SUTURES AND NEEDLES
WHY DO WE USE SUTURES?
1. WOUND CLOSURE 2. HEMOSTASIS
WHAT IS THE PURPOSE OF WOUND CLOSURE?
1. OCCLUDE FLOW OF BLOOD/BODILY FLUIDS
2. RESTORE FLOW OF BLOOD/BODILY FLUIDS
3. REINFORCE/STRENGTHEN TISSUE DURING/POST SURGERY
4. MINIMIZE SCARS
WHAT IS THE PURPOSE OF HEMOSTASIS?
1. TO TIE OFF/LIGATE VESSELS, TISSUES
2. TO MINIMIZE BLOOD LOSS
3. TO ALLOW BETTER VIEW OF SURGICAL FIELD
WHAT IS “SUTURE”? SUTURE IS…
1. THE MATERIAL USED TO APPROXIMATE TISSUE (ANATOMICAL STRUCTURES) FOR
CLOSURE
2. THE MATERIAL USED TO LIGATE/ANASTOMOSE VESSELS OR OTHER LUMENOUS
STRUCTURES
3. USED WITH OR WITHOUT A NEEDLE OR CLAMP ATTACHED TO IT
WHAT ARE THE PHYSICAL CHARACTERISTICS OF SUTURE? SUTURE IS…
1. MONOFILAMENT = 1 STRAND
MULTIFILAMENT = > 1 STRAND
TWISTED/BRAIDED
2. ABSORBABLE = BODY DIGESTS IT
NONABSORBABLE = NOT DIGESTED BY BODY
3. NATURAL = NATURE BASED
SYNTHETIC = ARTIFICIALLY BASED
4. CAPILLARITY = ABILITY TO ALLOW WICKING; MONOFILAMENT SUTURES = NO
CAPILLARITY
5. ELASTICITY = ABILITY TO STRETCH/EXPAND
6. MEMORY = ABILITY TO RETURN TO FORMER CONDITION
7. TENSILE STRENGTH = ABILITY TO WITHSTAND CERTAIN TENSION AMOUNT BEFORE
BREAKING
8. GAUGE = DIAMETER OF SUTURE; EXPRESSED IN WHOLE NUMBERS AND ZEROES
= THE LARGER THE GAUGE, THE FEWER THE ZEROES 3-0(000) - LARGER THAN 4-0(0000)
WHAT ARE THE HANDLING CHARACTERISTICS OF SUTURE? SUTURE HAS…
1. PLIABILITY = ABILITY TO BEND FREELY AND REPEATEDLY WITHOUT BREAKING
2. TISSUE DRAG = MEASURE OF EASE/DIFFICULTY WHEN USED IN TISSUES
3. KNOT STRENGTH = FORCE REQUIRED FOR KNOT TO SLIP; >SLIP POTENTIAL= ># KNOTS
WHAT TYPE OF TISSUE REACTIONS ARE POSSIBLE WITH SUTURE?
1. INERT = NO TISSUE REACTION
2. INFLAMMATORY POTENTIAL– EXPECTED SUTURE REACTION IN IRRITATED TISSUES
SYNTHETICS HAVE LESS TISSUE REACTION AND MORE PREDICTABLE ABSORPTION
RATES
3. ALLERGIC POTENTIAL = EXPECTED REACTION LOCAL/SYSTEMIC IF KNOWN PT ALLERGY
4. INFECTION POTENTIAL = EXPECTED REACTION WHEN INFECTION PRESENT
5. RATE OF ABSORPTION = EXPECTED TIME SUTURES REMAIN INTACT BEFORE TISSUE
DIGESTION
ABSORPTION HAPPENS BY…
HYDROLYSIS – SUTURE BREAKDOWN BY WATER IN BODY TISSUES – SYNTHETICS ONLY
PHAGOCYTOSIS – SUTURE BREAKDOWN BY ENZYMES IN BODY TISSUES – NATURALS
ONLY
HOW DO I HANDLE SUTURES AND NEEDLES?
SUTURES
1.AS LITTLE AS POSSIBLE
NEEDLES
ALWAYS PROTECT SHARPNESS – CHECK
FOR BURRS,DEFECTS
2.AVOID INSTRUMENT USE ON SUTURE –
PASS NEEDLES ON AN EXCHANGE BASIS
AS IT CRUSHES OR FLATTENS
ONLY
3.NEVER RUN GLOVED FINGER ALONG
PASS KEITH AS SCALPEL
STRAND – FRAYS, DECREASES STRENGTH
PASS CURVED ON NEEDLE HOLDER
4. ALWAYS PROTECT SUTURE NEEDLE AND KEEP NEEDLES SECURE/ORGANIZED – IN
STRAND – KEEP WITHIN STERILE FIELD
PACK, ON N. HOLDER, IN NEEDLE MAT
5.PASS APPROPRIATELY TO SURGEON –
DISPOSE OF PROPERLY, ACCOUNT FOR ALL
MAINTAIN TECHNIQUE
PIECES IF BROKEN AND COUNT PER POLICY
Specifics on handling sutures:
Open alcohol packed sutures over basin. RINSE, do not soak, before use.
Keep silk dry to retain tensile strength.
Handle wire carefully – tends to kink – can puncture gloves
NEVER PULL ON SWAGED NEEDLES TO STRAIGHTEN – hold about 3” from needle
HOW DO I CHOOSE A SUTURE/NEEDLE?
SHAPE
SIZE
POINT
STRAIGHT = KEITH = FINGER HELD
CURVED = PART CIRCLE = NEEDLE HOLDER
SMALL/DELICATE – EYES, VESSELS, MICRO
MEDIUM – GENERAL, MUSCLE, TENDONS
HEAVY – GYN, MUSCLE, BONE
TAPER – SOFT, DELICATE TISSUE
CUTTING - SKIN, DIFFICULT TO PENETRATE TISSUE
SUTURE PROPERTIES
(WHAT IS DEFINITIVE OF
SUTURE CHOSEN)
HANDLES WITH EASE, SECURELY HOLDS KNOTS, INERT/NO TISSUE
REACTION, RELIABLE/PREDICTABLE PERFORMANCE = DEFINITE
ABSORPTION TIME, RESISTS SHRINKING, DISCOURAGES BACTERIAL
GROWTH
SUTURE APPLICATION
EXTERIOR/INTERIOR SKIN LAYERS, MUSCLE, BODY CAVITIES,
(WHERE IT IS USED)
ORGANS, IMPLANTS OR PROSTHETICS
TISSUE CHARACTER
IN A TRAUMA OR WOUND AREA – CLEAN OR RAGGED
(WHAT IS TISSUE LIKE?)
VASCULARITY – BLOOD/FLUID VOLUME – CIRCULATION IN AREA
QUALITY – STRONG OR FRIABLE TISSUE NATURE
WOUND CHARACTER
DEPTH – DEEPER THE WOUND = GREATER DEAD SPACE AND
INFECTION POTENTIAL AND DEEPER CURVE TO NEEDLE NEEDED
DIRECTION – RUNS PARALLEL OR AT ANGLE TO TISSUE FIBERS
WHICH AFFECTS HEALING TIME AND PT COMFORT
LOCATION – ANTICIPATED TISSUE STRENGTH FOR GIVEN AREA
LENGTH – GREATER RISK FOR INFECTION, GREATER HEALING TIME
WOUND CLASS
I = CLEAN, FRESH, ELECTIVE INCISION
I
II = CLEAN/CONTAMINATED – FRESH, ELECTIVE INCISION TO
II
NORMAL TISSUE FLORA (NOSE, EAR, MOUTH, VAGINA, PENIS)
III
III = CONTAMINATED – FRESH POSTOP WOUND OR TRAUMA
IV
IV = DIRTY AND INFECTED – PERFORATED VISCERA, INFECTION OR
DISEASE PRESENT, FOREIGN DEBRIS, NECROTIC TISSUE
INCISION QUALITY
QUALITIES OF INCISION – LENGTH, LOCATION, DIRECTION, DEPTH
DIRECTLY RELATED TO WOUND CHARACTER
SURGEON PREFERENCE
NOTED ON PREFERENCE CARD – SUTURE TYPE, SIZE, NUMBER TO
PICK, WHERE IT IS USED
WHAT ARE COMMON SUTURE TECHNIQUES?
1. CONTINUOUS, RUNNING, OVER AND OVER, LOCKED, VERTICAL AND HORIZONTAL MATTRESS
– TIED AT SUTURE LINE ENDS ONLY, SINGLE SUTURE UTILIZED
- USUALLY MONOFILAMENT ON SKIN
- MULTIFILAMENT BELOW SKIN
ADVANTAGE – RAPID PLACEMENT, EVEN TENSION ALONG SUTURE LINE
DISADVANTAGE – BREAK AFFECTS ENTIRE LINE, WICKING POTENTIAL OF MULTIFILAMENT
WITH GREATER INFECTION POTENTIAL
2. INTERRUPTED – SUTURE LINE OF SINGLE STITCHES INDIVIDUALLY TIED
ADVANTAGE – 1 BROKEN STITCH REST OF LINE OKAY
STITCHES CAN BE REMOVED AS THEY HEAL, LEAVING OTHERS IN PLACE
DOES NOT LEND ITSELF TO WICKING DECREASING INFECTION POTENTIAL
DISADVANTAGE – UNEVEN SUTURE LINE TENSION, TIME CONSUMING PLACEMENT