SURGICAL SUTURES

SIRGICAL SUTURES

1. SURGICAL SUTURES LECTURE 6

2. definition Surgical sutures are medical devices used to hold body tissues together after an injury or  surgery A suture is a strand of fibrous material used to ligate blood vessels and approximate tissues together.

3. TYPES OF SUTURE Absorbable Non-Absorbable Braided ( multifilament)sutures Non- Braided (monofilament) sutures

4. Absorbable Sutures Absorbable suture materials are made from substances that can easily break down in the body’s tissue after a certain amount of time they can be made with natural or synthetic materials

5. Cont. Surgical suture materials are used in the closure of most wound types. The ideal suture should allow the healing tissue to recover sufficiently to keep the wound closed together once they are removed or absorbed.

6. CONT. T he ideal suture is the smallest possible to produce uniform tensile strength, securely hold the wound for the required time for healing, then be absorbed It should be easy to handle, produce minimal reaction, and knot securely

7. CONT. The time in which this absorption takes place  varies  between material, location of suture, and patient factors

8. Natural absorbable sutures These are sourced from natural fibers made from biological materials They are less frequently used, as they tend to provoke a greater tissue reaction Examples of natural surgical sutures are catgut suture and silk

9. Synthetic absorbable Sutures These are sutures manufactured from chemical synthesis. They tend to be more predictable than the natural sutures, particularly in their loss of tensile strength and absorption. Examples of Synthetic sutures include Nylon, Polyester, PDS, etc.

10. CONT. the amount of time it take for a suture to break down in the body depends on a few factors such as suture type, size and the location

11. Monofilament sutures Monofilament sutures are made of a single strand of material and are most resistant to the growth of microorganisms. Monofilament suture material is made of a single strand

12. CONT. Example of monofilament sutures are Nylon, Prolene , Polydioxanone (PDS)

13. Multifilament Sutures Multifilament suture material composed of several filaments twisted or braided together. It generally has greater tensile strength and better than monofilament suture material, and it handles and ties well

14. CONT. Example of multi-filament sutures are silk, vicryl , polyglycolic acid (PGA)

15. Types of absorbable sutures Gut.  This natural monofilament suture is used for repairing internal soft tissue wounds or lacerations The body has the strongest reaction to this suture and will often scar over Polydioxanone (PDS).  This synthetic monofilament suture can be used for many types of soft tissue wound repair such as abdominal closures

16. CONT. Poliglecaprone (MONOCRYL).  This synthetic monofilament suture is used for general use in soft tissue repair This suture is most commonly used to close skin in an invisible manner Polyglactin ( Vicryl ).  This synthetic braided suture is good for repairing hand or facial lacerations

17. VICRYL

18. Chromic catgut

19. monocryl

20. Absorbable Suture Materials Suture Type Absorbable Non-absorbable Monofilament Multifilament Vicryl ✓ ✓ PDS* ✓ ✓ Monocryl ✓ ✓ Nylon ✓ ✓ Prolene ✓ ✓ Silk ✓ ✓

21. Non-absorbable Sutures Non-absorbable sutures , are surgical sutures that cannot be absorbed by the body and needs to be removed at a later time. Sometimes, they are left in situ  permanently Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks Examples of non-absorbable sutures include: Silk, Nylon, Polyester, Polypropylene

22. Types of non-absorbable sutures Some examples of non-absorbable sutures can be found below. These types of sutures can all be used generally for soft tissue repair, including for both cardiovascular and neurological procedures. Nylon.  A natural monofilament suture. Polypropylene ( Prolene ).  A synthetic monofilament suture. Silk.  A braided natural suture. Polyester ( Ethibond ).  A braided synthetic suture.

23. PROLENE

24. silk

25. ETHILON

26. Non-absorbable Suture Materials Material Structure Strength Knot security Uses Silk Braided ++ ++++ Easy to handle Nylon Monofilament +++ ++ Common for skin closure Prolene Monofilament ++++ + High memory, subcuticular pull Dacron Braided ++ ++++ Good knot security

27. SUTURE SIZE

28. SUTURE SIZE

29. Surgical Needles The surgical needle allows the placement of the suture within the tissue, carrying the material through with minimal residual trauma The ideal surgical needle should be rigid enough to resist distortion, yet flexible enough to bend before breaking, be as slim as possible to minimize trauma, sharp enough to penetrate tissue with minimal resistance, and be stable within a needle holder to permit accurate placement

30. SUTURE NEEDLES

31. CONT. They are composed of: The swaged end connects the needle to the suture The needle body or shaft is the region grasped by the needle holder Round bodied needles are used in friable tissue such as liver and kidney

32. CONT. Cutting needles are triangular in shape, and have 3 cutting edges to penetrate tough tissue such as the skin and sternum, and have a cutting surface on the concave edge Reverse cutting needles have a cutting surface on the convex edge, and are ideal for tough tissue such as tendon or subcuticular sutures, and have reduced risk of cutting through tissue

33. CONT.

34. Wound closure strips Wound closure strips are porous surgical tape strips which can be used to close small wounds They are applied across the laceration in a manner which pulls the skin on either side of the wound together Wound closure strips may be used instead of sutures in some injuries, because they lessen scarring and are easier to care for

35. Steri -strip

36. CONT.

37. CONT. steri -strips also falls off naturally The advantages of skin closure tapes are The rate of wound infection is less with adhesive strips than with stitches. Also , it takes less time to apply skin closure tape. there is no need for a painful injection of anesthetic when using skin closure tapes

38. CONT. Disadvantages of using skin closure tapes include less precision in bringing wound edges together than suturing. Not all areas of the body can be taped. For example, body areas with secretions such as the armpits, palms, or soles are difficult areas to place adhesive strips. Areas with hair also would not be suitable for taping.

39. CONT.

40. Skin-glue This material is applied to the edges of the wound somewhat like glue and should keep the edges of the wound together until healing occurs. Adhesive glue is the newest method of wound repair and is becoming a popular alternative to stitches, especially for children. The adhesive simply falls off or wears away after about 5-7 days.

41. Metal staples Surgical staples are useful for closing many types of wounds. Staples have the advantage of being quicker and may cause fewer infections than stitches Disadvantages of staples are permanent scars if used inappropriately and imperfect aligning of the wound edges, which can lead to improper healing Staples are used on scalp lacerations and commonly used to close surgical wounds