SUTURES MATERIALSUTURES MATERIAL

SUTURINGSUTURING

• SUTURES:– used for putting the tissue back in place– usually use silk (non-resorbable)

• requires post-op visit to remove

– occasionally plain or chromic “gut” (resorbable) when close to student break time

• both made from sheep/cow , not “cat”

– Others (Dexon, nylon etc.) for special use

Different Types of SuturesDifferent Types of Sutures

• There are different kinds of sutures.

• Most sutures are actually done the same way but made out of different things.

• First we have to know there are two different master types, absorbable and nonabsorbable.

• Absorbable of course can be absorbed by the body naturally, and non... can't. .

What are the types of resorbable What are the types of resorbable sutures? Nonresorbable sutures?sutures? Nonresorbable sutures?

Resorbable • Plain gut • Chromic gut • Synthetic • Vicryl • Dexon

Non resorbable• Silk• Synthetic • Nylon • Mersilene • Prolene

Synthetic suture materialsSynthetic suture materials

• Absorbable – Polyglycolic Acid (Dexon) – Polyglactin (Vicryl) – Polydioxone (PDS) – Polyglyconate (Maxon)

• Non-Absorbable – Polyamide (Nylon) – Polyester (Dacron) – Polypropylene (Prolene)

Natural suture materialsNatural suture materials

• Absorbable – Catgut - Plain or chromic

• Non-Absorbable – Silk – Linen

– Stainless Steel Wire

CatgutCatgut

• Made from the submucosa of sheep gastrointestinal tract

• Broken down within about a week

• Chromic acid delays hydrolysis

• Even so it is destroyed before many wounds have healed

SilkSilk

• Strong and handles well but induces strong tissue reaction

• Capillarity encourages infection causing suture sinuses and abscesses

VicrylVicryl

• Tensile strength – 65% @ 14 days – 40% @ 21 days – 10% @ 35 days

• Absorption complete by 70 days

PolydioxonePolydioxone

• Tensile strength – 70% @ 14 days – 50% @ 28 days – 14% @ 56 days

• Absorption complete by 180 days

Absorbable suture are broken down Absorbable suture are broken down by either:by either:

• Proteolysis (e.g. Catgut)

• Hydrolysis (e.g. Vicryl, Dexon)

SUTURINGSUTURING• Info on front of package explains

– shape of needle– Thickness of suture material (higher no. thinner

suture– whether needle is “cutting” or “tapered”

Ethicon SuturesEthicon Sutures

Polyglycolic acid PCA Chromic catgut CC

Polypropylene Silk braided (SK)

• Thread length45cm,,60cm ,75cm,100cm,125cm,150cm

• Thread diameter8/0, 7/0,6/0, 5/0, 4/0, 3/0,2/0,1/0,1, 2, 3

• Needle length6mm, 8mm, 12mm, 18mm, 22mm, 30mm, 35mm, 40mm, 50mm

• Needle curvatureStraight, 1/2 circle, 1/2 circle (double), 1/4 circle, 1/4 circle (double)3/8 circle, 3/8 circle (double), 5/8 circle, loop round

• Cross section Round bodied, round bodied (heavy), curved cutting, curved cutting(heavy)Reverse cutting, reverse cutting (heavy), tapercut, micro-point spatula curved

needle identificationneedle identification

Needle shapeNeedle shape

Suture materialsSuture materials

Rapid Absorbable SutureRapid Absorbable Suture

DemeTech's Rapid Absorbable DemeTech's Rapid Absorbable Sutures Sutures

• DemeTech's Rapid Absorbable suture is a, synthetic, absorbable sterile, surgical suture composed of copolymers made from 90% glycolide and 10% L-lactide.

• . The absorption time for Rapid Absorbable is 42 to 56 days.DemeTech's Rapid Absorbable sutures are available violet and colorless.

• · DemeTech's Rapid Absorbable sutures give the best characteristics of both natural and synthetic sutures, allowing for the low infection rate of a synthetic suture, while providing the quick absorption and high tensile strength of collagen sutures (catguts).

MED EUROPE MED EUROPE

What are the principles of suturing What are the principles of suturing technique?technique?

• The suture should be grasped with the needle holder three-fourths of the distance from the tip.

• The needle should be perpendicular when it enters the tissue.

• The needle should be passed through the tissue to coincide with the shape of the needle.

• Sutures should be placed at an equal distance from the wound margin (2—3 mm) and at equal depths.

What are the principles of suturing What are the principles of suturing technique?technique?

• Sutures should be placed from mobile tissue to fixed tissue.

• Sutures should be placed from thin tissue to thick tissue.

• Sutures should not be overtightened.• Tissues should not be closed under tension.• Sutures should be 2—3 mm apart.• The suture knot should be on the side of the

wound.

When should intraoral sutures When should intraoral sutures be removed?be removed?

• In uncomplicated cases, sutures generally may be removed 5—7 days after placement.