Sutures

1. Sutures Tim Brandys MD FRCSC

2. Objectives At the end of this teaching session the student will recognize the following: • The importance of suture needle design for performance of different tasks. • 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.

3. Sutures Why do we care ?

4. Purpose of Suturing Close the wound and provide exogenous support of wound during healing.

5. Wound Healing • How long does it take ? • Healing: week 1 wound tensile strength 15-20% week 12 - 80%

6. Everything you wanted to know about sutures but were afraid to ask!

7. 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)

8. History

9. 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

10. The Basics

11. Different needles –Different Uses

13. Needle Anatomy • Point • Body • Swage

14. Taper point Spatula Point Conventional Cutting Reverse Cutting Needle types • Taper atraumatic passes through tissue by stretching it. Vascular ,bowel,liver,etc • Cutting • Conventional cutting • Reverse Cutting • Traumatic • Dense tissues skin ,fascia

15. Needle Curvature • 3/8 Circle • ½ circle • Straight needle

16. Suture Material What ,When ,Why and Where do use different suture material ?

17. The BASICS

18. Suture Characteristics Size: • Diameter size indicated by number of zeros • Example :7/0 small, number 2 large

19. Suture Characteristics Tensile Strength: • Weight required to break divided by cross sectional area (not same as absorption time) Strength Matters

20. Suture Characteristics Memory • Ability suture to regain original form after tying a knot Elasticity • Ability to regain original form after stretch.

21. Suture Characteristics • Natural /Synthetic • Monofilament/Multifilament • Absorbable/Non absorbable

22. Natural vs. Synthetic • Natural Max Reactivity • Gut • Silk • Synthetic Braided • Polysorb*/Vicryl • Dexon*II/S • Synthetic monofilaments • Biosyn*/Monocryl • Maxon*/PDS Reactivity - Minimum

23. Monofilament One strand Superior tissue passage Reduced knot security Smooth surface Stiffer material

24. Multifilament • Multiple strands, braids • coatings • Surface interstices - capillarity • Difficult tissue passage • Superior knot security • Supple strand

25. Absorbable/Non absorbable • Absorbable –dissolves • Non absorbable- permanent

26. Absorbable • Plain Gut Strength 7 days absorption 60 days • Chromic Gut Strength 14 days absorption 90 days

27. Absorbable • Vicryl/Polysorb Strength 28 days Absorption 56-90 days

28. Absorbable • Biosyn/Monocryl Strength 21 days Absorption 100 days

29. Absorbale • Maxon/PDS 11 Strength 42 days Absorption 180 days

30. Nonabsorbable • Silk • Nylon (Monosof) • Ticron • Prolene (Surgipro)

31. Suture Selection • Suture & Needle selection depends on tissue type,tension exerted on wound and wound location.

32. Suture Selection • Site of operation • Healing ability of tissues • Condition of the patient • Risk of infection • Post-operatives conditions

33. What sutures would you choose and why? • Closure of abdominal wall fascia • Liagation of a blood vessel • Closure of oral mucosa • Subcuticular skin closure

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