Sutures and Suturing
Dr. Muath Mustafa
Dept of Surgery, BMC
HOD. Dr. Ashraf Balbaa
Definition:
• Suture is a generic term for all materials used to
bring served body tissue together and to hold these
tissues in their normal position until healing takes
place
• A ligature is a strand of suture material used to tie
off (seal)blood vessels to prevent hemorrhage and
simple bleeding or to isolate a mass of tissue to be
excised (cut out)
History:
• 50,000 BC
Eyed needles are invented
• 1600 BC
One of the earliest known references to suture material.
Sutures are made from flax, hemp, bark fiber, hair, etc
• 1867-9
Joseph Lister proves that the body absorbs catgut sutures.
However he is most famous for demonstrating the need for antiseptic
techniques for sterilization of implanted sutures.
• 1918
George Merson begins the sale of eyeless needled sutures
where one strand of suture material is attached to the butt of the needle.
This type of swaged needle is still in use and is the standard today.
•
1947
• 1972
•
Introduction of Nylon.
First synthetic absorbable suture introduced.
2000
Distribution of gut material ends in many parts of Europe and
Japan due to Bovine Spongiform Encephalopathy (“Mad Cow Disease”)
Why do we need sutures?
1- Provide an adequate tension of wound closure
without dead space but loose enough to obviate
tissue ischemia and necrosis.
2- Maintain hemostasis.
3- Permit primary intention healing
4- Reduce postoperative pain
5- Provide support for tissue margins until they
have healed and the support no longer needed
6- Prevent bone exposure resulting in delayed
healing and unnecessary resorption
7- Permit proper flap position
Ideal sutures:
•
•
•
•
•
•
•
•
Can be used in any tissue
Easy to handle
Good knot security
Minimal tissue reaction
Unfriendly to bacteria
Strong yet small
Won’t tear through tissues
Cheap
Types of sutures:
ABSORBABLE SUTURE TYPES
Synthetic Absorbable
Natural Absorbable
Synthetic
Natural
Monofilament
Virtual
Monofilament
Short /
Medium
Short
ShortMedium
Medium
Fast
Absorbing
Gut
Plain
Gut
Chromic
Gut
Long
PDS
(polydioxanone)
Suture
MONOCRYL
(poliglecaprone )
Suture
Braided
Short
Medium
VICRYL
(polyglactin )
Suture
Coated VICRYL
(polyglactin ) Suture
NON-ABSORBABLE SUTURE TYPES
Natural
Monofilament
Braided
Surgical
Stainless
Steel
Silk Suture
Synthetic
Monofilament
ETHILON
Nylon
Suture
PRONOVA Poly
(Hexafluoropropylene
- VDF) Suture
PROLENE Polypropylene
Suture
Braided
NUROLON
Nylon
Suture
MERSILENE
Polyester
Fiber Suture
ETHIBOND EXCEL
Polyester Suture
Mechanisms of degradation of Sutures:
Natural Sutures
• Sutures made of material that can be found in nature
– Absorption method (if absorbable): Enzymatic reaction
(proteolysis)
Synthetic Sutures
• Sutures made of materials created by man
– Absorption Method (if absorbable): Hydrolysis – breakdown
in the presence of water or moisture
Types of surgical wounds:
Class I
Clean
Uninfected wound in which no inflammation is encountered
and respiratory, alimentary, genital, or uninfected urinary tract
is not entered.
Class II
Clean-contaminated
Operative wound in which respiratory, alimentary, genital, or
urinary tracts are entered under controlled conditions and
without unusual contamination.
Class III
Contaminated
Open, fresh, accidental wounds.
Class IV
Dirty-infected
Old traumatic wounds with retained devitalized tissue and
those that involve existing clinical infection or perforated
viscera.
Types of needles:
•
Eyed needles
– More Traumatic
– Only thread
through once
– Suture on a reel
– Tends to
unthread itself
easily
• Swaged-on
needles
– Much less traumatic
– More expensive
suture material
– Sterile
Points of Needles
• Taper
– Atraumatic
– Internal organs
• Cutting
• Cutting edge on inside
of circle
• Skin
• Traumatic
• Reverse Cutting
• Cutting edge on
outside of circle
• Skin
• Less traumatic
than cutting
Cutting vs Reverse Cutting
• Cutting
• Reverse
cutting
Shapes of Needles
•
•
•
•
3/8 circle
1/2 circle
Straight
Specialty
Problems Associated with Surgical Sutures
• Time-consuming nature of secure knot tying
• Need for knot security under all conditions with all sutures
• Risk of suture breakage during surgery
• Loss of control due to needle slippage or rotation within the
needle holder
• Postsurgical slippage of the knotted suture
• Early or pathologically induced degradation of absorbable
suture
THANK YOU