3. CLASSIFICATIONS OF SUTURE MATERIALS
According to source:
•1.Natural
•2.Synthetic
•3.Metallic
According to structure:
•1.Monofilament
•2.Multifilament
6. ABSORBABLE SUTURES
1. Catgut:
• It is obtained from the from the submucosa of small intes
tine of a sheep .
• Serosal layer of bovine intestine .
• Initially it was reffered to as “kitgut” meaning the cord
• Sterlised by ionising radiation or by ethylene oxide.
• Available in presterlised aluminium foils containing 85%
ethyl alcohol, it cannot be autoclaved.
7. • Heat denature the protein and tensile strength is reduced.
• The absorption time can be delayed by treatment with chromic acid ,
iodine , tannin , formalin,or other chemicals.
• The catgut is also avialable as plain catgut, mild chromic catgut,mdi
um chromic catgut and extra chromic catgut based on the degree of
treatment with chromic acid.
• Plain Catgut Type A: Absorbed in about 5 days
• Mild chromic catgut Type B : Absorbed in about 10 days
• Medium Chromic Type C : Absorbed in about 20 days
• Extra Chromic Type D : Absorbed in about 40 days
8. Kangaroo tendon :
•It is obtained from the tendon of tail of the kankaroo
• It is used for suturing joint capsule, hernial ring and places where more stren
gth is required.
3. Fascia lata :
•It is obtained from bovine fascia lata and it is available in tape like pieces pres
erved in glass tube.
4. Cargile membrane:
•It is obtained ffom bovine caecum in the form of thin sheet
• It is used to cover surfaces from which peritoneum has been removed. It is n
ot gnerally used.
9. Polyglactin 910 (vicryl):
•It is synthetic braided absorbable suture material consist of glycolic ac
id and lactic acid in the ratio of 9:1.
•Sterlised by ethylene oxide.Absorbed by hydrolysis in 40 to 90 days .
• Used in occular surgery and closing of muscles after laprotomy.
•It is inert , non-pyrogenic and produces mild tissue reaction. It remains
stable in contaminated wound.
10. 7. Polyglycolic acid (dexon):
•It is synthetic suture material prepared from glycolic acid.
•It is smooth, strong and absorbable.
• Absorbed in 100 to 200 days by hydrolysis.
•Used in closure of clean wound .
• size varies from 6/0 to 1.
14. CONTRAINDICATIONS TO SUTU
RING
• Redness
• Edema of the wound margins
• Infection
• Fever
• Puncture wounds
• Animal bites
• Tendon, verve, or vessel involvement
• Wound more than 12 hours old (body) and 24 h
rs (face)
15. CLOSURE TYPES
• Primary closure (primary intention)
• Wound edges are brought together so that they are adjacent to each other (re-
approximated)
• Examples: well-repaired lacerations, well reduced bone fractures, healing afte
r flap surgery
• Secondary closure (secondary intention)
• Wound is left open and closes naturally (granulation)
• Examples: gingivectomy, gingivoplasty,tooth extraction sockets, poorly reduced
fractures
• Tertiary closure (delayed primary closure)
• Wound is left open for a number of days and then closed if it is found to be cle
an
• Examples: healing of wounds by use of tissue grafts.
17. TYPES OF CLOSURES
● Simple interrupted closure – most commonly used, good for shallow
wounds without edge tension
● Continuous closure (running sutures) – good for hemostasis (scalp w
ounds) and long wounds with minimal tension
● Locking continuous - useful in wounds under moderate tension or in t
hose requiring additional hemostasis because of oozing from the ski
n edges
● Subcuticular – good for cosmetic results
● Vertical mattress – useful in maximizing wound eversion, reducing de
ad space, and minimizing tension across the wound
● Horizontal mattress – good for fragile skin and high tension wounds
● Percutaneous (deep) closure – good to close dead space and decre
ase wound tension
18. SIMPLE INTERRUPTED SUTURI
NG
• Apply the needle to the needle driver
• Clasp needle 1/2 to 2/3 back from tip
• Rule of halves:
• Matches wound edges better; avoids dog ears
• Vary from rule when too much tension across wound
21. SUTURING
• The needle enters the skin with
a 1/4-inch bite from the wound
edge at 90 degrees
• Visualize Erlenmeyer flask
• Evert wound edges
• Because scars contract over ti
me
22. SUTURING
• Release the needle from the needle driver, reach into the wound a
nd grasp the needle with the needle driver. Pull it free to give enoug
h suture material to enter the opposite side of the wound.
• Use the forceps and lightly grasp the skin edge and arc the needle
through the opposite edge inside the wound edge taking equal bites.
• Rotate your wrist to follow the arc of the needle.
• Principle: minimize trauma to the skin, and don’t bend the needle.
Follow the path of least resistance.
23. SUTURING
• Release the needle and grasp the portion of the
needle protruding from the skin with the needle dr
iver. Pull the needle through the skin until you hav
e approximately 1 to 1/2-inch suture strand protru
ding form the bites site.
• Release the needle from the needle driver and
wrap the suture around the needle driver two time
s.
24.
25. SIMPLE INTERRUPTED SUTURING
• Grasp the end of the suture material with the needle driver and pull
the two lines across the wound site in opposite direction (this is one t
hrow).
• Do not position the knot directly over the wound edge.
• Repeat 3-4 throws to ensuring knot security. On each throw revers
e the order of wrap.
• Cut the ends of the suture 1/4-inch from the knot.
• The remaining sutures are inserted in the same manner
27. THE TRICK TO AN INSTRUMENT
TIE
• Always place the suture holder parallel t
o the wound’s direction.
• Hold the longer side of the suture (with t
he needle) and wrap OVER the suture hol
der.
• With each tie, move your suture-holding
hand to the OTHER side.
• By always wrapping OVER and moving t
he hand to the OTHER side = square kno
ts!!
