At operation theatre ZHC karachi by younus khan

1. SUTURE MATERIALS ANDSUTURE MATERIALS AND
TECHNIQUESTECHNIQUES

4. The Ideal Suture MaterialThe Ideal Suture Material
• Can be used in any tissueCan be used in any tissue
• Easy to handleEasy to handle
• Good knot securityGood knot security
• Minimal tissue reactionMinimal tissue reaction

5. The Ideal Suture MaterialThe Ideal Suture Material
• Unfriendly to bacteriaUnfriendly to bacteria
• Strong yet smallStrong yet small
• Won’t tear through tissuesWon’t tear through tissues
• CheapCheap

6. What’s It Used for?What’s It Used for?
• To bring tissue edges together and speedTo bring tissue edges together and speed
wound healing (=tissue apposition)wound healing (=tissue apposition)
• Orthopedic surgery to help stabilize jointsOrthopedic surgery to help stabilize joints
– Repair ligamentsRepair ligaments
• Ligate vessels or tissuesLigate vessels or tissues

8. Types of NeedlesTypes of Needles
• Eyed needlesEyed needles
– More TraumaticMore Traumatic
– Only threadOnly thread
through oncethrough once
– Suture on a reelSuture on a reel
– Tends toTends to
unthread itselfunthread itself
easilyeasily

9. Types of NeedlesTypes of Needles
• Swaged-onSwaged-on
needlesneedles
– Much lessMuch less
traumatictraumatic
– More expensiveMore expensive
suture materialsuture material
– SterileSterile

10. Points of NeedlesPoints of Needles
• TaperTaper
– AtraumaticAtraumatic
– Internal organsInternal organs

11. Points of NeedlesPoints of Needles
• CuttingCutting
• Cutting edge onCutting edge on
inside of circleinside of circle
• SkinSkin
• TraumaticTraumatic

12. Points of NeedlesPoints of Needles
• Reverse CuttingReverse Cutting
• Cutting edge onCutting edge on
outside of circleoutside of circle
• SkinSkin
• Less traumaticLess traumatic
than cuttingthan cutting

13. Cutting vs Reverse CuttingCutting vs Reverse Cutting
• CuttingCutting
• ReverseReverse
cuttingcutting

14. Shapes of NeedlesShapes of Needles
• 3/8 circle3/8 circle
• 1/2 circle1/2 circle
• StraightStraight
• SpecialtySpecialty

16. Characteristics of Suture MaterialCharacteristics of Suture Material
• Absorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable
• Monofilament Vs. MultifilamentMonofilament Vs. Multifilament
• Natural or SyntheticNatural or Synthetic

18. Absorbable SuturesAbsorbable Sutures
• InternalInternal
• Intradermal/ subcuticularIntradermal/ subcuticular
• Rarely on skinRarely on skin

19. Absorbable SuturesAbsorbable Sutures
Natural Fiber Synthetic Fiber
Monofilament
Poly(glycolide-co-ε-
caprolactone)
(Monocryl)*
Poly(p-diaxonone) (PDS II)*
Poly(glycolide co-
trimethylene
carbonate) (Maxon)+
Braided
Polyglactin 910 (Vicryl)*
Polyglactin 910 (Vicryl
Rapide)*
Polyglycolic acid (Dexon)+
Twisted
Plain Surgical Gut
Light Surgical Gut
Medium Surgical Gut
Heavy Surgical Gut
BSR = Approximate days after placement when 50% of breaking strength remains.

20. Non-absorbable SutureNon-absorbable Suture
• Primarily SkinPrimarily Skin
– Needs to be removed laterNeeds to be removed later
• Stainless steel = exceptionStainless steel = exception
– Can be used internallyCan be used internally
• LigatureLigature
• OrthopedicsOrthopedics
– Can be left in place for long periodsCan be left in place for long periods

21. Common Nonabsorbable SuturesCommon Nonabsorbable Sutures
Monofilament
Polypropylene (Prolene* & Surgilene+
)
Nylon (Ethilon* & Dermalon+
)
Braided
Polyester (Mersilene*)
Silk
Nylon (Surgilon* & Nurolon+
)
Braided & Coated
Polyester & Polybuterate (Ethibond*)
Polyester & Silicone (Tichron+
)
Polyester & Teflon (Tevdek#
)
Silk & Beeswax
Multifilament Sheathed Multistrand Nylon & Polyethylene Sheath (Supramid$
)
Operation theatre zhc

24. Reading the Suture LabelReading the Suture Label
• CompanyCompany
Needle
Size
Order Code
Name
Also:
LENGTH
NEEDLE
SYMBOL
COLOR
Absorbable
or Non

25. Monofilament Vs. MultifilamentMonofilament Vs. Multifilament
• memorymemory easy to handleeasy to handle
• less tissue dragless tissue drag more tissue dragmore tissue drag
• doesn’t wickdoesn’t wick wicks/ bacteriawicks/ bacteria
• poor knot securitypoor knot security good knot securitygood knot security
• -- tissue reactiontissue reaction ++tissue reactiontissue reaction

26. Gut/ Chromic GutGut/ Chromic Gut
• Made of submucosaMade of submucosa
of small intestinesof small intestines
• MultifilamentMultifilament
• Breaks down byBreaks down by
phagocytosis:phagocytosis:
inflammatory reactioninflammatory reaction
commoncommon

27. Gut/ Chromic GutGut/ Chromic Gut
• Chromic: tanned, lastsChromic: tanned, lasts
longer, less reactivelonger, less reactive
• Easy handlingEasy handling
• Plain: 3-5 daysPlain: 3-5 days
• Chromic: 10-15 daysChromic: 10-15 days
• Bacteria love this stuff!Bacteria love this stuff!

28. Collagen and SilkCollagen and Silk
• Natural suturesNatural sutures
• VERY reactive,VERY reactive,
absorbableabsorbable
• Ophthalmic surgeryOphthalmic surgery
onlyonly

29. Vicryl (Polyglactin 910)Vicryl (Polyglactin 910)
• Braided, synthetic, absorbableBraided, synthetic, absorbable
• Stronger than gut: retains strengthStronger than gut: retains strength 33
weeksweeks
• Broken down by enzymes, notBroken down by enzymes, not
phagocytosisphagocytosis
• Break-down products inhibit bacterialBreak-down products inhibit bacterial
growthgrowth
– Can use in contaminated wounds, unlikeCan use in contaminated wounds, unlike
other multifilamentsother multifilaments

32. PDS (polydioxine)PDS (polydioxine)
• Monofilament (less drag, worse knotMonofilament (less drag, worse knot
security – lots of “memory”)security – lots of “memory”)
• Synthetic, absorbableSynthetic, absorbable
• Very good tensile strength (better thanVery good tensile strength (better than
gut, vicryl, dexon) whichgut, vicryl, dexon) which lasts monthslasts months
• Absorbed completely byAbsorbed completely by 182 days182 days

33. MMaxon (polyglyconate)axon (polyglyconate)
• MMonofilament-onofilament- mmemoryemory
• Synthetic AbsorbableSynthetic Absorbable
• Very little tissue dragVery little tissue drag
• Poor knot securityPoor knot security
• Very strongVery strong

34. NONABSORBABLE SUTURESNONABSORBABLE SUTURES
• Natural or SyntheticNatural or Synthetic
• Monofilament or multifilamentMonofilament or multifilament

35. NYLONNYLON
• SyntheticSynthetic
• Mono or MultifilamentMono or Multifilament
• MemoryMemory
• Very little tissue reactionVery little tissue reaction
• Poor knot securityPoor knot security

36. PolypropylenePolypropylene
• Prolene, SurgileneProlene, Surgilene
• Monofilament, SyntheticMonofilament, Synthetic
• Won’t lose tensile strength over timeWon’t lose tensile strength over time
• Good knot securityGood knot security
• Very little tissue reactionVery little tissue reaction

37. Stainless SteelStainless Steel
• MonofilamentMonofilament
• Strongest !Strongest !
• Great knot securityGreat knot security
• Difficult handlingDifficult handling
• Can cut through tissuesCan cut through tissues
• Very little tissue reaction, won’t harborVery little tissue reaction, won’t harbor
bacteriabacteria

38. Skin StaplesSkin Staples
• Very common in human medicineVery common in human medicine
• ExpensiveExpensive
• Very easyVery easy
• Very secureVery secure
• Very little tissue reactionVery little tissue reaction
• Removal =Removal =
– Special tool requiredSpecial tool required

39. Tissue AdhesiveTissue Adhesive
• Nexaband, Vetbond,Nexaband, Vetbond,
and othersand others
• Little strengthLittle strength
• Should not be placedShould not be placed
between skin layersbetween skin layers
or inside bodyor inside body

40. Suture PatternsSuture Patterns

41. Knot StrengthKnot Strength
• Generally 4 “throws” for >90% knotGenerally 4 “throws” for >90% knot
security (nylon may need 5)security (nylon may need 5)
– Less “throws” = more likely to untie itselfLess “throws” = more likely to untie itself
• Stainless steel = exception againStainless steel = exception again
– 2 “throws” = 99% knot security2 “throws” = 99% knot security

42. Simple InterruptedSimple Interrupted
Simple Interrupted Suture

47. Simple ContinuousSimple Continuous

48. Ford InterlockingFord Interlocking

49. SubcuticularSubcuticular

53. THANK YOU ALL
M.YOUNUS
SR.OT. TECHNOLOGIST
MBA (H&HM)