Sutures material

suture material

1. Suture material

2. The term “ SUTURE” – describes any strand of material utilised to ligate blood vessels or approximate tissues during the wound healing period A number of different shapes, sizes and thread materials as well as different types of needles have been developed over its millennia of history.

3. Through many millennia , various suture materials were used, debated and remained largely unchanged. Sutures were made of plant materials ( flax , hemp and cotton) or animal material (hair , tendon, muscle strips and nerves, silk, catgut)

4. THE GOALS OF SUTURING Provide an adequate tension of wound closure without dead space but loose enough to obviate tissue ischemia and necrosis Maintain hemostasis Permit primary intention healing Reduce postoperative pain Provide support for tissue margins until they have healed

5. Protecting underlying tissue from infection or other irritating factors Permits proper flap position Prevent bone exposure resulting in delayed healing and bone resorption

6. QUALITIES OF A SUTURE MATERIAL Adequate tensile strength Easy to handle Low cappillarity Flexibility and Elasticity Knotable Easily sterlisable Uniformity Smooth surface Non reactivity Absorbility

7. TYPE OF SUTURE MATERIAL

8. ACCORDING TO THEIR ORIGIN Organic Synthetic metallic

9. ACCORDING TO THEIR BEHAVIOUR IN TISSUE Absorbable Non - absorbable

10. Braided Non braided

11. ACCORDING TO THEIR STRUCTURE Monofilament multifilament

12. MONOFILAMENT MULTIFILAMENT Single strand of suture material Fibers are twisted or braided together Minimal tissue trauma More tissue resistence Smooth tying but more knots needed Few knots needed Harder to handle due to memory Easier to handle Examples : nylon , monocryl , prolene , pds Examples: vicryl , silk ,chromic

13. NATURAL SYNTHETIC Biological Synthetic polymers Cause inflammatory reaction Less or minimal inflammatory reaction Examples : catgut , silk Examples: nylon , prolene

14. BRAIDED NON BRAIDED Has capillary action No capillary action Increased infection risk Less infection risk Less smooth passage Smooth tissue passage Less tensile strength Higher tensile strength Better handling Has memory Better knot security More knots required

15. FACTORS THAT INFLUENCE SURGEON’S CHOICE Biological characteristics of the material in tissue i.e. absorbable vs non absorbable. Healing characteristics of tissue Location and length of the incision Cosmetic result desired

16. Cont …….. Presence or absence of infection Physical characteristics of the material : knot tying ease of passage through tissue Pts problem such as obesity , debility , advanced age and disease etc .

17. ABSORBABLE SUTURES Sterile strands prepared from collagen derived from healthy mammals or from a synthetic polymer They are capable of being absorbed or digested by the body cells and tissue in which they are embedded during and after the healing process. Examples – surgical gut , collagen suture, monocryl , vicryl , pds , maxon , daxon

18. SURGICAL GUT 1 - Often referred as catgut 2 - It is derived from submucosa of sheep intestine or serosa of beef intestine 3 - Types : (a) Plain surgical gut (b) Chromic surgical gut (c) Fast absorbing plain surgical gut

19. PLAIN SURGICAL GUT 1- It loses its tensile strength in 7-10 days. 2- It is completely digested within 60 days. 3- used to ligate superficial vessels , suture subcutaneous tissues and other tissues that heal rapidly 3- Seldom used now due to poor strength and high tissue reaction

20. FAST ABSORBING PLAIN SURGICAL GUT It is produced by preheating Maintains strength for 3-5 days Primarily used for epidermal suturing where sutures are required for only 5-7 days

21. CHROMIC SURGICAL GUT It is treated in a chromium salt solution to improve handling and to resist absorption in tissues It loses its tensile strength in 21 – 28 days Completely absorbed within 90 days Moderate tissue reaction

22. MONOCRYL (POLIGLECAPRONE 25) Synthetic absorbable suture Monofilament Copolymer of glycolide and epsilon – caprolactone Tensile strength – 50%-60% remains at 1 week 21%- 30% remains at 2 week lost within 3 weeks Minimal acute inflamatory reaction Complete absorption withon 90-120 days Frequently used for subcuticular in skin , ligation,GIT and muscle surgery

23. COATED VICRYL (POLYGLACTIN 910) Synthetic absorble suture Braided multifilament coated with a mixture of equal parts of a copolymer of glycolide , L- lactide and calcium stearate. Coating provides a nonflaking lubricant for smooth passage through tissue and precise knot placement. Tensile strength - =75% remains at 2wk =50% remains at 3 wk =25% remains at 4 wk complete absorption within 60 -90 days M inimal acute inflamatory reaction

24. PDSII (POLYDIOXANONE) Synthetic absorbable suture Monofilament Extruded from polyester polymer Tensile strength - = 70% remains at 2 wk = 50% remains at 4 wk = 25 % remains at 6 wk complete absorption at 180 days Minimal tissue reaction .

25. MAXON (POLYGLYCONATE) Synthetic absorbable suture Monofliment Copolymer of glycolic acid and trimethylene carbonate Complete absorption within 6 months Tensile strength - = 70% remains at 2 wk = 55% remains at 3 wk

26. DEXON (POLYGYCOLIC ACID) Synthetic absorable suture Braided, multifilament Homopolymer of glycolic acid T ensile strength - 40% remains at 1wk 20% remains at 3wk C omplete absorption within 60-90 days Minimal tissue reaction

27. NON ABSORBABLE SUTURES Strands of natural or synthetic material that effectively resist enzymatic digestion or absorption in living tissue . Examples – silk ,linen ,surgical steel , nylon etc

28. SURGICAL SILK It is an animal product made from the fiber spun by silkworm larvae in making their cocoons. Braided or twisted , multifilament suture Not a true nonabsorbable material as it loses its much of its tensile strength after 1yr and disappear within 2 years Moderate to high acute inflammatory reactions

29. SURGICAL STEEL Mono or multifilament An alloy of iron , nickel and chromium Tensile strength - infinite (>1yr) Minimal tissue reaction Frequently used for sternotomy wound

30. SURGICAL NYLON Nylon is a polyamide polymer derived by chemical synthesis from coal ,air and water. It produces minimal tissue reaction. It has high tensile strength It degrades by hydrolysis in tissue @15-20% per yr It is available in 3 forms –(a) monofilament (b) uncoated multifilament (c) coated multifilament Used for skin closure , abd. wall closure, plastic surgery microsurgery , neurosurgery, ophthalmic surgery

31. ETHILON AND DERMALON (MONOFILAMENT NYLON SUTURE) Long chain aliphatic polymers nylon 6 or nylon 6,6 Good tensile strength Minimal tissue reactivity Disadvantages are its handling and knot security

32. NUROLON (UNCOATED MULTIFILAMENT NYLON) Braided Long – chain aliphatic polymers nylon 6 or nylon6,6

33. SURGILON (COATED MULTIFILAMENT NYLON) Braided Treated with silicone to enhance its smooth passage through tissue

34. POLYESTER FIBRE SUTURE Polymer of terephthalic acid and polyethylene Monofilament or Braided multifilament Available in two forms – uncoated and coated Infinite tensile strength (>1yr) No significant change known to occur in vivo Minimal tissue reactivity

35. MERSILENE AND DACRON SUTURE U ncoated polyester fiber suture Braided , monofilament Exert a sawing or tearing effect when passed through tissue

36. ETHIBOND SUTURE Coated polyester fiber suture Braided , monofilament Has coating of POLYBUTILATE which acts as surgical lubricant Lesser sawing effect

37. PROLENE SUTURE Monofilament Isotactic crystalline stereoisomer of polypropylene Most inert similar to stainless steel Not subject to degradation or weaking by action of tissue enzymes Infinite tensile strength (>1yr) Frequently used for cardiovascular surgery , plastic, ophthalmic surgery Minimal tissue reactivity

38. ab

39. cont

40. Non ab

41. cont

42. Suture selection