- Smallest diameter that will secure wounded tissue o Minimize trauma o Reduce amount of foreign material - No advantage to using suture that is stronger than tissue sutured - United States Pharmacopeia (USP): 12-0 smallest to 7 largest

- Determined by torsional stiffness and diameter o Influences handling and use - Ligating vessels and continuous suture patterns

- Multifilament fibers o Fluid and bacteria get into interstices o Coating can reduce (don’t use in infected tissues) - Braided materials: examples: polyglycolic acid and silk - Monofilament: noncapillary

- single strand of material - less tissue drag - lack interstices or bacteria and fluid

- more pliable and flexible - can be coated: reduce drag and increases handling

- Maintain tensile strength - Noncapillary - Good handling - Secure knots; 4 throws

7 – Suture Materials Flashcards by Danielle Groenendijk

What is suture material’s role in wound repair?

Hemostasis
Support for healing tissue
o Few days: muscle, SQ, skin
o Weeks: fascia
o Months: tendons

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What makes an ideal suture material?

Suture will lose strength at same rate that tissues gain strength
Absorbed by tissue: minimal tissue reaction
Easy to handle
Reacts minimally in tissue
Inhibits bacterial growth
Holds securely when knotted
Resists shrinking in tissues
Noncapillary
Nonallergenic
Noncarcinogenic
Nonferromagnetic
*does NOT exist

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Size

Smallest diameter that will secure wounded tissue
o Minimize trauma
o Reduce amount of foreign material
No advantage to using suture that is stronger than tissue sutured
*United States Pharmacopeia (USP): 12-0 smallest to 7 largest

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Suture size and tensile strength

Smaller it is then the less tensile strength it has

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Flexibility

Determined by torsional stiffness and diameter
o Influences handling and use
Ligating vessels and continuous suture patterns

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Flexibility examples:

Silk: flexible
Nylon and surgical gut=less flexible
Braided polyester=intermediate flexibility
Wire=least flexible

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Capillarity

Multifilament fibers
o Fluid and bacteria get into interstices
o Coating can reduce (don’t use in infected tissues)
Braided materials: examples: polyglycolic acid and silk
Monofilament: noncapillary

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Knot tensile strength

*sutures should be as strong as the normal tissue

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Relative know security

Holding capacity of suture expressed as percentage of its tensile strength
*if low knot security then maybe need to go up in size

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Mechanisms of absorption

Digestion by tissue enzymes and phagocytosis
o Sutures of organic origin (ex. surgical gut)
Hydrolysis
o Synthetic polymers
*encapsulated/walled off by fibrous tissues=NON absorbable

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Monofilament

single strand of material
less tissue drag
lack interstices or bacteria and fluid

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Multifilament

more pliable and flexible
can be coated: reduce drag and increases handling

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Absorbable suture material: facts

tensile strength: 60 days
loss of strength and complete absorption=varies with type of suture material

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Organic absorbable suture materials

short term
phagocytosis
o inflammatory reaction
absorption rate increased by infection or digestive enzymes

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Catgut (surgical gut)

submucosa of sheep or serosa of bovine intestine
90% collagen
Phagocytosis
o Rapidly in infected sites or within digestive enzymes
**Inflammatory reaction occurs
*loses strength rapidly
*poor knot security
*high capillary

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Synthetic absorbable suture materials

Hydrolysis
o Minimal tissue reaction
Absorption not as influenced by infection or digestive enzymes

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Monofilament: long term?

PDS II, Maxon, Biosyn
*rentain tensile strength longer than multifilament sutures
o Complete absorption at 6 months (PDS and Maxon)
o Complete absorption 120 days (Biosyn)

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PDS II

Maintain tensile strength
Noncapillary
Good handling
Secure knots; 4 throws

Polyglyconate (Maxon)

Maintain tensile strength
Noncapillary
Good handling
Secure knots

Glycomer 631 (Biosyn)

Maintain tensile strength
Non capillary
Good handling
Secure knots
*aborbs slightly faster than Maxon and PDS

Monofilament: short to medium term

Monocryl and Caprosyn
o Tensile strength: 2-3 weeks (30% at 14 days)
o Absorbed rapidly
Pliable, lack stiffness, good handling

Multifilament: medium term

Dexon
o 100-120 days: absorption
Vicryl
o CLOSE ABDOMEN IN COLIC SURGERY
o 40-90 days: absorption
*braided
o Harbor bacteria
o Increased capillary
*good handling: saws tissues
*secure knots: want long tails

Silk

Maintain tensile strength
o 50% at 1 year
Good handling
Secure knots

Polymerized caprolactam (Supramid)

Maintain tensile strength (greater than nylon)
Good handling
Cheap
Secure knots: 4 throws
**don’t bury: infectious and fistulation
o Inner core and outer sheath: breaks and allows bacteria

Polyester (Ethibond)

- Maintain tensile strength (greater than nylon) - Good handling: saw tissue - Secure knot: 6 throws

Polybutester (Novafil) and Polypropylene (prolene)

- *common for skin - Maintain tensile strength - Noncapillary - Good handling: slippery - Secure knot: 4 throws

Dermalon

- Maintain tensile strength - Good hangling: more memory - Secure knots: 4 throws - Antibacterial

Stainless steel

- Maintain tensile strength (greater than nylon) - Non capillary - Secure knots - Difficult to handle

What will you use for skin?

- Monofilament nonabsorbable

What will you use for subcutaneous tissue?

- Synthetic absorbable

What will you use for fascia?

- Monofilament absorbable or nonabsorbable

What will you use for a tendon?

- Monofilament absorbable or Nylon

Suture needles (2)

- Swaged on o Less traumatic o Technically easier - Eye needle o More traumatic o Technically difficult

Suture needle shapes

- Straight - **3/8 circle: what we use most of the time - ½ curved - Half circle - *depth of wound might determine your type of circle

Suture needle points

- Taper: point and then circular o Fascia, SQ, intestine or bladder (NOT skin) - Cutting: point is within the curve of needle=could cut through tissue - Reverse cutting: doesn’t cut when you are pulling up (flat on inside of circle) o Most of the swaged on needles - Trocar cut

Needle choice for different tissues

- Skin: cutting - Bowel, SQ: taper - Fascia, tendon: taper or modified cutting

Linea alba: suture choice

- Absorbable - Either: monofilament or multifilament - Cutting needle - Long lasting - *PDS or vicryl

Subcutaneous tissue: suture choice

- Absorbable - Monofilament or coated multifilament - Taper - Quick to absorb - *monocryl

Skin: suture choice

- Non-absorbable (except if not going to see the patient again) - Monofilament - Cutting - Non-absorbable - *prolene, novalfil, PDS (non-absorbable)

Parenchymal organs (liver, spleen, kidney): suture choice

- Absorbable - Monofilament - Taper - Quick to absorb - *Monocryl

Hollow viscous organs (trachea, GI, bladder): suture choice

- Absorbable - Monofilament - Taper - In between - *monocryl, dexon (not in urine)

Vessel ligation: suture choice

- Absorbable - Multifilament=will allow for better knot security - Either: not using a needle most of the time - Long lasting - *PDS, vicryl, maxon, biosyn

Vessel anastomosis: suture choice

- Nonabsorbable - Monofilament - Taper - Long lasting - *prolene