The document discusses surgical sutures and needles. It covers their properties, types, uses and techniques for placement and removal. Some key points include: 1) Sutures must be pliable, sterilized, non-reactive and have adequate tensile strength for wound healing. Absorbable sutures like Vicryl degrade over time while non-absorbables like nylon are permanent. 2) Needles come in different shapes, sizes and points for various tissue types. They have an eye, body and point. 3) Common suture techniques include simple interrupted, continuous, mattress and subcuticular closure. Knot security requires at least 4 throws. 4)

2. 1- Pliability, for ease of handling
2- Knot security
3- must be sterilized
4- Appropriate elasticity
5- Nonreactivity
6- Adequate tensile strength for wound
healing
7- Chemical biodegradability as opposed to
foreign body breakdown

3. 8-Non allergic
9-Non carcinogenic
10-Not favour bacterial growth

4. 1. To bring tissue edges together and speed
wound healing (=tissue apposition)
2. Orthopedic surgery to help stabilize joints
 Repair ligaments
3. Ligate vessels or tissues

5. The surgical needle has a basic design
composed of three parts
 1-The eye which is swaged and permits the suture
and needle to act as a single unit to decrease
trauma
 2-The body which is the widest point of the
needle and is also referred to as the
grasping area
 3-The point which runs from the tip to the
maximum cross-sectional area of the body

7. Points of Needles
Taper
Atraumatic
Internal organs
and thin mucosa
But suturing is
hard

8. Points of
Needles
Cutting
Cutting edge on
inside of circle
Skin
Traumatic

9. Points of Needles
Reverse Cutting
Cutting edge on
outside of circle
Skin
Less traumatic
than cutting

11. Shapes of
Needles
3/8 circle
1/2 circle
Straight
Specialty

12.  AbsorbableVs. Nonabsorbable
 MonofilamentVs. Multifilament
 Natural or Synthetic

13.  less tissue-reactive and therefore leave less
scarring as long as they are removed in a
timely fashion
I. Natural : silk
II. Synthetic : nylon, prolene, polyester, s.s
 Primarily Skin
 Ligation of BVs.

14.  Advantage is that the sutures do not need to be
removed
I. Natural : catgut
II. Synthetic : vicryl, dexon, PDS
 Internal
 Intradermal/ subcuticular
 Rarely on skin
 In children
 When Difficult removal

16. Also:
LENGTH
NEEDLE
SYMBOL
COLOR
Absorbable
or Non
Order Code
Size
Name
Needle
Company

17.  memory easy to handle
 less tissue drag more tissue drag
 doesn’t wick wicks/ bacteria
 poor knot security good knot security
 - tissue reaction +tissue reaction

18. Suture Knot
Tensile Tissue Tensile Ease of
Suture Raw Material Absorption Strength Reaction StrengthType Uses Handing
Plain gut Collagen from Digested + Moderate + + + Plain Rapidly +
healthy by body (Least) + + + + healing
mammals enzymes mucosa
within avoid
70 days suture
removal
Chromic Collagen from Digested + Moderate + + + Chromic As above +
healthy by body but less Slower
mammals enzymes than plain absorption
treated with within gut
chromic salts + + + +

19. Suture Knot
Tensile Tissue Tensile Ease of
Suture Raw Material Absorption Strength Reaction StrengthType Uses Handing
Coated Copolymer of Hydrolysis + + + Mild + + Braided Subepi- + + + +
Vicryl lactide and 56-70 days + + coated elial
(Polyglactin glycolide Mucosal
910) coated with surfaces
polyglactin Vessel
370 and ligation
calcium All types
stearate of general
closure
PDS Polyester Slow + + + + Slight + + Mono- Absorbable + +
(polydi- polymer hydrolysis + filament suture with
oxanone) 180 - 210 extended
days wound support

20. Suture Knot
Tensile Tissue Tensile Ease of
Suture Raw Material Absorption Strength Reaction StrengthType Uses Handing
Dexon Homopolymer slow + + + Mild + + Braided subepith- + + +
(polygly- of glycolic hydrolysis + + coated elial
colic acid coated after 60 - sutures
acid) with 90 days Mucosal + + + +
polaxamer surfaces
188 Vessel
ligation
Surgical Natural Usually + + Moderate + Braided Mucosal + + + +
silk protein cannot be + + + + (least) surfaces
fiber of raw found after
silk.Treated 2 years
with silicon
protein or wax

21. Suture Knot
Tensile Tissue Tensile Ease of
Suture Raw Material Absorption Strength Reaction StrengthType Uses Handing
Nylon Polyamide Degrades at + + + Extremely + + Mono- Skin + +
Duralon polymer a rate of 15- low filament closure
Ethilon 20%per year 0 - +
Nylon Polyamide Degrades at + + + Extremely + + Braided Skin + + + +
Nurolon polymer a rate of 15- low closure
Surgilon 20%per year 0 - + Mucosal
surfaces
Polyester Polyester Nonabsorbable + + + Minimal + + + Braided Cardiova- + + +
Mersilene Polvethylene + scular and
Dacron Terephthalate plastic
Ethibond surgery
General
surgery

23. Suture Knot
Tensile Tissue Tensile Ease of
Suture Raw Material Absorption Strength Reaction StrengthType Uses Handing
Prolene Polymer of Nonabsorbale + + + Minimal+ + + Mono- General, + +
(polypro- propylene transient filament plastic,
pylene) acute cardiova-
reaction scular, skin
opthalmology
Gor-Tex Expanded Nonabsorbale + + + Extremely + + Mono- AllTypes + + + +
polytetrafluoro- low filament of soft-
ethylene 0 - + tissue
approxi-
mation &
cardiova-
scular
surgery

26.  Very common in human medicine
 Expensive
 Very easy
 Very secure
 Very little tissue reaction
 Removal =
 Special tool required

29.  Little strength
 Should not be placed between skin layers or
inside body

30.  Needle holder: used to grab onto the
suture needle
 Forceps: used to hold the tissues gently
and to grab the needle
 Suture scissors: used to cut the stitch from
the rest of the suture material

33. The needle should
be held in
the jaws of the
needle holder at
its midpoint

35. Hold the forceps as you would hold a writing instrument

36.  Sutures placed on the face should be
approximately 2–3 mm from the skin edge
and 3–5 mm apart. Sutures placed elsewhere
on the body should be approximately 3–4 mm
from the skin edge and 5–10 mm apart.

38.  Start on the side of the wound opposite and
farthest from you to ensure that you are
always sewing toward yourself.

39. 1- Force should always be applied in the
direction that follows the curvature of the
needle
2- Suturing should always be from movable
to a nonmovable tissue
3- Avoid excessive tissue bites with small
needle as it will be difficult to retrieve them

40. 4- Use only sharp needles with minimal force.
Replace dull needles
5- Never force the needle through the tissue
6- Grasp the needle in the body one-quarter
to one-half of the length from the swaged
area. Do not hold the swaged area; this
may bend or break the needle. Do not
grasp the point area as damage or notching
may result.

41. 7- Avoid retrieving the needle from the tissue
by the tip. This will damage or dull the
needle
8- Suture should be placed in keratinized
tissue whenever possible
9- An adequate tissue bite is required to
prevent the flap from tearing

42.  A suture knot has three components
1-The loop created by the knot
2-The knot itself, which is composed of a
number of tight “throws”, each throw
represents a weave of the two stands
3-The ears, which are the cut ends of the
suture

44.  Generally 4 “throws” for >90% knot security
(nylon may need 5)
 Less “throws” = more likely to untie itself

49.  Simple Interrupted
 Continuous
 Horizontal mattress
 Vertical Mattress Sutures
 Sub-cuticular closure
 Figure of eight

52.  used for simple laceration closures or closure of
office procedures like biopsies or lesion
removals.
 Interrupted sutures can be used in all areas but
may take longer to place than a continuous
suture
 They are the technique of choice if you are
worried about the cleanliness of the wound.
 If the wound looks like it is becoming infected, a
few sutures can be removed easily without
disrupting the entire closure

55.  Place the sutures again and again without
tying each individual suture.
 If the wound is very clean and it is easy to
bring the edges together, a continuous
closure is adequate and quicker to perform.
 Continuous closure is the technique of choice
to help stop bleeding from the skin edges,
which is important, for example, in a scalp
laceration.

56.  Mattress sutures are a good choice when the
skin edges are difficult to evert
 It is a bit more technically challenging to
place mattress sutures, but it is often worth
the effort because good dermis-to-dermis
contact is achieved

58. • Used with wounds with poor circulation
• Helps eliminate tension on wound edges
• Requires fewer sutures to close a wound
• Can be placed quite quickly

60. • Deep and shallow approximation of the tissue
• Can be used for wounds under tension.
• Can be useful with lax tissue e.g. elbow and
knee.
• Should not be used on the face because of
blind placement of the deep part of the
suture

62. • Used for cosmetic closures
• Use an absorbable suture if you plan to leave
the sutures in and bury the knots
• Use either nylon or prolene (best) and keep
the suture sliding while you are closing. The
suture then can be easily removed with no
exterior marks. The ends can be taped or a
knot on the skin.

64.  Indication:This technique is useful for wide,
gaping wounds and when it is difficult to
evert the skin edges

65. Figure-of-eight
suture.
This technique
is used primarily to
reapproximate
deep tissues such as
muscle or fascia
Not common used
in skin

70. 1-The area should be swabbed with
hydrogen peroxide for removal of
encrusted necrotic debris, blood, and
serum from about the sutures
2- A sharp suture scissors should be used to
cut the loops of individual or continuous
sutures about the teeth

71. 3- It is often helpful to use a No. 23 explorer
to help lift the sutures if they are within the
sulcus or in close opposition to the tissue
4- A cotton pliers is used to remove the
suture. The location of the knots should be
noted so that they can be removed first.
This will prevent unnecessary entrapment
under the flap

72.  Suture should be removed in 7 to 10 days to
prevent epithelialization or wicking about
the suture