Needles & sutures (A quick Review)
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This document provides a summary of the history and types of needles and sutures used in surgery. It discusses key historical landmarks in suture development, including the earliest known medical records describing sutures from Ancient Egypt. It also outlines the development of mass-produced sterile catgut sutures in the late 19th century. The document describes the anatomy of surgical needles and various suture materials, sizes, and packaging. It compares absorbable and non-absorbable, natural and synthetic, monofilament and braided suture types. Finally, it discusses ideal suture characteristics and factors to consider when selecting a suture for a procedure.
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Needles & sutures (A quick Review)
- 1. Needles & Sutures How to Select and Understand Shady Nafie - Urology LAT James Cook University Hospital February 2015
- 2. Historical Landmarks • Oldest known medical record describing trauma and sutures • Ancient Egyptian, dated 3500 B.C. • Edwin Smith Surgical Papyrus, discovered 1862 • Sutures were fashioned from hair, cotton or silk.
- 3. Historical Landmarks • Joseph Lister, British surgeon and pioneer of antiseptic surgery. • Tried to sterilise silk suture in carbolic acid, unsuccessful. • Sterilised catgut, marked reduction in incidence of infection, 1869.
- 4. Historical Landmarks • Robert Wood Johnson and brothers established Johnson & Johnson, 1885. • Mass production of sterile catgut, 1886. • Independent division of suture production - Ethicon, 1956.
- 5. Needles
- 6. Anatomy of Needles Made of Stainless steel
- 7. The Point • Needle body is round and tapers smoothly to a point. For soft tissue e.g. bowels, blood vessels. • Needle body is round and has a blunt end. Reduces risk of needle sticks. For less dense internal tissue e.g. muscle and fascia.
- 8. The Point • Needle body is triangular and has a sharpened cutting edge on the inside curve. For tough tissue e.g. skin, tendons • Cutting edge on the outside. Decrease the likelihood of sutures pulling through tissue.
- 10. The Eye (End) Closed Swaged • Non traumatic. • Minimise handling & preparation. • Don't unthread prematurely. • More traumatic. • Unthreads prematurely. • More intaoperative handling.
- 11. Sutures
- 12. Suture Materials Absorbable Non-Absorbale Natural Syntheic Monofilament Multifilament
- 13. Suture Materials Absorbable (<60 days) Non-Absorbable (>60 days) Advantages -Broken down by body -No foreign body left -Permanent wound support Disadvantages -Limited time of wound support -Suture sinus -Foreign body left
- 14. Suture Materials Synthetic Natural Advantages -Absorption by hydrolysis -Predictable absorption -Strength -Handling & knotting -Economic Disadvantages -Monofilament handling -Tissue reaction
- 15. Suture Materials Monofilament Braided Advantages -Smooth -Less tissue trauma -Less infection -No capillarity -Strength -Soft & Pliable -Good handling -Good Knotting Disadvantages -Slippery handling -Less Pliable -More Knotting -Capillary action -Tissue trauma -Harbours bacteria
- 16. Suture Materials Absorbable (<60 days) Non-Absorbable (>60 days) Monofilament - Gut - Monocryl (2/52) - PDS (3/52) - Steel - Nylon - Prolene Braided - Vicryl (2/52) - Silk - Cotton - Ethibond - Dacron
- 17. Suture Sizes USP size Diameter in mm 10-0 0.02 8-0 0.04 5-0 0.10 4-0 0.15 3-0 0.20 2-0 0.30 0 0.35 1 0.40 2 0.50 3 0.60 United States Pharmacopeia (USP)
- 18. Suture Packing Suture size Material Length Product code Needle shape Needle length Suture colour Point type Needle circle Needle code
- 19. Ideal Suture • Gentle passage through tissues • Comfortable handling • Knot security • Maximum tensile strength • Consistent performance • Minimal tissue reaction • Predictable absorption
- 20. Selecting a Suture • Anatomic site • Surgeon's preference • Required suture characteristics
- 21. Thank You
Editor's Notes
- I just chose what I thought would be interesting historical land marks to tell you about. The first, the oldest known medical text describing surgical sutures was found in an ancient Egyptian papyrus dated 3500 B.C. Discovered in 1862, and known now by the name of Edwin Smith Surgical Papyrus.
- The second is that Joseph Lister (British Surgeon), is the first to try sterilising surgical sutures. He tried to sterilise silk with carbolic acid, but was unsuccessful. In 1869 he managed to sterilise catgut, which markedly reduced incidence of post operative infection and death.
- Inspired by Joseph Lister work, Robert Wood Johnson and brothers established Johnson & Johnson company which mass produced the sterile cat gut. In 1956 established an independent division of suture production named Ethicon.
- Needles as we know them today are made of stainless steel. Any surgical needle has a point, a body and an end (eye).
- Needle point has several shapes. The first one is taper needle which has a round body that tapers smoothly to a point, it is used in soft tissue like bowels and blood vessels. The second is blunt point needle, which has a round body that tapers to a blunt end to reduce the risk of needle pricks. It is used in less dense internal tissue like muscle and fascia.
- Another one is the conventional cutting needle, which has a sharp cutting edge on the inside curve, it is used in tough tissue like skin or tendons. There is also have the reverse cutting needle, in which the cutting edge is on the outside curve, to decrease the likelihood of sutures pulling through the tissue.
- This slide shows the different shapes of a needle body. It can be straight which is usually used in the skin. It can be curved or part of a circle.
- The end (or the eye) of the needle could be closed or swaged. What we normally use now days is the swaged end needle, which is atraumatic to the tissue, minimise handling and preparation in theatre and don’t unthread prematurely.
- Suture material can have several classifications, either.. I will mention some advantages and disadvantages of each those types.
- The main advantage of the absorbable sutures is that no foreign body is left in the patient. On the other hand, non-absorbable sutures offer a permanent wound support, but they carry the risk of developing a suture sinus.
- Although the natural sutures are economic, but they cause a significant tissue reaction. On the other hand, synthetic sutures offer strength and predictable absorption.
- While braided sutures offer good handling & knotting, they cary the risk of harbouring bacteria. On the other hand, monofilament sutures are smoother with less tissue trauma and less risk of infection. But, they are more difficult to handle and require more knotting.
- These are the most common suture types that we use in urology. All the ones in bold are synthetic, while the ones with normal font are natural.
- Suture sizes are usually described in Zeros, according to the USP system. The suture sizes that we usually use in urology range from 1-0 to 4-0, the diameters of which range from 0.15 mm to 0.4 mm.
- This is how a conventional suture packaging would look like.
- So, the ideal suture would be gentle while passing through tissues, comfortable in handling, with high knot security. Offers maximum tensile strength and consistent performance with minimal tissue reaction and predictable absorption.
- The selection of a suture depends on the anatomic site, the surgeon’s preference and the required tissue characteristics.