SIRGICAL SUTURES

1. SURGICAL SUTURES
LECTURE 6

2. definition
Surgical sutures are medical devices used
to hold body tissues together after an
injury or surgery
A suture is a strand of fibrous material
used to ligate blood vessels and
approximate tissues together.

3. TYPES OF SUTURE
 Absorbable
 Non-Absorbable
 Braided (multifilament)sutures
 Non- Braided (monofilament) sutures

4. Absorbable Sutures
Absorbable suture materials are
made from substances that can
easily break down in the body’s
tissue after a certain amount of time
they can be made with natural or
synthetic materials

5. Cont.
Surgical suture materials are used in
the closure of most wound types.
The ideal suture should allow
the healing tissue to recover
sufficiently to keep the wound
closed together once they are removed
or absorbed.

6. CONT.
The ideal suture is the smallest
possible to produce uniform tensile
strength, securely hold the wound for
the required time for healing, then be
absorbed
 It should be easy to handle, produce
minimal reaction, and knot securely

7. CONT.
The time in which this absorption
takes place varies between
material, location of suture, and
patient factors

8. Natural absorbable sutures
These are sourced from natural fibers
made from biological materials
 They are less frequently used, as they
tend to provoke a greater tissue reaction
Examples of natural surgical sutures are
catgut suture and silk

9. Synthetic absorbable Sutures
These are sutures manufactured from chemical
synthesis. They tend to be more predictable
than the natural sutures, particularly in their
loss of tensile strength and absorption.
Examples of Synthetic sutures include Nylon,
Polyester, PDS, etc.

10. CONT.
the amount of time it take for a
suture to break down in the body
depends on a few factors such as
suture type, size and the location

11. Monofilament sutures
Monofilament sutures are made of a
single strand of material and are most
resistant to the growth of
microorganisms.
Monofilament suture material is made
of a single strand

12. CONT.
Example of monofilament sutures are
Nylon, Prolene, Polydioxanone (PDS)

13. Multifilament Sutures
Multifilament suture material
composed of several filaments twisted
or braided together. It generally has
greater tensile strength and better than
monofilament suture material, and it
handles and ties well

14. CONT.
Example of multi-filament sutures are silk,
vicryl, polyglycolic acid (PGA)

15. Types of absorbable sutures
 Gut. This natural monofilament suture is used for
repairing internal soft tissue wounds or lacerations
 The body has the strongest reaction to this suture
and will often scar over
 Polydioxanone (PDS). This synthetic
monofilament suture can be used for many types
of soft tissue wound repair such as abdominal
closures

16. CONT.
 Poliglecaprone (MONOCRYL). This synthetic
monofilament suture is used for general use in
soft tissue repair This suture is most commonly
used to close skin in an invisible manner
 Polyglactin (Vicryl). This synthetic braided
suture is good for repairing hand or facial
lacerations

17. VICRYL

18. Chromic catgut

19. monocryl

20. Absorbable Suture Materials
Suture Type Absorbable Non-absorbable Monofilament Multifilament
Vicryl ✓ ✓
PDS* ✓ ✓
Monocryl ✓ ✓
Nylon ✓ ✓
Prolene ✓ ✓
Silk ✓ ✓

21. Non-absorbable Sutures
 Non-absorbable sutures, are surgical sutures that cannot
be absorbed by the body and needs to be removed at a later
time. Sometimes, they are left in situ permanently
 Non-absorbable sutures are used either on skin wound
closure, where the sutures can be removed after a few weeks
 Examples of non-absorbable sutures include: Silk, Nylon,
Polyester, Polypropylene

22. Types of non-absorbablesutures
Some examples of non-absorbable sutures can be found
below. These types of sutures can all be used generally for
soft tissue repair, including for both cardiovascular and
neurological procedures.
 Nylon. A natural monofilament suture.
 Polypropylene (Prolene). A synthetic monofilament
suture.
 Silk. A braided natural suture.
 Polyester (Ethibond). A braided synthetic suture.

23. PROLENE

24. silk

25. ETHILON

26. Non-absorbable Suture Materials
Material Structure Strength Knot security Uses
Silk Braided ++ ++++ Easy to handle
Nylon Monofilament +++ ++
Common for
skin closure
Prolene Monofilament ++++ +
High memory,
subcuticular
pull
Dacron Braided ++ ++++
Good knot
security

27. SUTURE SIZE

28. SUTURE SIZE

29. Surgical Needles
 The surgical needle allows the placement of the
suture within the tissue, carrying the material
through with minimal residual trauma
 The ideal surgical needle should be rigid enough to
resist distortion, yet flexible enough to bend before
breaking, be as slim as possible to minimize
trauma, sharp enough to penetrate tissue with
minimal resistance, and be stable within a needle
holder to permit accurate placement

30. SUTURE NEEDLES

31. CONT.
They are composed of:
The swaged end connects the needle to the
suture
The needle body or shaft is the region grasped
by the needle holder
Round bodied needles are used in friable tissue
such as liver and kidney

32. CONT.
Cutting needles are triangular in shape, and
have 3 cutting edges to penetrate tough tissue
such as the skin and sternum, and have a
cutting surface on the concave edge
Reverse cutting needles have a cutting
surface on the convex edge, and are ideal for
tough tissue such as tendon or subcuticular
sutures, and have reduced risk of cutting
through tissue

33. CONT.

34. Wound closure strips
Wound closure strips are porous surgical tape
strips which can be used to close small wounds
They are applied across the laceration in a
manner which pulls the skin on either side of
the wound together
Wound closure strips may be used instead of
sutures in some injuries, because they lessen
scarring and are easier to care for

35. Steri-strip

36. CONT.

37. CONT.
steri-strips also falls off naturally
The advantages of skin closure tapes are
 The rate of wound infection is less with
adhesive strips than with stitches.
Also, it takes less time to apply skin closure
tape.
there is no need for a painful injection of
anesthetic when using skin closure tapes

38. CONT.
 Disadvantages of using skin closure tapes include
less precision in bringing wound edges together
than suturing.
 Not all areas of the body can be taped. For
example, body areas with secretions such as the
armpits, palms, or soles are difficult areas to place
adhesive strips.
 Areas with hair also would not be suitable for
taping.

39. CONT.

40. Skin-glue
 This material is applied to the edges of the wound
somewhat like glue and should keep the edges of
the wound together until healing occurs.
 Adhesive glue is the newest method of wound
repair and is becoming a popular alternative to
stitches, especially for children.
 The adhesive simply falls off or wears away after
about 5-7 days.

41. Metal staples
 Surgical staples are useful for closing many types
of wounds. Staples have the advantage of being
quicker and may cause fewer infections than
stitches
 Disadvantages of staples are permanent scars if
used inappropriately and imperfect aligning of the
wound edges, which can lead to improper healing
 Staples are used on scalp lacerations and
commonly used to close surgical wounds