suturing Flashcards
made of materials that are not
readily broken down by the
body’s enzymes or by
hydrolysis
non absorbable sutures
Absorbable Suture is broken
down by one of two methods
1. Enzymatic breakdown of
organic material
Plain or Chromatic
2. Hydrolysis
Vicryl
consists of processed collagen derived from
the submucosa of animal intestines
cat gut (absorbable)
broken down enzymatically after about 7
days
plain gut (absorbable)
collagen treated with chromium salts
to delay break down
typically loses its strength after 2-3
weeks is completely digested after about 3 months
chromic gut (absorbable)
(e.g., Vicryl and Monocryl). These materials
are broken down non-enzymatically by hydrolysis;
water penetrates the suture filaments and causes
breakdown of the polymer chain.
As a result, synthetic absorbable sutures tend to
evoke less tissue reaction than plain or chromic gut
polymers (absorbable)
retains 75% of its original tensile
strength at 2 weeks and retains 50% at 3
weeks
vicryl
retains 60-70% of its strength at 1
week and 30-40% at 2 weeks
monocryl
soft, pliable
monofilament material that retains about 50%
of its strength at 4 weeks after implantation
PDS II (p-dioxanone)
Synthetic non-absorbable materials
Nylon, Prolene, and Mersilene
There are naturally occurring non-absorbable materials
silk and cotton
single smooth strand
they glide through tissues with less
friction
may be associated with lower rates of
infection
one generally ties knots with 5 or 6
“throws”
monofilament
The bigger the suture material,
the bigger the needle
multiple fibers woven together
less likely to slip
3 throws with silk or Mersilene
multifilament
Taper to the point, and a cross-section anywhere along the shaft would reveal a round shaft
used for tissue that is easy to penetrate, such as bowel or blood
vessels.
Causes excess trauma to the skin because of difficulty in penetration and the need to grasp the skin edge very tightly with forceps.
taper needles
the bigger the number
the smaller the size of the suture
Most sutures come as a single piece, with
the suture material swaged onto the base of
the needle.
Taper or “smooth”
Cutting
similar to a
conventional cutting needle, except
that the cutting edge faces down
instead of up. This may decrease
the likelihood of sutures pulling
through tissue in some cases
revers cutting needle
Triangular in shape, and the apex
forms a cutting surface, which
facilitates penetration of tough
tissue, such as skin. make it much easier to penetrate tough tissue.
cutting needle
how should you grab the needle
The needle should be grasped in the
tip of the needle holder about 2/3 of
the way back from the point.
Grasping further back at the swaged
end tends to weaken the needle and
its attachment to the suture, and you
are likely to bend the needle.
The forceps should be held so one arm is an
extension of thumb and the other is an extension of
your index finger
The base of the forceps should rest on the dorsal
surface of the web space between the thumb and
index finger
The forceps allow you to create counter traction and
control the position of the skin edge to facilitate
passage of the needle perpendicularly through the
skin
The forceps should also be used to grasp the
needle when repositioning it in the needle holder
forceps
The ideal skin suture should form a
right angle (rectangle)
The most common method is to place the
thumb and ring finger slightly into the
instrument’s rings.
This allows you to pronate and supinate and to
open and close the jaws of the needle holder.
Avoid inserting your fingers far into the rings of
the instrument, since this will tie up your fingers
and impede your mobility.
Some surgeons do not put their fingers into the
rings at all and simply grasp the rings and body
of the needle holder in the palm of their hand.
needle holder
generally held with the
thumb slightly in one ring and the ring
finger in the other. The index finger
stabilizes the instrument by resting on
the shaft.
When cutting sutures, some
recommend sliding the tips of the
scissors down the strands to the point
where they will be cut, but it probably
makes more sense to simply move the
tips of the scissors directed to the point
where the cut will be made.
For external non-absorbable sutures it
is important to leave 4-5 mm “ears” to
facilitate suture removal
scissors
