Suture & Needles.ppt

basic surgical skills

1. SUTURES AND NEEDLES
MATERIALS
Dr Kushalini
Department of Surgery
Hospital Seberang Jaya

2. SUTURES AND NEEDLES

3. Physical properties of sutures
Tensile strength -the force that a suture can
withstand before it will break
Handling -easy to handle; flexibility and texture
Knot security -the ability of suture to hold a
knot without slipping
Flex life -ability to bent continously without
breaking
Tissue reactivity –foreign body reaction to
suture

4. Ideal Suture materials
•Sterile when placed in tissue
•Strength during critical wound healing period
–12-14 days most tissues but longer for tendon and
fascia
•Knot security
•Minimal foreign body tissue reaction
•Minimal tissue passage trauma
•Absorption

5. Factors influencing suture choice
•Kind of surgery to be performed
•Presence or absence of infection
•Physical condition of patient
•Ability tissue to tolerate the suture
•Surgeon preference

6. CLASSIFICATION
•Non absorbable or absorbable
•Monofilament or multifilament (Braided)
•Biological or synthetic

7. Suture
Absorbable
Synthetic
Braided Monofilament
Biologic
Non
absorbable
Biologic Synthetic
Braided Monofilament

8. Absorbable
•Hold wound edges temporarily until it heals
sufficiently to withstand normal stress
•Digested by enzymatic degradation(absorbed
by inflammmatory response to foreign
protein) or hydrolysis
Eg catgut, Ecosorb

9. Absorbable
Biologic
Catgut (absorbed by
inflammmatory
response to foreign
protein)
Plain wound holding
strength 2-4days
Chromic wound
holding strength 5-
7days, can untie after
2-72hours
Synthetic (absortion
by hydrolysis)
Braided
Polyglycolic(ecosorb,
safil),
polyglactin(vicryl)
wound holding
strength 14-21days
Monofilament
Polyglyconate
(maxon)wound
holding strength 6
weeks

10. Non-absorbable
•Permanent wound closure and/or to be
removed after healing completes
•Not digested by body enzyms or hydrolisis but
•However some sutures lose their strength and
fragmented by hydrolysis over long period of
time
–eg silk and nylon

11. Non-absorbable
Biologic
Silk causes tissue
reactivity to foreign
body
Synthetic
Braided polyester eg
Dacron/Ticronor linen
Monofilament –minimal
tissue reaction egNylon,
polypropylene(prolene)
steel

12. Non-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)
Absorbable

13. Monofilament or Braided
•Monofilament
•single strand of material
•less resistance when passing through tissue
•less harbouring or microorgamism (non-capillary)
•Need extreme care during handling because crushing of the
suture (by instrument) creates weak spot
–eg; Brilon (Nylon), Ecolene (Polypropylene)
•Braided (Multifilament)
•Consist of several thread twisted/braided
•Higher tensile strength and flexibility
•Shows capillary effect
–Silk, Ecosorb (PGLA)

14. Suture Size and Usage

16. General Principles for Suture
Selection
•Do not use dyed sutures on the skin
•Use monofilament on the skin as
multifilament harbor BACTERIA
•Non-absorbable cause less scarring but must
be removed
•Location and layer, patient factors, strength,
healing, site and availability

17. Suture Selection
•Absorbable for GI, urinary or biliary
•Non-absorbable or extended for up to 6 mos
for skin, tendons, fascia
•Cosmetics = monofilament or subcuticular
•Ligatures usually absorbable

19. Needle Anatomy
55 % of needles are ½ circle
35 % of needles are 3/8 circle
Skin
Closure,
Gastrointestinal
Urology
Opthalmolgy
Needle tip
Needle Body
Needle shaft

20. A good suture needle should be;
Good penetration with low resistance
Rigid to avoid easy bending
Good Ductility -easy to bend but not break
Corrosion resistant –to avoid foreign material entry to wound
Good gripping qualities of needle body
Ideal body shape for easy penetration during suturing

21. Needle
•Made from stainless steel
•Needle to thread ratio must be 1:1, ensure
stepless transition between needle and suture
•Needle tip, shape and smoothness of the body
determine the ease of tissue penetration and
trauma

23. Guidelines to Selection of Needle
•Cutting needles are used in tough tissue such
as skin, fascia and tendon. Reverse cutting
used when there a risk of cut through
•Round bodied used for closure of intestines,
ducts and other delicate tissues such as dura
•Blunt needle is used in parenchymatous or
delicate tissues. The puncture close more
easily
•Straight cutting needle is for skin suture

28. Needle Holder & correct holding of needles