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Sutures
Tim Brandys MD FRCSC
Objectives
At the end of this teaching session the student will recognize the following:
1. The importance of suture needle design for performance of different tasks.
2. The importance of differences in suture material for different tasks.
The student will demonstrate the ability to make appropriate needle and suture material selections for different tasks.
Sutures
Why do we care ?
Purpose of Suturing
Close the wound and provide
exogenous support of wound during healing.
Wound Healing
How long does it take ?
Healing:
week 1
wound tensile strength 15-20%
week 12
- 80%
Everything you wanted to know about sutures but were afraid to
ask!
History Earliest reports of Suture date back the
Ancient Egyptians in 3000 BC Oldest Known Suture was found in a
Mummy from 1100 BC First detailed Description of wound sutures
is from the Indian sage Sushruta in 500 BC Early Suture materials included :fibers from
plants (Flax,Hemp,Cotton) or Animal products (hair,tendon,gut)
History
History
Lister –routine sterilization of sutures in the late 1800’s
1930’S and 1950’s synthetic sutures (polyesters,polyglycolic acid)
Silk and gut sutures are the only remnants of ancient sutures still in use today
The Basics
Different needles –Different Uses
Needle Anatomy
Point Body Swage
Needle types
Taper atraumatic passes
through tissue by stretching it.
Vascular ,bowel,liver,etc Cutting
– Conventional cutting– Reverse Cutting– Traumatic– Dense tissues
skin ,fascia
Conventional Cutting
Reverse Cutting
Spatula Point
Taper point
Needle Curvature
3/8 Circle
½ circle
Straight needle
Suture Material
What ,When ,Why and Where do use different suture material ?
The BASICS
Suture Characteristics
Size: Diameter size
indicated by number of zeros
Example :7/0 small, number 2 large
Suture Characteristics
Tensile Strength: Weight required to
break divided by cross sectional area (not same as absorption time)
Strength Matters
Suture Characteristics
Memory Ability suture to
regain original form after tying a knot
Elasticity Ability to regain
original form after stretch.
Suture Characteristics
Natural /Synthetic Monofilament/
Multifilament Absorbable/Non
absorbable
Natural vs. Synthetic Natural Max Reactivity
– Gut – Silk
Synthetic Braided– Polysorb*/Vicryl– Dexon*II/S
Synthetic monofilaments– Biosyn*/Monocryl– Maxon*/PDS
Reactivity - Minimum
Monofilament
One strandSuperior tissue passageReduced knot security
Smooth surface Stiffer material
Multifilament
Multiple strands, braids
coatings Surface interstices -
capillarity Difficult tissue
passage Superior knot
security Supple strand
Absorbable/Non absorbable Absorbable –dissolves
• Non absorbable- permanent
Absorbable
Plain Gut
Strength 7 days
absorption 60 days Chromic Gut
Strength 14 days
absorption 90 days
Absorbable
Vicryl/Polysorb
Strength 28 days
Absorption 56-90 days
Absorbable
Biosyn/Monocryl
Strength 21 days
Absorption 100 days
Absorbale
Maxon/PDS 11
Strength 42 days
Absorption 180 days
Nonabsorbable
Silk Nylon (Monosof) Ticron Prolene (Surgipro)
Suture Selection
Suture & Needle selection depends on tissue type,tension exerted on wound and wound location.
Suture Selection
Site of operation Healing ability of
tissues Condition of the
patient Risk of infection Post-operatives
conditions
What sutures would you choose and why?
Closure of abdominal wall fascia
Liagation of a blood vessel
Closure of oral mucosa
Subcuticular skin closure
Suture ?
Suture?
Suture ?
Suture ?
Suture ?