1. SUTURE MATERIAL

2. Critical Wound Healing Period Tissue Skin Mucosa Subcutaneous Peritoneum Fascia 5-7 days 5-7 days 7-14 days 7-14 days 14-28 days 0 5 7 14 21 28 Tissue Healing Time/Days

3. Surgical Wound Classification • Clean: (1-5% risk of infection) Operative incisionalwithout penetrating infectious organs • Clean-contaminated: (3-11% risk)operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and without unusual contamination.  the biliary tract, appendix, vagina, and oropharynx

4. Surgical Wound Classification • Contaminated: (10-17% risk) open, fresh, accidental wounds, operations with gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent • Dirty or infected: (>27% risk) old traumatic wounds , necrotic tissue, perforated viscera postoperative infection predicted

5. Types of Sutures • Absorbable or non-absorbable (natural or synthetic) • Monofilament or multifilament (braided) • Sizes 3 to 12-0

6. Non-absorbable Absorbable • Not biodegradable and permanent • Nylon • Prolene • Stainless steel • Silk (natural, can break down over years) • Degraded via inflammatory response • Vicryl • Monocryl • PDS • Chromic • Cat gut (natural)

7. Natural Suture Synthetic • Biological • Cause inflammatory reaction • Catgut (connective from cow or sheep) • Silk (from silkworm fibers) • Chromic catgut • Synthetic polymers • Do not cause inflammatory response • Nylon • Vicryl • Monocryl • PDS • Prolene

8. Monofilament Multifilament (braided) • Single strand of suture material • Minimal tissue trauma • Smooth tying but more knots needed • Harder to handle due to memory • Examples: nylon, monocryl, prolene, PDS • Fibers are braided or twisted together • More tissue resistance • Easier to handle • Fewer knots needed • Examples: vicryl, silk, chromic

9. Suture Selection • Use monofilament on the skin as multifilament harbor BACTERIA • Non-absorbable cause less scarring but must be removed • Absorbable for GI, urinary or biliary • Non-absorbable or extended for up to 6 mos for skin, tendons, fascia • Cosmetics = monofilament or subcuticular

10. Suture Sizes

11. Surgical Needles • 2 basic configurations for curved needles • Cutting: cutting edge can cut through tough tissue, such as skin • Tapered: no cutting edge. For softer tissue inside the body

12. Surgical Needles

13. Contraindications to Suturing • Redness • Edema of the wound margins • Infection • Fever • Puncture wounds • Animal bites • Tendon, verve, or vessel involvement • Wound more than 12 hours old (body) and 24 hrs (face)

15. Continuous Locking and Nonlocking Sutures

16. Subcuticular suture

17. Vertical Mattress Good for everting wound edges (neck, forehead creases, concave surfaces)

19. Suture Removal • Average time frame is 7 – 10 days • FACE: 3 – 5 d • NECK: 5 – 7 d • SCALP: 7 – 12 days • UPPER EXTREMITY, TRUNK: 10 – 14 days • LOWER EXTREMITY: 14 – 28 days • SOLES, PALMS, BACK OR OVER JOINTS: 10 days • Any suture with pus or signs of infections should be removed immediately.

20. THANK YOU