is a concern.
Is Monocryl or Vicryl stronger?
Monocryl has higher initial tensile strength but loses it more rapidly (30-40% remaining at 2 weeks). Vicryl maintains moderate strength longer (50% at 3 weeks). The strength comparison is context-dependent on the timeline of interest.
Can I use Monocryl and Vicryl interchangeably?
No—they have different absorption profiles and structural properties. Monocryl is optimized for subcuticular skin closure, while Vicryl is more versatile across tissue depths requiring extended support.
Which costs more: Monocryl or Vicryl?
Monocryl 4-0 costs approximately $23.00 per unit compared to $16.00 for Vicryl 4-0. However, total cost considerations including OR time, outcomes, and potential complications are more significant than material cost differences.
Do I need to remove Monocryl or Vicryl sutures?
Neither requires removal—both are absorbed by the body. This advantage extends to bioabsorbable closure systems like SubQ It!, which combines the speed of traditional staplers with absorbable subcuticular fasteners, eliminating removal appointments entirely.
