Surgery

1. Presented by :Lehak Chawla -46, Magdolina -47
Manisha Tamang -48, Muskan -49
SUTURES

2. CONTENTS
• Introduction
• Characteristics of suture materials
• Classification
• Suture techniques

3. INTRODUCTION
• Sutures are soft threads used to hold tissues together .
• Must not be too hard twisted , thick or sparse.
Historical materials :
oLinen , silk , metal clips ( Roman times )
oHorsehair , cotton , vegetable materials ( India and East Africa )
oCatgut and black ant mandibles ( South America )

4. CHARACTERISTICS OF AN IDEAL
SUTURE MATERIAL
Five main characteristics to consider :
1. Physical structure
2. Strength
3. Tensile behaviour
4. Absorbability
5. Biological behaviour

5. Physical structure
Monofilament:
• Smooth, less tissue drag, prone to knot
slippage.
Multifilament/Braided:
• Stronger, more tissue drag, higher
infection risk.
• Coated variants reduce friction and
bacterial adherence.
Strength
• Depends on diameter and material
• Tensile strength: Force needed to break
suture.
• Absorbable materials: Lose strength
over time.
• Non-absorbable: Retain strength longer
(e.g., polypropylene).
Tensile behaviour
•Elastic sutures: returns to original length
after tension.
•Plastic sutures : deform without
returning.
• Memory effect: sutures may retain shape
from packaging.
Absorbability
• Absorbable sutures: Gradually degraded (e.g., PDS, catgut).
• Non-absorbable: Permanent or very
slow degradation.
• Used in situations requiring long-term
strength.
Biological behaviour
Depends on material origin:
• Natural (e.g., catgut): Unpredictable
absorption, possible irritation.
• Synthetic polymers: Predictable,
minimal tissue reaction.

9. Suture Techniques
• Interrupted Sutures.
• Continuous sutures.
• Mattress sutures.
• Subcuticular suture.

10. Interrupted Sutures
• Needle is inserted at right angles to the incision
and then to passed through both aspects of the
suture line and exit again at right angles.
• Needle has to be rotated through the tissues rather
than to be dragged through, to avoid unnecessarily
enlarging the needle hole.
• Successive suture should be placed at twice this
distance apart.
• In linear wounds, it is sometimes easier to insert
the middle suture first and then to complete the
closure by successively inserting sutures, halving
the remaining deficits in the wound length.
Distance from the entry
point of the needle to
edge of the wound.
Depth of tissue
being sutured

11. Continuous Sutures.
• The first suture is inserted in an identical manner to an
interrupted suture, but the rest are inserted in a
continuous manner until the far end of the wound is
reached.
• Each throw of the continuous suture should be inserted
at right angles to the wound, and the externally
observed suture material will usually lie diagonally to
the axis of the wound..
• There is more danger of producing too much tension by
using too little suture length than there is of leaving the
suture line too lax.
• At the far end of the wound, this suture line should be
secured either by using an Aberdeen knot or by tying
the free end to the loop of the last suture to be inserted.
• Postoperative oedema will often take up any slack in
the suture material.

12. Mattress sutures.
• It may be either vertical or horizontal.
• It’s used to produce either eversion or inversion of a
wound edge
• The initial suture is inserted as for an interrupted
suture, but then the needle moves either
horizontally or vertically and traverses both edges
of the wound once again.
Such sutures are very useful in producing accurate
approximation of wound edges, especially when the
edges to be anastomosed are irregular in depth or
disposition.

13. Subcuticular Suture.
• The suture material used may be either
absorbable or non-absorbable.
• Small bites of the subcuticular tissues are
taken on alternate sites of the wound and then
gently pulled together, thus approximating the
wound edges without the risk of the cross-
hatched markings of interrupted sutures.
This technique is used in skin where a cosmetic
appearance is important and where the skin edges
may be approximated easily.
The ends may be secured by means of a collar
and bead, or tied loosely over the wound.
The ends may be secured using a buried knot.
Non-Absorbable sutures Absorbable sutures

16. • Bailey and Love’s Short Practice of Surgery, 28th
edition Boca
Raton : CRC Press ; 2022
REFERENCE

17. Thank You