The slides demonstrated that Suturing are of different methods and styles ,and are applied for different tissues and for different surgical techniques and procedures. Sutures are of Different materials and used for different styles and tissues . Modern innovations in wound suturing ,wound closure are also described in the slides .

1. SUTURES & SUTURING IN
SURGERY
BY
DR MUKORO DUKE GEORGE
B.SC,MBBS,MCS,HSECERT,ATLS,DTM&HLIVERPOOL
GRADUATE MEMBER NIM
NDUTH,

2. OUTLINE
o
INTRODUCTION

HISTORICAL BACKGROUND

DEFINITIONS
o QUALITIES OF AN IDEAL SUTURE
o CLASSIFICATION/STRENGTH
o TYPES/USES
o SUTURE SELECTION
o SUTURE ACCESSORIES(NEEDLES)
o STERILIZATION OF SUTURES
o SUTURE REMOVAL
o COMPLICATIONS
o RECENT ADVANCES
o CONCLUSION
o REFERENCES

3. INTRODUCTION
•
•
DEFINATIONS ⌂ Suturing refers to sewing
together two structure using suture threaded on a
needle. The purpose of suture is to hold tissues
together until strong enough to support itself
during wound healing.
Ligating or ligaturing refers to tying a ductal
structure such as blood vessel simply by means of
a suture thread.

4. INTRODUCTION
 HISTORICAL BACKGROUND
 Sutures are used to improve & speed healing
 Hx dates back to 550-3000BC
 Early sutures were Flax, Silk, Linen strips & cotton
 Synthetic sutures are now available

5. DEFINITIONS
 Suture is a material used to approximate living tissues
or xtures together
 Ligature is a suture used to encircle a bld vessel to
arrest or control bleeding
 Tensile strength is the ability of the material or tissues
to resist deformation or breakage
 Elasticity is the ability of the material to regain its
original form or length after deformation
 Pliability is the ability to adjust knot tension & to
secure knot
 Memory is the inherent capability of suture to return or
maintain its original gross shape

6. QUALITIES OF AN IDEAL SUTURE
by Lord Mogniham (1865 – 1936)
 Sterile and easily sterilizable
 Serve all purpose
 Minimal tissue :non-electrolytic, non-capillary, non-allergenic,
non-carcinogenic (and non-thrombogenic in vascular surgery.
 Easy to handle
 Hold knot securely
 High tensile strength
 Favourable absorption profile
 Resistant to infection
 Available
 Inexpensive

7. Features of a suture
1)
2)
3)
4)
5)
6)
7)
8)
9)
Suture stength - Measured by instron tensiometer.
Tissue Reactivity
Handling
Knotting
Sterilization
Absorbility
Viability
Elasticity
Size

8. CLASSIFICATION OF SUTURES/STRENGTH
 ABSORPTION
ABILITY
Absorbable
ORIGIN
Natural
Synthetic
Non-absorbable Natural
Synthetic
CONFIGURATION
Monofilament
Multifilament
Monofilament
Multifilament
 TRAUMATIC & ATRAUMATIC
STRENGTH : Ranges from smallest(10/0) to largest(5)

9. ABSORBABLE
NON ABSORBABLE
1. Catgut
Silk,
2. Chromic Catgut
Linen
3. Dexon (Polyglycolic acid)
Cotton
4. Vicryl (Polyglacitin)
Horse/Human hair
5. PDS (Polydioxanone)
Nylon or Ethilon
6. Collagen
Polyester (Teflon)
7.
Polypropylene (Prolene)
Maxon (Polyglyconate)
.8. Poliglecaprone
Stainless steel
Aluminium Wire
Clips
Staples
Skin tapes
Surgical adhesives

10. TENSILE STRENGTH/ABSORBABILITY
Suture
T/S loss
Absorption tissue
Catgut
15 days
60 days
Chronic Catgut
30 days
80 – 120 days
Polyglyconic
30 days
90 days
Polyglactin(vicryl) 32 days
70 days
Polydioxanone
56 days
180 days
Nylon
25% in 2yrs
Prolene
Indefinite
Dacron
Indefinite
acid(DEXON)

11. TYPES/USES
 ABSORBABLE – NATURAL
 Plain catgut:light milk,Derived from submucusa
of sheep intestine or serosa of beef intestine
 Used for ligating superficial bld vessels & subcut
fatty tissues
 Chromic catgut:yellow,Treated with chromium
salt.
 Adv may be used in the presence of infection

12. ABSORBABLE - SYNTHETIC
 Polyglactin (vicryl):cream,
copolymer of lactide &
glycolide
 Minimal tissue rxn
 Used in general soft tissue
approx,intestinal
anastomosis,vessels ligation
in all surgical specialties
Dexon(Polyglyconic
acid):purple/cream
Homo polymers of glycolide.
Avoid in adipose tissue
Losses tensile strength more
rapidly than vicryl.
 Other e.g
Polyglyconate(maxon)
polydiaxone(PDS),Polyglecap
rone(monocryl)

13. NON-ABSORBABLE-NATURAL
 Surgical silk:Black, Derived from the cocoon of the
silk worm larvae, superior handling xtics,Trigger
inflam rxns,Undergo proteolysis & undetected by
2yrs,Used in ligating maj bld ves,tendon repair etc
 Surgical steel & wires
 High tensile strength
 Hold knots very well
 Used in orthopaedic,Neurosurg,& Thoracic surg
 Other e.g Virgin silk,cotton, linen

14. NON-ABSORBABLE - SYNTHETIC
 Nylon:Is a polyamide polymer,blue
 81% tensile strength at 1yr & 66% at 11yrs
 Elicits minimal tissue rxn
 Has good memory
 Pliable when moist
 Premoistened form is used cosmetic plastic surgery
 Its elasticity makes it useful for skin closure &
Herniorhapy
 Other e.g;Polypropylene(prolene),Polyester
fiber(Mersilene/Dacron,Ethibond)

15. SYNTHETIC NON-ABSORBABLE (CUT)
Staples and chips:
Faster than traditional suture, in gut anastomosis, vascular
&bronchial closure.
Skin tapes:
Impervious to sweat, wound infection less, avoid suture marks.
Surgical adhesives:
Expanded polytetra fuoroethylene

16. Monofilament Suture
 Grossly appears as single strand of suture




material; all fibers run parallel
Minimal tissue trauma
Resists harbouring microorganisms
Ties smoothly
Requires more knots than multifilament suture
Possesses memory
Examples:
Monocryl, PDS, Prolene, Nylon

17. Multifilament Suture
 Fibers are twisted or braided together
 Greater resistance in tissue
 Provides good handling and ease off tying
 Fewer knots required
 Examples:
 Vicryl (braided)
 Chromic (twisted)
 Silk (braided)

18. SUTURE SELECTION
 Depends on surgeons training & preference
 Smallest suture is preferable
 Tensile strength of suture should not exceed that of
tissues
 Aesthetics should be considered e.g head&neck
 Mobility of the region e.g Limbs & trunk
 Tension of the tissues to be sutured e.g major
musculocutaneous flaps
 Non-absorbable considered in skin,fascia,tendon
 Absorbable considered in rapidly healing tissues
 Monofiliments preferable in contaminated wounds

19. Suture Size
United States Pharmacopeia
 Sized according to diameter with “0” as reference size
Numbers alone indicate progressively larger sutures
(“1”,“2”, etc)
 Numbers followed by a “0” indicate progressively
smaller sutures (“2-0”, “4-0”, etc)
 Smaller<------------------------------------->Larger
.....”3-0”...”2-0”...”1-0”...”0”...”1”...”2”...”3”.....

20. SIZE OF SUTURES
 OLD GAUGE(USPD)
 8/0
 7/0









6/0
5/0
4/0
3/0
2/0
0
1
2
3
4
DIAMETER IN MM
0.05
0.O7
0.1
0.15
0.2
0.3
0.35
0.4
0.5
0.6
0.7
0.8

21. Wound Closure
Basic suturing techniques:
 Simple sutures
 Mattress sutures
 Subcuticular sutures
Goal: “approximate,, not strangulate”

22. Ideal Wound Closure
 Allow for meticulous wound closure
 Easily and readily applied
 Painless
 low risk to provider
 Inexpensive
 Minimal scarring
 Low infection rate

23. METHODS OF SUTURING
 1. CONTINUOUS SUTURING
►Rapid application
►Efficient
►Haemostatic
►Easily drawn tight
►Edges may overlap
►Whole wound may open if any breaks
 2. INTERRUPTED SUTURING
►Skin
►Infected sites
►1mm apart on the face
►1cm apart at other areas

24. Continuous Locking and Nonlocking Sutures

26. Simple, Interrupted

27. Vertical Mattress
Good for everting wound edges
(neck, forehead creases, concave surfaces)

29. Horizontal Mattress
Good for closing wound edges under high tension,
and for hemostasis.

30. Horizontal Mattress

31. SUTURE ACCESSORY-NEEDLES





Ideal surgical needle
High quality stainless steel
Smallest diameter possible
Stable in the grasp of needle holder
Sharp enough to penetrate tissues with minimal
resistance & trauma
Sterile & corrosive resistant

32. ANATOMY OF THE NEEDLE

33. POINT
 Cutting;
 Conventional cutting
 Reverse cutting
 Side cutting
 Taper(round needle)
 Blunt

34. BODY
 Straight
 Half curved
 Curved: ski 1/4 circle 3/8 circle 1/2 circle 5/8 circle
 Compound curved
SWAGE
 Channel swage
 Drill swage
 Non swaged

35. STERILIZATION OF SUTURES
 May affect suture properties to some extent
 Gamma Radiation
 Ethylene oxide;poisonous gas,is less attractive
 Autoclave
 Sutures are usually stored in sterile pack by the
manufacturers,their integrity must be checked b/4
use

36. Packaging…
Metric Gauge
Imperial Gauge
Product (re-order) Code
Needle size
& curvature
Needle type
Needle point
Needle profile
Sterilised
Ethylene Oxide
Do Not Re-use
See Instructions
for use
Expiry date
Batch Number

37. SUTURE REMOVAL
 Sutures on the superficial(skin) wounds are removed






after serving their fxn
Duration depends on the site;
Head & Face = 3-5d
Arms & Hands = 7-10d
Chest
=7-10d
Abdomen =7-1od
Lower limbs/feet =10-14d

38. COMPLICATIONS
 Usually less if proper selection is followed
 Failure
 Undo
 Tissue rxn
 Infection
 Abscess and sinus formation
 scarring

39. RECENT ADVANCES
 Staples & Clips
 Formed from high quality stainless steel
 New absorbable clips made of polydiaxone are
available
 Staples are suitable for skin closure
 Stapling gun for bowel anastomosis are popular
 Skin Tapes & Adhesives e.g Dermabond
 Non-suture methods of closing wound edges
 Applied after adequate subcuticular closure
 Minimal infection rate & no tissue rxn
 EXPENSIVE

40. Adhesive Tapes
 Less reactive than staples
 Use of tissue adhesive
adjunct (benzoin)
 Poor outcome in areas of
tension
 Seldom used for primary
closure
 Use after suture removal

41. Adhesive Tapes
Advantages
• Least
reactive
• Lowest
infection rate
• Rapid
application
• Patient
comfort
• Low cost
• No risk of
needle stick
Disadvantages
• Frequently
falls off
• Lower tensile
strength than
sutures
• Highest rate of
dehiscence
• Requires use
of toxic
adjuncts
• Cannot be
used in areas
of hair
• Cannot get wet

42. Staples
 More rapidly placed
 Less foreign body
reaction
 Scalp, trunk, extremities
 Do not allow for
meticulous closure

43. Dermabond®
 A sterile, liquid topical skin
adhesive
 Reacts with moisture on skin
surface to form a strong, flexible
bond
 Only for easily approximated skin
edges of wounds
 punctures from minimally
invasive surgery
 simple, thoroughly cleansed,
lacerations

44. Dermabond®
 Standard surgical wound prep and dry
 Crack ampule or applicator tip up; invert
 Hold skin edges approximated horizontally
 Gently and evenly apply at least two thin
layers on the surface of the edges with a
brushing motion with at least 30 s between
each layer, hold for 60 s after last layer until
not tacky
 Apply dressing

45. CONCLUSION
 Human body is very delicate & important.When
surgeries are needed to improve our health is very
important to select a suitable suture.Today we know
alots of biomaterials to select,but is important to
always think of biocompatibility.

46. REFERENCES
1) Post-graduate surgery, candidates guide M.A.R
Alfallouji,2nd edition
2) Principles & practice of surgery including
pathology in the Tropics, E.A.Badoe etal 3rd edition
3) Clinical surgery Alfred Cusheri etal 2nd edition
4) www.e.medicine.com

47. THANK YOU
FOR
LISTENING