Sutures Tim Brandys MD FRCSC
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.
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
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
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 strand Superior tissue passage Reduced 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
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