SUTURES MATERIALS & SUTURING TECHNIQUES.pptx

1. SUTURES MATERIALS & SUTURING
TECHNIQUES
Dr Abdulkadir Mohamed
05-Sep-2023
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2. Outlines
 Definition
 Goals of suturing
 Armamentarium of suturing
 Suture materials
 Principles of suturing
 Suturing techniques
 Removal of suture
 Reasons for failures of sutures
 Possible complications
 Alternative to suture
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3. DEFINITIONS:
What is suture?
Suture is a stich or series of stiches made to secure
apposition of the edges of a surgical or traumatic
wound.
What is suture materials?
Suture materials is an artificial fibers used to keep
wound together until they hold themselves by natural
which is synthesized & oven into a stronger scar.
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4. GOALS OF SUTURING
1. Wound edge apposition.
2. Provide adequate tension.
3. Maintain haemostasis.
4. Aid in wound healing.
5. Avoid wound infection.
6. Produce aesthetically pleasing scar by
approximating skin edges.
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5. SUTURE CHARACTERISTICS
physical structure:
• Monofilament-
• This suture material is smooth & tends to slide
through tissues easily.
• Difficult to knot.
• Can be damaged by gripping it with needle holder or
forceps. That can lead to fracture of the suture
materials.
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6. SUTURE CHARACTERISTICS
Multifilament-
• Easy to knot.
• Have a greater surface area than monofilaments.
• Have a capillary actions where bacteria may
lodge & be responsible for persistent infections.
• This material can be coated with silicone in order
to make it smooth.
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7. SUTURE CHARACTERISTICS
• Tensile strength:
It can be expressed as the force required to break it when
pulling the two ends apart
It depends upon:
• Constituent of suture materials.
• Thickness of suture materials.
• How it is handled in the tissue.
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8. SUTURE CHARACTERISTICS
• Absorbability:
– Suture materials may be absorbable or non-absorbable.
– This property must be taken into consideration when choosing
suture materials for specific wound closures.
– Oral mucosa & Deep sturcture need to be absorbable suture
materials but vascular anastomoses need non-absorbable
suture materials.
• Biological Behaviour:
– It depends upon the constituent of raw materials.
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9. Armamentarium of suturing
• Needle holder
• A suture needle
• Suture materials
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10. Needle holder
• Parts:
– Working tip/jaws
– Hinge joint
– Shank/body
– Catch mechanism/ratchet
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11. Needle holder
• How to hold?
The needle holder is held
with thumb & ring finger
through the rings & with the
index finger along the length
of needle holder to provide
stability & control.
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12. A suture needle
• Made up of either
SS(stainless steel) or
carbon steel.
Parts:
• 1.tip/point
• 2. body/shaft
• 3.eye/swaged end
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13. Shapes of needles
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14. Classification of needle
• According to Shape
1. Straight
2. Curved
• According to eye:
1.Eyed needle/Traumatic
2.Eyeless needle/Atraumatic
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15. Classification of needle
• According to cutting edge
1. Round body
2. Cutting body:-
• Conventional
• Reverse cutting
• According to its tip
1. Triangular
2. Round
3. Blunt
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16. SUTURE MATERIALS
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17. SUTURE MATERIALS
• Ideal properties:
✓ Easy to handle.
✓ Predictable behaviour in tissues.
✓ Predictable tensile strength.
✓ Sterile.
✓ Secure knotting ability.
✓ Minimal tissue reaction.
✓ Non-alergenic, non-carcinogenic,non-shrinkage.
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18. CLASSIFICATIONS OF SUTURE MATERIALS
• According to source:
1. Natural
2. Synthetic
3. Metallic
• According to structure:
1. Monofilament
2. Multifilament
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19. CLASSIFICATIONS OF SUTURE MATERIALS
• According to fate:
1. Absorbable
2. Non-absorbable
• According to coating:
1. Coated
2. Uncoated
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20. Natural
Absorbable:-
– catgut
– Chromic catgut
– Collagen
– Fascia lata
– Beef tendon
Non- absorbable:-
– Silk
– Silk worm gut
– Linen
– Cotton
– Ramie
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21. Synthetic
Absorbable:
– Polyglycolic acid
– Polyglactic acid
– Polyglactin (vicryl)
– Polydioxanone(PDS)
Non- absorbable:
– Nylone (polyamide)
– Polypropyline (Prolene)
– Polyesters
– polyethelene
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22. Metallic
• SS (stainless steel)
• Tantalum
• Silver
• Gold
• Aluminium
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23. Monofilament
Absorbable:
– Catgut
– Chromic catgut
– Vicryl
– PDS
Non-absorbable:
– Polypropylene
– Polyester
– Nylone
– Polyvenyleidene
fluoride/PVDF
– suture
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24. Multifilament
Absorbable:
• Vicryl
• Polyglycolic acid
Non- absorbable:
• Silk
• Cotton
• linen
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25. Monofilament vs multifilment
Monofilament:
– Has no capillary action
– Less infection risk
– Smooth tissue passage
– Higher tensile strength
– More throws required
Multifilament:
– Has capillary action
– Increased infection risk
– Less smooth passage
– Less tensile strength
– Better knot security
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26. Absorbables Non absorbable
• Absorbable:
– Degraded by enzymes,
hydrolysis or phagocytosis
– Used to hold the edges in
approximation temporarily
until the wound is heal.
Non- absorbable:
– Encapsulated or walled off
by fibrosis.
– Used to suture at sites
where tensile strength need
to be maintained.
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27. Summary
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28. Selection of suture materials
• Condition of the wound.
• Tissues to be repaired.
• Tensile strength.
• Knot holding characteristics.
• Reaction of surrounding tissues.
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29. Commonly Used Suture MaterialsCommonly Used
Suture Materials
• Polypropylene (prolene)
• It is synthetic, non-absorbable monofilament suture
materials.
• Polymer of propylene.
* Uses:
1.General surgery.
2.Plastic surgery.
3.Cardiovascular surgery.
4.Skin closure.
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30. • Advantages:
1. Won't loose tensile
strength over time.
2. Good knot security.
3. Very little tissue reaction.
4. High plasticity.
• Disadvantage:
1.Stretch when pulled.
2. Loosens when edema
subsides.
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31. Commonly Used Suture MaterialsCommonly Used
Suture Materials
Silk:
• It is natural, non-absorbable multifilament suture
materials.
• Made from the filament spun by silkworm larva.
* Uses:
1.Opthalmic surgery.
2.General surgery.
3.plastic surgery.
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32. • Advantage:
1.Ease of handling.
2.Good knot security.
3.Cost effective.
• Disadvantage:
1. Very reactive.
2.can't be used in presence of
infection.
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33. Commonly Used Suture Materials
Vicryl
• It is synthetic & absorbable suture materials.
• Monofilament/multifilament & coated/uncoated.
• Available in purple color/undyed.
* Uses:
1. Intra oral suturing.
2. Gut anastomoses.
3. Vascular ligature.
4. Opthalmic surgery
5. Superficial soft tissue approximation of the skin and mucosa.
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34. Advantage:
1. Minimal tissue reactivity.
2. Can be used in infected
tissues.
3. Stronger than gut retains
strength 3 weeks.
Disadvantage:
1. In case of prolong
approximation can't be used.
2. Delayed absorption &
increased inflammation.
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35. Suture sizes
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36. Principle of suturing
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37. Principle of suturing
• The needle should be
grasped at approximately
1/3 of the distance from
the eye & 2/3 from point.
• The needle should be
pierced the tissue
perpendicular to its
surface.
• The needle should be
placed equidistant (2-
3mm) from the incision
line.
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38. Principle of suturing
• The depth of penetration
should be equal on both
side of incision line.
• The needle always passes
from -
– The movable tissue to the
fixed tissue.
– Thinner tissue to the thicker
tissue.
– Deeper tissue to the
superficial tissue.
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39. Principle of suturing
• The tissue never be closed
under tension.
• Each suture must be
placed 3-4 mm apart from
the incision line.
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40. Suturing techniques
• Interrupted suture.
• Continuous suture.
• Mattress suture.
• Figure of 8 (eight) suture.
• Subcuticular suture.
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41. Interrupted suture
Use:
• closure of wound
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42. Interrupted sutures
Advantages:
✓ Simple
✓ Performed in urgent situations
✓ Easy to remove
Disadvantage:
✓ Failed to bring all surfaces in contact
✓ Less supportive for healing
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43. Techniques or interrupted sutures
→ Cleansing & debridement.
→ Selection of appropriate suture.
→ Wound margins are accurately opposed.
→ Suture needle is held with the needle holder positioned at
least one third of the length of the suture away from the end of
suture attachment.
→ A 'bite of skin is taken at a landmarked site.
→ The suture needle is advanced to the depth of the wound
margin & then out through the wound opening.
→ The needle is next inserted via the depth of the wound &
rotated up through the opposite skin margin & the landmarked
site for apposition of the wound.
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44. Continuous sutures
Continuous suture are of 3 types:-
– Simple continuous suture.
– Locking continuous suture.
– Continuous over & over suture.
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45. Simple continuous sutures
uses:
• Well approximated wounds with minimal tension.
Advantage:
• Rapid technique for closure.
• Even distribution of tension over the suture line.
Disadvantage:
• Shouldn't be used in areas of existing tension.
• Not possible to free a few sutures at a time.
• When one suture breaks it affects the whole closure.
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46. Technique for simple continuous sutures
• The beginning of the simple
continuous suture is similar to
the simple interrupted suture.
• The needle is then reinserted
in a continuous fashion such
that the suture passes
perpendicular to the incision
line.
• The suture is ended by
passing a square knot over the
untightened end of the suture.
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47. Locking continuous sutures
Uses:
• Long edentulous areas.
• Tuberosities/retromolar areas.
Advantage:
• Avoid the multiple knot of the interrupted suture.
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48. Locking continuous sutures
• Technique:
• At first a single interrupted
suture is used to make a tie.
• The needle is next inserted
through the underlying
surface of the flap.
• The needle is then passed
through the remaining loop
of the suture & the suture is
pulled tightly,thus loocking it.
• This procedure is continued
until the final suture is tied
off at the terminal end.
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49. Continuous over & over suture
• Initially a simple interrupted
suture is placed & the needle is
then reinserted in a continuous
fashion such that the suture
passes perpendicular to the
incision line below & obliquely
above.
• The suture is ended by passing
a knot over the untightened end
of the suture.
• It provides a rapid technique for
closure & distribute the tension
uniformly over the suture line.
• It also offers a more water tight
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50. Layered closure
• Wounds that involved only the skin are often best closed
with a single layer of interrupted suture
• In case of deep wounds, tissue should be closed in
layers to remove dead space & confer strength to the
wound
• The technique for layered closures involves closing the
deeper tissues first, usually with a continuous sutures &
then closing the skin with interrupted sutures.
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51. Layered repair
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52. Mattress sutures
These suture
may be:-
Horizontal. Vertical.
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53. Horizontal mattress sutures
• This procedure is continued till the entire length of the
incision & a knot is then tied.
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54. Vertical mattress sutures
• It is similar to the horizontal mattress except the depth of
penetration, i.e. when the needle is brought back from the
second flap to the first, the depth of penetration is more
superficial.
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55. Vertical mattress sutures
Uses:
• Closing deep wounds abdomen or hip.
Advantage:
• Decreasing the dead space & providing increased
strength.
• Doesn't interfere with healing.
Disadvantage:
• Approximation is difficult.
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56. Figure of eight) suture
Advantage: Rapid closure
Disadvantage:
• Due to its orientation,it is
difficult to remove & it
leaves a significant
amount of suture threads
inside the socket.
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57. Subcuticular suture
• Usually a running stitch, but can be interrupted
• Intradermal horizontal bites.
• Allow suture to remain for a longer period of time without
development of crosshatch scaring.
Uses:
• Simple, uncomplicated wound.
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58. Subcuticar suture
Advantage:
• Excellent cosmetic
closure.
• No stitch to remove.
Disadvantage:
• Technically more difficult to
master.
• Doesn't hold in thin skin
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59. Removal of suture
• Face 3-5 days
• Lip 3-5 days
• Oral cavity 6-8 days
• Neck 5-6 days
• Scalp 7-10 days
• Chest 10-14 days
• Abdomen 10-14 days
• Leg 10-14 days
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60. Principles of Suture removal
• Principle of suture removal
• Suture area is first clean with normal saline.
• The suture is grasped with non tooth dissecting forceps &
lifted above the epithelial surface.
• Scissors are then passed through one loop & then
transected close to the surface to avoid dragging
contaminated suture materials through tissues.
• The suture is then pulled towards the incision line to
prevent dehiscence. if suture entrapped in a
scab,application of hydrogen per oxide/normal saline is
necessary.
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61. Principle of suture removal
• If pieces of suture left infection may occur
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62. Reasons for failure of sutures
• Breakage
• Cuts out
• Knot slips
• Extruded suture
• Resorbs too rapidly
• Removed too early
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63. Possible complications of leaving sutures for many
days
• Sutural abscess.
• Scar or stitch mark.
• Dermoid cyst
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64. Alternatives to suture
Name:
• Staples
• Tissue adhesives
• Tape
Disadvantage:
• Not absolute alternative to mechanical means
• More tissue reaction
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65. Thank you
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