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 ?