Suturing Flashcards
Goals of Suturing
• Aid in wound healing
• Avoid wound infection
• Assist hemostasis
• Produce aesthetically pleasing scar by approximating skin edges
History of sutures
• The earliest records of surgical suture date back to 3500 B.C. in Egypt.
• The script is now known as The Edwin Smith Surgical Papyrus.
• The first sutures were fashioned from hair, cotton, tendon, or silk. They were used on needles made of bone, stone, or wood.
• In 1867, Joseph Lister first attempted to sterilize suture.
• He used silk suture that was ‘sterilized’ in carbolic acid. The first trials were unsuccessful.
Phases of wound healing
• Coagulation
Begins immediately following injury
• Epithelialization
Of the surgical repair should occur within 48 hours of suturing
• New blood vessel growth
Peaks at 4 days
• Collagen reformation
Starts at 48 hours, peaks at 1 week and continues for
12 months
• Wound contraction
Starts 3-4 days and can last up to 2 years after the injury / repair
Factors limiting wound healing
• Steroids
• Sepsis
• Malnutrition
• Diabetes
• Obesity
• Smoking
• Chemotherapy and Radiation
• Anticoagulants
• Anti-platelet medications
• Collagen and Vascular Diseases
• Local factors
LAYERS OF SKIN
Squamous epithelium
Epidermis
Dermis
Subcutaneous tissue
Connective tissues
Muscle
SUTURE MATERIAL
• Absorbable vs. Non-Absorbable
• Natural vs. Synthetic
• Monofilament vs. Braided
Absorbable
• Natural: Gut - beef serosa or sheep submucosa
• Synthetic: Vicryl, Monocryl, PDS(polydixanone)
Non-absorbable
• Natural: Silk, Steel, Cotton
• Synthetic: Nylon, Prolene, Ethibond, Dacron
Monofilament
• Monocryl, Nylon, Prolene, PDS(polydixanone), Gut, Steel
Braided
• Silk, Cotton, Vicryl*, Ethibond, Dacron
Uncoated
• Plain suture. If absorbable, breaks down faster.
Coated
• Chromic, Polyglactin, Antibiotic. • If absorbale, delays breakdown.
SUTURE PROPERTIES
• Tensile Strength:
Measure of a material or tissue’s ability to resist deformation and breakage
• Breaking Strength:
The tension at which suture failure occurs.
The maximum limit of the tensile strength.
• Elasticity:
Measure of the ability of the material to regain its original form and length after
deformation.
• If deformed beyond its elastic property, the suture is greatly weakened.
• Plasticity:
Measure of the ability to deform without breaking.
• Memory:
Inherent tendency of suture material to retain its shape.
• Related to the elasticity, plasticity, and diameter of the suture.
• Pliability:
Ease of manipulating the suture, such as the ability to adjust knot tension and to
secure knots.
• Related to the suture material, filament type, and diameter.
• Absorption:
• Progressive breakdown and loss of mass and/or volume of suture material; does not correlate with initial tensile strength. Ultimately, tensile strength is lost as the suture degrades.
• Straight-Pull Tensile Strength:
• Linear breaking strength of suture material.
• Knot Strength:
• Amount of force necessary to cause a knot to slip (related to the coefficient of friction and
plasticity)
• Knot-Pull Tensile Strength:
• Breaking strength of the knot.
. Capillarity
SUTURE CONSTRUCTION
Point
Body
Swage
NEEDLE TYPES
• Tapered
Minimizes potential tearing, bleeding, and tissue damage.
• Cutting
Conventional versus Reverse Cutting
• The needle has 2 opposing cutting edges. Designed for penetration through dense tissue
Blunt
• Blunt-Point design for suturing tissue that is extremely friable or densely vascular. • Liver, spleen, kidney, pancreas.
7 Ideal properties of suture materials
Biocompatible
Sterile
High tensile strength
Easy handling
Good knowing strength
Uniformity in size and thickness
Dissolve in body fluids at the same rate as tissue heals
