Needles & SuturesHow to Select and Understand
Shady Nafie - Urology LAT
James Cook University Hospital
February 2015
Historical Landmarks
• Oldest known medical record describing trauma and sutures
• Ancient Egyptian, dated 3500 B.C.
• Edwin Smith Surgical Papyrus, discovered 1862
• Sutures were fashioned from hair, cotton or silk.
Historical Landmarks
• Joseph Lister, British surgeon and pioneer of antiseptic surgery.
• Tried to sterilise silk suture in carbolic acid, unsuccessful.
• Sterilised catgut, marked reduction in incidence of infection, 1869.
Historical Landmarks
• Robert Wood Johnson and brothers established Johnson & Johnson, 1885.
• Mass production of sterile catgut, 1886.
• Independent division of suture production - Ethicon, 1956.
The Point
• Needle body is round and tapers smoothly to a point. For soft tissue e.g. bowels, blood vessels.
• Needle body is round and has a blunt end. Reduces risk of needle sticks. For less dense internal tissue e.g. muscle and fascia.
The Point
• Needle body is triangular and has a sharpened cutting edge on the inside curve. For tough tissue e.g. skin, tendons
• Cutting edge on the outside . Decrease the likelihood of sutures pulling through tissue.
The Eye (End)
Closed Swaged
• Non traumatic.
• Minimise handling & preparation.
• Don't unthread prematurely.
• More traumatic.
• Unthreads prematurely.
• More intaoperative handling.
Suture MaterialsAbsorbable
(<60 days)Non-Absorbable
(>60 days)
Advantages -Broken down by body-No foreign body left
-Permanent wound support
Disadvantages-Limited time of wound support
-Suture sinus-Foreign body left
Suture MaterialsSynthetic Natural
Advantages
-Absorption by hydrolysis
-Predictable absorption-Strength
-Handling & knotting-Economic
Disadvantages -Monofilament handling -Tissue reaction
Suture MaterialsMonofilament Braided
Advantages
-Smooth-Less tissue trauma-Less infection-No capillarity
-Strength-Soft & Pliable-Good handling-Good Knotting
Disadvantages-Slippery handling-Less Pliable-More Knotting
-Capillary action-Tissue trauma-Harbours bacteria
Suture MaterialsAbsorbable
(<60 days)Non-Absorbable
(>60 days)
Monofilament- Gut
- Monocryl (2/52)- PDS (3/52)
- Steel- Nylon
- Prolene
Braided - Vicryl (2/52)
- Silk- Cotton
- Ethibond- Dacron
Suture Sizes
USP size Diameter in mm
10-0 0.02
8-0 0.04
5-0 0.10
4-0 0.15
3-0 0.20
2-0 0.30
0 0.35
1 0.40
2 0.50
3 0.60
United States Pharmacopeia (USP)
Suture Packing
Suture size
Material
Length
Product code
Needle shape
Needle length
Suture colour
Point type
Needle circle
Needle code
Ideal Suture• Gentle passage through tissues
• Comfortable handling
• Knot security
• Maximum tensile strength
• Consistent performance
• Minimal tissue reaction
• Predictable absorption