Suture Material and Needle Choices SA Surgery

Question 1

Properties of Absorbable Sutures

Answer 1

• rapid breakdown ≤ 60 days
• if natural– phagocytosis
• if synthetic– hydrolysis/non-enzymatic

Question 2

Absorbable natural sutures

Answer 2

1. Plain gut

2. Chromic gut

Question 3

Plain gut

Answer 3

• absorbable
• natural– purified collagen from ruminant mucosa and submucosa
• monofilament character

Question 4

Chromic gut

Answer 4

• absorbable
• natural
• increasing tensile strength
• increased inflammation

Question 5

Absorbable synthetic sutures

Answer 5

Derived from polymers

1. Polyglycolic acid/PGA/Dexon- multifilament
2. Polyglactin 910/Vicryl- multifilament
3. Poliglecaprone 25/Monocryl- monofilament
4. Polydioxinone/PDS- monofilament

Question 6

Non-absorbable suture characteristics

Answer 6

• suture does NOT breakdown over time (>60 days)
• suture placed with the intent of remaining permanently or removal after complete healing (i.e. skin sutures)
• effective tensile strength remains high over time
• used for skin and drain placement
• should not use below the skin, unless for PDA surgery
• braided suture increases risk for infection

Question 7

Non-absorbable natural sutures

Answer 7

1. Silk
2. Cotton
3. Umbilical tape

Question 8

Non-absorbable synthetic sutures

Answer 8

• skin closure, urethrostomy, vascular suturing
  1. Nylon
  2. Polypropylene
  3. Polyester
  4. Braunamid- multifilament, more tissue reactivity
  5. Polyester

Question 9

Multifilament suture characteristics

Answer 9

• capillary (wicking)
• increased inflammation
• good handling
• tissue drag/chatter
• soft suture ends
• increased risk of infection

Question 10

Monofilament suture characteristics

Answer 10

• less wicking
• less inflammation/infection
• poorer handling
• less tissue drag
• stiffer ends
• poor knot security

Question 11

Rapidly absorbed sutures

Answer 11

> 80% strength loss in 14 days

1. Polyglactin/Vicryl
2. Vicryl Rapide– 50% absorbed in 5 days
3. Polyglecaprone/Monocryl– 50% in 7 days; good for bladder, bad for body wall
4. Chromic gut– 33% in 7 days–weaker suture integrity than the synthetic sutures

Question 12

Prolonged absorbable sutures

Answer 12

• Synthetic monofilament
• absorption 183 days; <30% absorbed after 14 days
  1. Polydioxinone/PDS
  2. Maxon

Question 13

Important concepts to remember

Answer 13

• fascia= holding layer (ex. holding layer for abdominal wall is the external rectus fascia)
• suture should be at least as strong at the tissue through which it passes
• choose smallest suture size possible– less tissue trauma
• loss of suture strength should be proportional to the anticipated gain in wound strength
• highly collagenous tissue is stronger but heals slower than parenchymal tissue
• early dehiscence is almost always surgeon error

Question 14

Suture needle types and indications

Answer 14

1. Taper (round)– parenchymal tissue
2. Cutting (triangular, cutting on concave side)– collagenated tissues, skin/intradermal
3. Reverse cutting (triangular, cutting on convex side)– stronger than cutting, intradermal