SUTURES PRESENTATION IN SURGERY REVISED.pdf

Suture presentation in surgery

1. SUTURES
BY DR SINGOYI, DR LIBINGI, DR MANDA, DR LWEENDO, NAMOONGA
SHAMAMBO (7TH YEAR ) AND LIMPHO SIKAZINDU (3RD YEAR)

2. DEFINITION
A SUTURE IS A MEDICAL DEVICE USED TO HOLD TISSUES TOGETHER AFTERAN INJURY, SURGERY,
OR WOUND, PROMOTING HEALING AND TISSUE REPAIR. SUTURES ARE TYPICALLY MADE OF
THREAD-LIKE MATERIALS, EITHER ABSORBABLE OR NON-ABSORBABLE, AND ARE USED TO:
1.CLOSE WOUNDS
2.REPAIR DAMAGED TISSUES
3.HOLD TISSUES IN PLACE
4.SUPPORT HEALING

4. SUTURES PLAY A CRUCIAL ROLE IN:
1. WOUND CLOSURE: SUTURES PROMOTE HEALING BY BRINGING TISSUES
TOGETHER.
2. TISSUE REPAIR: SUTURES REINFORCE DAMAGED TISSUES.
3. HEMOSTASIS: SUTURES HELP CONTROL BLEEDING.
4. INFECTION PREVENTION: SUTURES REDUCE THE RISK OF INFECTION.
5. COSMETIC OUTCOMES: SUTURES MINIMIZE SCARRING.
6. SURGICAL PROCEDURES: SUTURES ARE ESSENTIAL FOR VARIOUS SURGICAL
SPECIALTIES.
7. EMERGENCY CARE: SUTURES ARE USED IN EMERGENCY SITUATIONS TO STABILIZE
PATIENTS.

5. CLASSIFICATION
THE MAIN FACTORS USED TO CLASSIFY SUTURES TYPES ARE:
1. ABSORBABLE VS. NON-ABSORBABLE
2. SYNTHETIC VS. NATURAL
3. MONOFILAMENT VS. MULTIFILAMENT

6. ABSORBABLE SUTURE
1. PLAIN CATGUTIS DERIVED FROM SUBMUCOSA OF JEJUNUM OF SHEEP.
IT IS ABSORBED BY INFLAMMATORY REACTION AND PHAGOCYTOSIS—
ABSORPTION TIME IS 7 DAYS.
2. CHROMIC CATGUTIS CATGUT WITH CHROMIC ACID SALT.
ITS ABSORPTION TIME IS 21 DAYS.
3. VICRYL (POLYGLACTIC ACID):
IT IS SYNTHETIC ABSORBABLE SUTURE MATERIAL.
IT GETS ABSORBED IN 90 DAYS.
IT IS MULTIFILAMENT AND BRAIDED

7. NON ABSORBABLE
•SILK
•POLYPROPYLENE
•COTTON
•LINEN
•STEEL
NATURAL
-CATGUT.
-SILK.
-COTTON.
-LINEN.

8. SYNTHETIC
•VICRYL, DEXON, POLYDIOXANONE SUTURE (PDS), MAXON.
•POLYPROPYLENE, POLYETHYLENE, POLYESTER, POLYAMIDE.
BRAIDED: POLYESTER, POLYAMIDE, VICRYL, DEXON, SILK.
TWISTED: COTTON, LINEN.
MONOFILAMENT: POLYPROPYLENE, POLYETHYLENE, PDS, CATGUT, STEEL.
MULTIFILAMENT: POLYESTER, POLYAMIDE, VICRYL, DEXON, SILK, COTTON.
-COATED.
-UNCOATED

9. •FOR ABSORBABLE SUTURES
-ABSORPTION TIME OR HALF LIFE IS DEFINED AS THE TIME TAKEN FOR THE TENSILE STRENGTH OF A
MATERIAL TO BE REDUCED TO HALF IT’S ORIGINAL VALUE.
-DISSOLUTION TIME IS TIME TAKEN FOR A THREAD TO BE DISSOLVED COMPLETELY
THESE ARE INFLUENCED BY MANY FACTORS SUCH AS:
THREAD THICKNESS
TYPE OF TISSUE BEING SUTURED
GENERAL CONDITION OF THE PATIENT

11. TABLE FOR HALF-LIFE AND DISSOLUTION TIME.
Material Half-life (days) Dissolution time (days)
Plain catgut 7 7-14 day
Chromic catgut 21 60% by 28 days
Vicryl 60-90 21 days
Dexon 90-120 14 days
Maxon 180 45% by 21 days
Poly Dioxanonesuture 120 50% by 7 days and 80% by 14
days
Monocryl 120 31% by 6 weeks

12. NEEDLES
SHAPE
-STRAIGHT, CURVED AND HALF CURVED NEEDLES
POINT
-CUTTING NEEDLE , ROUND NEEDLE, BLUNT NEEDLE, TAPPERD NEEDLE
EYE TYPE
-CLOSED EYE NEEDLE, OPEN EYE NEEDLE
SIZE
-FINE NEEDLE, MEDIUM, LARGE NEEDLE

15. SUTURE REMOVAL
INDICATIONS FOR SUTURE REMOVAL:
1. HEALING IS COMPLETE
2. SUTURES ARE NO LONGER NEEDED
3. PATIENT’S COMFORT AND COSMETIC CONCERNS
TIMING FOR SUTURE REMOVAL:
1. FACE: 4-7 DAYS
2. NECK: 7-10 DAYS
3. SCALP: 7-14 DAYS
4. TRUNK: 10-14 DAYS
5. EXTREMITIES: 10-21 DAYS
6. PALMS AND SOLES: 14-21 DAYS

16. SUTURE REMOVAL TECHNIQUES:
1. CUTTING THE SUTURE
2. REMOVING WITH FORCEPS
3. DISSOLVING WITH ENZYME SOLUTION
PRECAUTIONS:
1. CLEAN AND PREPARE THE AREA
2. USE STERILE INSTRUMENTS
3. AVOID TOUCHING THE WOUND
4. MONITOR FOR SIGNS OF INFECTION
TYPES OF SUTURES TO REMOVE:
1. NON-ABSORBABLE SUTURES
2. ABSORBABLE SUTURES (IF PROBLEMATIC)
3. STAPLES

17. COMPLICATIONS
EARLY COMPLICATIONS
1. INFECTION
2. BLEEDING
3. HEMATOMA
4. WOUND DEHISCENCE
5. SUTURE REACTION (ALLERGY/INTOLERANCE)
6. ADHESIONS
LATE COMPLICATIONS
1. KELOID/HYPERTROPHIC SCARRING
2. SUTURE GRANULOMA
3. FOREIGN BODY REACTION
4. SINUS TRACT FORMATION
5. NERVE DAMAGE

18. FEATURES OF IDEAL SULTURING MATERIAL
PHYSICAL PROPERTIES:
1. STRENGTH: SUFFICIENT TENSILE STRENGTH
2. ELASTICITY: MINIMAL STRETCHING OR DEFORMATION
3. FLEXIBILITY: EASY HANDLING AND KNOT-TYING
4. DURABILITY: RESISTANT TO DEGRADATION
5. BIOCOMPATIBILITY: NON-TOXIC, NON-ALLERGENIC
BIOLOGICAL PROPERTIES:
1. BIODEGRADABILITY: ABSORBABLE SUTURES DEGRADE NATURALLY
2. NON-TOXICITY: NO HARMFUL BYPRODUCTS
3. HYPOALLERGENICITY: MINIMAL ALLERGIC REACTIONS
4. TISSUE COMPATIBILITY: NO ADVERSE TISSUE REACTIONS
5. RESISTANCE TO INFECTION

19. HANDLING PROPERTIES:
1. EASY KNOT-TYING
2. SMOOTH PASSAGE THROUGH TISSUE
3. MINIMAL TISSUE DRAG
4. SECURE KNOT HOLDING
5. EASY SUTURE REMOVAL
CLINICAL PROPERTIES:
1. HEMOSTASIS: PROMOTES BLEEDING CONTROL
2. WOUND CLOSURE: EFFECTIVE CLOSURE WITH MINIMAL GAP
3. TISSUE SUPPORT: MAINTAINS TISSUE POSITION
4. COSMETIC OUTCOME: MINIMAL SCARRING
5. LOW COMPLICATION RATE

20. EXAMPLES OF IDEAL SUTURE MATERIALS:
1. VICRYL (ABSORBABLE)
2. MONOCRYL (ABSORBABLE)
3. NYLON (NON-ABSORBABLE)
4. POLYESTER (NON-ABSORBABLE)
5. SILK (NATURAL, NON-ABSORBABLE)

22. TYPES OF SUTURING TECHNIQUES

23. SIMPLE INTERRUPTED

24. SIMPLE RUNNING SUTURE

25. HORIZONTAL MATTRESS

26. HALF BURRIED

27. TYPES OF KNOT

28. THANK YOU