10. Suture material characteristics (including size), different needle types

Question 1

10. Suture material characteristics (including size), different needle types

Answer 1

Suture characteristics
-suture size
-smallest safe size should be used
-USP most commonly used
>5-0 bigger than 7-0
>if zero behind = bigger the number
>0 is between 2-0 and 1 = 0 is bigger than 2-0, 0 is smaller than 1
>smallest is 7-0 = 0,05 mm
>biggest is 2 = 0,5 mm

Suture material characteristics
-flexibility– determined by torsional stiffness and diameter
-surface characteristics and coating– influence movement through tissues
-capillarity– high capillarity increases likelyhood of infection
-monofilament/multifilament
-knot tensile strength
-relative knot security
-knot holding capability
-absorbable/non-absorbable

Benefits of different suture types
-monofilament
*low capillarity
* less tissue damage
-multifilament
* knot security
* handling
* flexibility
* strength
=monofilament should be preferred unless indicated otherwise.

Absorbable suture material
-short term: natural(Catgut) and synthetic(Vicryl)
-medium term: braided(Vicryl) and monofilament(Monocryl)
-long term: braided and monofilament(Maxon)
*natural–are absorbed by enzymatic activity of the tissue or by phagocytosis
*synthetic – are degraded by hydrolysis
*most of the absorbable sutures lose tensile strength in 60 days.

Non-absorbable suture material
-natural:silk
-synthetic:braided(Nurolon) and monofilament(Ethilon)
*will be encapsulated within tissues
*tensile strength lost in several years, but never absorbed
*nylon 30% 2 years
*silk 30% 14 days, 50% 1 year
*usually meant to be temporary and therefore removed after

Tissue adhesives(kudosliimat)
*used for clean superficial wounds
*not to be used in case the wound is:
-contaminated
-deep
-inflamed
-resulting from a bite
*also not used if subdermal pockets are deeper than 5mm
*subcutaneous sutures indicated
*reaches maximum bonding strength within 2,5 minutes
*equivalent in strength to healed tissue at 7 days after repair

Needles
-needles are chosen for appropriate tissue
-they are characterized by their ductility(taipuisuus),
sharpness and strength
-according to geometry needles are divided
into traumatic and atraumatic categories
-needles without built in suture material.

Needle point geometry(neulan kärjen geometria)
1.taperpoint(kartiopiste)-Atraumatic
*thin round tip, no cutting edges
*spreads tissues, does not cut
*suturing soft tissues
2.tapercut-traumatic
*reverse cutting edge tip and taperpoint(kartiomainen) body
*dense, tough fibrous tissue (fascia, ligaments)
*cardiovascular procedures
3.regular cutting(säännöllinen leikkaus)-traumatic
*3 cutting edges, 1 on the inside
*very sharp
*cuts, does not spread
*promotes“cut out” of tissue
4.reverse cutting(käänteinen leikkaus)-traumatic
*3 cutting edges, 1 on the outside
*stronger than regular cutting needle (3.)
*reduced amount of tissue cut out(vähentynyt määrä kudosta leikattu pois)
5.spatula point(lastulan kärki)-traumatic
*flat on the top and bottom, cutting sides
*ophthalmologic procedures(silmäleikkaukset)
6.blunt point(tylppä kärki)-atraumatic
*blunt point(tylsä kärki)
*spreads, does not cut
*soft, parenchymal tissue (liver, kidneys)