Sutures are materials used in surgery for a variety of reason ranging from surgical repair of wounds, ligature, etc. There are a wide variety of sutures with different characteristics that must be born in mind while choosing a suture

1. SUTURES IN SURGERY
DR. ALUMONA C. O

2. OUTLINE
• Introduction
• Historical Perspective
• Statement of Surgical Importance
• The Ideal Suture
• Suture characteristics
• Applications in surgery
• Classification
• Some common sutures
• Sterilization
• Selecting a Suture
• Suturing techniques
• Knotting Techniques
• Suture Removal
• Needles
• Complications
• Recent Advances (staples, barbed sutures, glues etc
• References

3. Introduction
• Sutures are medical devices used to co-apt
tissues following trauma or surgery.
• Surgical stitches
• Natural or synthetic materials
• Application continue to evolve

4. Historical Perspective
• Tendon strips , Acacia thorns: East Africa
• Black ants: South America
• Horse hair, cotton, leather: India (1000BC)
• Linen, silk, metal clips: Roman empire

5. Statement of Surgical Importance
• Sutures are crucial in surgical repair of
wounds, a proper understanding of their
properties, interactions with body tissues,
principle of use and complications are
necessary to ensure good wound healing and
safety

6. The Ideal Suture
• Sterile
• Predictable: tissue behaviour, tensile strength
• Minimal tissue activity:
– non electrolytic,
– non capillary,
– non allergenic,
– non carcinogenic,
– non thrombogenic (in vascular surgery)

7. The Ideal Suture cont
• Easy to handly
• High knot security
• High tensile strength
• Favourable absorption profile
• Resistant to infection
• Readily available
• cheap

8. Classifications
Absorption Profile Source Configuration
Absorbable Natural Monofilament
Synthetic Multifilament
Non-absorbable Natural Monofilament
Synthetic Multifilament
Size (small to large): 10-0 … 6-0 … 4-0 … 2-0 … 0…, 1, 2, 3, 4, 5
Dyed or Plain

9. Suture Characteristics
• Physical Structure:
– monofilament or multifilament
– Knotting implication
– Toughness
– Tissue activity

10. Suture Characteristics cont
• Strength: depends on
– Constituent material: absorbable or non-
absorbable
– Thickness/diametre
– Handling
• (tensile strength vs material in vivo strength)

11. Suture Characteristics cont
• Tensile Behaviour:
– Elasticity; memory
– Plasticity; kinking
• Knot integrity
• Absorbability:
– Absorbable: in biliary and urinary tract surgery
– Non absorbable: in vascular anastomosis, artificial
grafts, prosthesis

12. Suture Characteristics cont
• Biological behaviour:
– Depends on constituent material
– Degradation: Proteolysis vs Hydrolysis
– Transmission of infection
– Local recurrence of gut tumours

13. APPLICATIONS IN SURGERY
• Suturing
• Ligatures
• Anchorage
• Stay
• Tissues retraction
• Tags
• etc

14. Some common sutures- Absorbable

15. Some common sutures: Non-Absorbable

16. Sterilization of sutures
• Gamma Radiation
• Ethylene Oxide
• Autoclave
• Catgut are package in alcohol solution to
retain flexibility

17. Selecting Suture
• Surgeon factor
– Training, Experience, Preference
• Nature of tissue
• Region of the body
• Suture
– Size
– Structure
– Tensile strength
– Absorbability

18. Suture Techniques
• Interrupted sutures
– Inserted and exited at
right angle to the incision
– Needle should be rotated
through tissue without
dragging
• Continuous sutures
– Needs an assistant to
maintain tension

19. • Mattress suture
– Vertical or horizontal
– Used for accurate
approximation of wound
edges
– To produce invertion or
evertion of wound edges
– Horizontal mattress used
to secure hemostasis

20. • Subcuticular suture
– Used on the skin
– For cosmesis
– Absorbable or non
absorbable may be used

21. Knotting Techniques
• Must be firm without strangulating the tissue
• Must be unable to slip or unravel
• Must be as small as possible to minimize amount of
foreign material
• Tension must not be exerted on the tissue while
securing the knot
• The suture material must not be sawed during tying
• The suture thread must not be grasped with
instruments
• Multiple throws must be used for sutures with memory
• Cut sutures 1-2mm from knot to avoid unraveling

23. Suture Removal
• When depends on the site
• Head and face: 3-5 days
• Arms and hands: 7-10 days
• Chest: 7-10 days
• Abdomen: 7-10 days
• Lower limbs: 10-14 days
• Infection

24. Needles

25. Needle points

26. Needle shapes

27. Complications of sutures
• Failure
• Tissue reaction
• Infection
• Abscess and sinus formation
• Malignancy
• Scarring

28. Recent Trends
• Staples and clips
• Absorbable clips from PDS
• Stapling guns for bowel anastomosis
• Skin adhesives eg Dermabond
• Barbed sutures: knots not needed. Used in
laparoscopic surgeries

29. Conclusion
• Sutures are very common and indispensible
tools in surgery however it must be born in
mind that they are foreign bodies. Hence
necessary principles of use must be applied
for safety of the patient

30. Refrences
• Bailey, H., Love, R. J. M. N., Mann, C. V., & Russell, R. C. G. Bailey
and Love short practice of surgery. 27th Edition. London: Chapman
& Hall medical. (2018)
• Archampong E. Q., Naaeder S. B., Ugwu B. Baja’s Principle and
practice of Surgery. 5th Edition. Ghana Publishing Corporation.
(2015)
• M.A.R Alfallouji. Post-graduate surgery, candidates guide,2nd
edition
• Clinical surgery Alfred Cusheri etal 2nd edition
• www.e.medicine.com
• https://periobasics.com/sutures-and-suturing-techniques/
• https://camls-us.org/wp-content/uploads/2018/05/10.30am-
Handout-Cherpelis-Needles-2018.pdf