SUTURES
K. Sumanasree.
9th term, MIMS mandya
HISTORY:
HISTORY
East African tribes :ligation of blood vessels using tendon strips, and use of Acacia thorns, these Acacia thorns were pushed into the wound and
wrapped with vegetable matter round the thorn into figure of eight.
South Americans , performed wound closure using black ants to bite the wound together, their jaws acting like skin clips and then the ant was
twisted off leaving head in place and keeping the wound apposed.
Indian surgeons used horse hair, cotton, leather sutures.
Roman times, the silk, metal clips, we’re used.
End of 19th century, silk and catgut became popular.
Desirable characteristics of an ideal suture
material:
DESIRABLE CHARACTERISTICS OF AN IDEAL SUTURE MATERIAL:
Easy to handle.
Sterile.
Predictable behavior in tissues.
Predictable tensile strength.
Glides through tissues easily.
Secure knotting ability.
Inexpensive.
Easily available.
Non allergenic.
Non carcinogenic.
Non shrinkage.
LESS MEMORY.
SUTURES CHARACTERS:
1. Physical structure.
2. Strength.
3. Tensile behavior.
4. Absorbability.
5. Biological behavior.
1.Physical structure.
MONOFILAMENT: MULTI/POLYFILAMENT:
Made up of single strand of fibre. Made up of multiple stands braided together.
Smooth and strong. Easier to handle.
Knots are not stable, hence may be loose. (6 to Knots are stable. (3 to 4knots).
8 Knots) .
No crevices. Has crevices.
Less chances of bacterial infection. Crevices lodge in the bacteria and causes
bacterial infection and persistent infection.
2.Strength.
Strength Of a suture material depends on,
It’s constituent material.
Its thickness.
How it is handled in the tissues.
Tensile strength of a suture is expressed as the force required to break it when pulling it’s two ends apart.
But, what actually matters is the IN VIVO strength of the suture material.
3.Tensile behavior.
Based on deformability and flexibility, the suture material can be,
1.Elastic: material will return to it’s original length once the tension is released.
2. Plastic: material can’t return to it’s original length.
MEMORY :the sutures keep curling up in shape they adopted within packaging. Hence, less memory is an
ideal feature.
4.Absorbability.
Absorbable: Non absorbable:
Absorbed in tissues by enzymatic digestion/ Persist in times for indfinite period of time.
phagocytosis/hydrolysis.
NATURAL: Catgut NATURAL: Silk
Cromic catgut. Linen
SYNTHETIC: Polyglycaprone SYNTHETIC: Prolene
PDS Polyester
Vicry (polyglactin) Elthilon
Dexon (Polyglycolic Acid) Nylon
Uses of Absorbable Suture Material
In bowel anastomosis GJ , Resection and anastomosis (vicryl)
In Cholecystojejunostomy, Choledochojejunostomy, Pancreaticojejunostomy
Suturing muscle, fascia, peritoneum, subcutaneous tissue , mucosa.
Ligation of pedicles during Hysterectomy.
In Circumcision
NOTE: Absorbable suture material should not be used for Suturing nerves and vessels( Vasular Anastomosis)
Uses of non absorbable suture material:
HERINORRHAPHY
Closure of abdomen after Laprotomy
For vascular anastomosis , nerves and tendon suturing.
Suturing the skin
5. BIOLOGICAL BEHAVIOUR
Itis based on constiuent of raw material used
Ex; Catgut are proteolysed and may cause local irritaton.
Synthetic polymers are hydrolysed.
Chronic catgut:
1. Tanned withwith
Chromium salts, to
improve the handling and
resist the degradation in
tissues.
Plain catgut :
1.Made from
Submucosa of sheep's
ileum.
2 .preservative
usedused for packing
is, ISOPROPYL
ALCOHOL.
PDS (polydiaoxanone) :
1. Is an polyster polymer.
2. Used in Whipples
procedure.
Polyglycolic acid(Dexon) :
1.polymer of glycolic
acid.
2. Has high affinity to
E. Coli., Staph.
Aureus.
MONOCRYL(poly glycaprone) :
59411. Is a polymer of
glycolide and
caprolactonecaprolactone.
2.used for subcuticular
sururing..
VICRYL:
1.Polyglactin.
2. Co polymer of
glycolide and lactide.
3. Violet in colour.
4. Known as WORK
HORSE
SUTURESUTURES for
general surgeons.
5. Delayed absorbable
sututre.
SILK Suture :
Nylon Suture :
Ethilon Suture:
Polyester Suture:
Polypropylene Suture:
NEEDLES
In the past needles had eyes in them and the suture material had to be loaded into them
Currently needles used are eyeless and Atraumatic , the suture material is embeded within the shank of the
needle.
Needle has three parts 1.SHANK 2.BODY 3.POINT
Parts of the Needle
ROUND BODY NEEDLES CUTTING NEEDLES
On cross section Round. Cutting needles are
Triangular , apex pointing inwards .
Reverse cutting needles are
triangular, apex pointing outwards.
uses These are non traumatic , used for Traumatic needles used for tough
delicate structutres such as; bowel structures , such as ; skin, fascia .
and bladder, cadiovascular
surgeries.
Suture techniques
1. Interrupted sutures .
2. Continuous sutures.
3. Mattress sutures.
4. Subcuticular sutures.
5. Purse string sutures.
5941
Knotting techniques
General principles are,
Knot must be tied firmly , but without strangulation of tissues.
Knot must be unable to slip or unravel.
Knot must be as small as possible to minimize the amount of foreign material .
Knot must be bedded down carefully.
Suture material should not be sawed as this leads to weakening of the thread.
Suture material must be laid square while tying otherwise tension applied during tightening may cause breakage or
fracture of the thread .
Standard surgical knot is the reef knot.
In continous suture technique ,ABERDEEN knot may be used as final knot.
Suture is cut off after knotting the ends should be left about 1 to 2 mm long to prevent unraveling.
Alternatives to sutures
Skin adhesive strips.
Tissue glue.
Staples .
Skin adhesive strips.
THANK YOU. 😊
