Ideal Suture for Surgeons
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The Ideal Suture Material Can be used in any tissue Easy to handle Good knot security Minimal tissue reaction Unfriendly to bacteria Strong yet small Won’t tear through tissues Cheap USES: To bring tissue edges together and speed wound healing (=tissue apposition) Orthopedic surgery to help stabilize joints Repair ligaments Ligate vessels or tis
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Ideal Suture for Surgeons
- 1. SUTURE MATERIALS ANDSUTURE MATERIALS AND TECHNIQUESTECHNIQUES PROF. SREEJOY PATNAIK
- 2. 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
- 3. The Ideal Suture MaterialThe Ideal Suture Material • Unfriendly to bacteriaUnfriendly to bacteria • Strong yet smallStrong yet small • WonWon’’t tear through tissuest tear through tissues • CheapCheap
- 4. WhatWhat’’s It Used for?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
- 5. 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
- 6. Types of NeedlesTypes of Needles • Swaged-onSwaged-on needlesneedles – Much lessMuch less traumatictraumatic – More expensiveMore expensive suture materialsuture material – SterileSterile
- 7. Points of NeedlesPoints of Needles • TaperTaper – AtraumaticAtraumatic – Internal organsInternal organs
- 8. Points of NeedlesPoints of Needles • CuttingCutting • Cutting edge onCutting edge on inside of circleinside of circle • SkinSkin • TraumaticTraumatic
- 9. 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
- 10. Cutting vs Reverse CuttingCutting vs Reverse Cutting • CuttingCutting • ReverseReverse cuttingcutting
- 11. Shapes of NeedlesShapes of Needles • 3/8 circle3/8 circle • 1/2 circle1/2 circle • StraightStraight • SpecialtySpecialty
- 12. Characteristics of Suture MaterialCharacteristics of Suture Material • Absorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable • Monofilament Vs. MultifilamentMonofilament Vs. Multifilament • Natural or SyntheticNatural or Synthetic
- 13. Absorbable SuturesAbsorbable Sutures • InternalInternal • Intradermal/ subcuticularIntradermal/ subcuticular • Rarely on skinRarely on skin
- 14. 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
- 16. Reading the Suture LabelReading the Suture Label • CompanyCompany Needle Size Order Code Name Also: LENGTH NEEDLE SYMBOL COLOR Absorbable or Non
- 17. ChoosingChoosing Absorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable • How long you need itHow long you need it to workto work • Do you want to seeDo you want to see the animal again forthe animal again for suture removalsuture removal
- 18. Monofilament Vs. MultifilamentMonofilament Vs. Multifilament • memorymemory easy to handleeasy to handle • less tissue dragless tissue drag more tissue dragmore tissue drag • doesndoesn’’t wickt wick wicks/ bacteriawicks/ bacteria • poor knot securitypoor knot security good knot securitygood knot security • -- tissue reactiontissue reaction ++tissue reactiontissue reaction
- 19. Natural Vs. SyntheticNatural Vs. Synthetic • Natural:Natural: – GutGut – Chromic GutChromic Gut – SilkSilk – CollagenCollagen • All are absorbableAll are absorbable
- 20. 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
- 21. 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!
- 22. Collagen and SilkCollagen and Silk • Natural suturesNatural sutures • VERY reactive,VERY reactive, absorbableabsorbable • Ophthalmic surgeryOphthalmic surgery onlyonly
- 23. 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
- 24. Dexon and PGADexon and PGA • Polymer of glycolic acidsPolymer of glycolic acids • Braided, synthetic, absorbableBraided, synthetic, absorbable • Broken down by enzymesBroken down by enzymes • Both PGA and dexon have increasedBoth PGA and dexon have increased tissue drag, good knot securitytissue drag, good knot security • Both are stronger than gutBoth are stronger than gut
- 25. PDS (polydioxine)PDS (polydioxine) • Monofilament (less drag, worse knotMonofilament (less drag, worse knot security – lots ofsecurity – lots of ““memorymemory””)) • 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
- 26. 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
- 27. NONABSORBABLE SUTURESNONABSORBABLE SUTURES • Natural or SyntheticNatural or Synthetic • Monofilament or multifilamentMonofilament or multifilament
- 28. NYLONNYLON • SyntheticSynthetic • Mono or MultifilamentMono or Multifilament • MemoryMemory • Very little tissue reactionVery little tissue reaction • Poor knot securityPoor knot security
- 29. Polymerized CaprolactumPolymerized Caprolactum • Vetafil, Braunamid, SupramidVetafil, Braunamid, Supramid • Multifilament suture with protein coatingMultifilament suture with protein coating • SyntheticSynthetic • Good knot security, easy handlingGood knot security, easy handling • Not very reactiveNot very reactive • DonDon’’t use in contaminated woundt use in contaminated wound • Usually comes on a reelUsually comes on a reel
- 30. PolypropylenePolypropylene • Prolene, SurgileneProlene, Surgilene • Monofilament, SyntheticMonofilament, Synthetic • WonWon’’t lose tensile strength over timet lose tensile strength over time • Good knot securityGood knot security • Very little tissue reactionVery little tissue reaction
- 31. 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, wonVery little tissue reaction, won’’t harbort harbor bacteriabacteria
- 32. Suture SizesSuture Sizes • Sized #5-4-3-2-1-0-00-000-0000…30-0Sized #5-4-3-2-1-0-00-000-0000…30-0 – BIGGER >>>>>>>>>>>>>>>>SMALLERBIGGER >>>>>>>>>>>>>>>>SMALLER • 00 = 2-0,00 = 2-0, ““two oughttwo ought”” • SA : 0 through 3-0 (Optho 5-0 >>7-0)SA : 0 through 3-0 (Optho 5-0 >>7-0) • LA : 0 through 3LA : 0 through 3
- 33. Suture Sizes (cont)Suture Sizes (cont) • Stainless SteelStainless Steel – In gauges (like needles)In gauges (like needles) • Smaller gauge = bigger, strongerSmaller gauge = bigger, stronger • Larger gauge= smaller, finerLarger gauge= smaller, finer – 26 gauge =26 gauge = ““oughtought”” – 28 gauge = 2-028 gauge = 2-0
- 34. 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
- 35. 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
- 37. Knot StrengthKnot Strength • Generally 4Generally 4 ““throwsthrows”” for >90% knotfor >90% knot security (nylon may need 5)security (nylon may need 5) – LessLess ““throwsthrows”” = more likely to untie itself= more likely to untie itself • Stainless steel = exception againStainless steel = exception again – 22 ““throwsthrows”” = 99% knot security= 99% knot security
- 38. Simple InterruptedSimple Interrupted Simple Interrupted Suture