Sunteți pe pagina 1din 42

CLASSIFICATION OF SUTURES

ABSORBAkBLE NON ABSORBABLE

NATURAL
SYNTHETIC
MONOFILAMENT POLYFILAMENT
MONOFILAMENT POLYFILAMENT
2)
1) Surgical Collagen
Gut •PDS II •Polyglactin

•Moncryl •Dexon

c) CHROMIC •Daxon
a) PLAIN

b) FAST
ABSORBING
ABSORBABLE SUTURES:

1) are made of materials which are metabolized inside the


body after around three weeks as a result of sequential
attacks by lysosomal enzymes.

2) can be divided into:


a) natural (Surgical Gut, collagen) or
synthetic (PDS, Monocryl, Maxon, Dexon, Vicryl)

b) monofilament (Surgical Gut, collagen,PDS, Monocryl,


maxon) or polyfilament (Dexon, Vicryl)
a) SURGICAL GUT SUTURE (Catgut):
• An absorbable, sterile surgical suture composed
of purified connective tissue (mostly collagen)
derived from either:
– the serosal layer of beef (bovine) or
– the submucosal fibrous layer of sheep (ovine)
intestines.

c) CHROMIC:
(treated with Chromium
salts e.g. hromium
trioxide)
1A) Surgical gut: PLAIN

•Tensile strength is maintained for 7-10


days post-implantation

•Absorption is complete within 70 days.

• This type of suture is used for


(1) repairing rapidly healing tissues that
require minimal support
2) ligating superficial blood vessels.

B) Surgical gut:, FAST


ABSORBING

This type of suture is indicated for


epidermal use (required only for 5-7 d) and
is not recommended for internal use
c) Surgical gut: Chromic

Tensile strength is maintained for 10-14


days.
(Chromium salts result in more collagen
crosslinks, making the suture more resistant
to breakdown by the body)

The absorption rate is slowed by


chromium salt (90 d).

•Natural fiber absorbable sutures have


several distinct disadvantages:

1.Natural fiber absorbable sutures have a


tendency to fray during knot construction.

2.There is more variability in their


retention of tensile strength than is found
with the synthetic absorbable sutures
2) COLLAGEN SUTURES:
• The collagen sutures are derived from the
submucosal layer of ovine small intestine
or the serosal layer bovine small intestine
(same as surgical gut)
BUT
• This collagenous tissue is treated with an
aldehyde solution, which cross-links and
strengthens the suture and makes it more
resistant to enzymatic degradation.
Absorbable sutures:
• Because permanent sutures cause little or no tissue reaction, they
result in less scarring. Therefore, permanent sutures are generally
used at the top layer.
• There are exceptions to using non-absorbable sutures at the top
skin layer:
1. In epidermal skin that is very difficult to see, such as
inside the mouth or nose, absorbable sutures are
routinely used.

2. Occasionally, absorbable sutures are used on the top


skin level in children. Children heal very well and removing
sutures can be difficult because of screaming, moving,
uncooperative kids.
SYNTHETIC
MONOFILAMENT
PDS II
• This is a polyester monofilament suture made of
polydioxanone.
• This suture provides extended wound support and
elicits only a slight tissue reaction.
• Tensile strength is 70% at 14 days and 25% at 42
days.
• Wound support remains for up to 6 weeks. Absorption
is minimal for the first 90 days and essentially
complete within 6 months.
• This material has a low affinity for microorganisms
(like other monofilament).
• PDS II suture is used for soft tissue approximation,
especially in pediatric, cardiovascular, gynecologic,
ophthalmic, plastic, and digestive (colonic) situations.
Monocryl
• copolymer of glycolide and
e-caprolactone.
• The suture has superior pliability, leading
to ease in handling and tying.
• Tensile strength is high initially, 50-60% at
7 days, and is lost at 21 days.
• Absorption is complete at 91-119 days.
• Poliglecaprone 25 sutures are used for
subcuticular closure and soft tissue
approximations and ligations.
Maxon
• this material has a similar tensile strength
and absorption profile to PDS.
• prepared from a copolymer of glycolic acid
and trimethylene carbonate.
• The sutures are sterile, inert,
noncollagenous and nonantigenic.
• Long term wound support.
SYNTHETIC
POLYFILAMENT
Polyglactin (Vicryl)
• This is a braided multifilament suture coated with a
copolymer of lactide and glycolide (polyglactin 370)
• The water-repelling quality of lactide slows loss of
tensile strength, and the bulkiness of lactide leads to
rapid absorption of suture mass once tensile strength
is lost.
• Calcium stearate coats the suture, which permits easy
tissue passage, precise knot placement, and smooth
tie-down.
• Tensile strength is approximately 65% at 14 days post
implantation.
• Absorption is minimal for 40 days and complete in 56-
70 days.
• These sutures cause only minimal tissue reaction.
Dexon
• composed of the homopolymer of glycolic
acid
• The sutures are sterile, inert, noncollagenous
and nonantigenic.
• available in the undyed natural beige color
and also green dyed to enhance visibility in
tissue.
• Advantages:
1)Requires fewer throws to establish knot
security and therefore deposits less foreign
material into the body.
2)Secure wound closure.
HAIR
• Natural,Non absorbable,
monofilamentous suture
• Human hair/horse hair
• Keratin in hair makes it
non absorbable
• Low cost and high
availabliity
• Useful in small,
superficial fresh/surgical
wounds to preserve the
cosmetic aspect,
ophthalmic surgery
Natural Polyfilament Sutures
• Silk
• Linen
• cotton
Silk
• Natural polyfilament – can be twisted or braided,
dyed or undyed, coated or uncoated.
• Raw material – raw silk from silkworm
• Tensile strength lost by 6 months
• Absorbed over 1-2 years
• Moderate to high tissue reaction
• Contraindicated in vascular prostheses and
routine skin closure
• Frequently used in ligation and suturing where
long term tissue support is necessary
Linen
• Natural polyfilament – twisted
• Raw material – long staple flax fibres
• Tensile strength - loses 50% by 6 months
• Non Absorbable
• Moderate tissue reaction
• Not advised for use in vascular prostheses
• Used in ligation and suturing of GI surgery
although less commonly
COTTON
• Natural polyfilament non
absorbable suture
• Can be used internally
and externally
• Used wet for maximum
tensile strength, braided
cotton fibres
• Black cotton/white cotton
• Similar adv and disad to
silk
• Less expensive and lower
chance of bacterial
adherence than silk
Synthetic monofilament
• Nylon
• Prolene
• Stainless Steel
• PTFE
Nylon (Ethilon)
• Synthetic monofilament – dyed or non dyed
• Raw material – polyamide polymer
• Tensile strength - 15 – 20% lost per year
• Absorbs at about 15 – 20% per year
• Low tissue reaction
• No contraindications
• Used in general surgery eg. Skin, abdominal
wall, hernia repair
Prolene
• Synthetic monofilament – dyed or non dyed
• Raw material – polymer of propylene
• Tensile strength infinite
• Non absorbable
• Low tissue reaction
• No contraindications
• Used in general surgery in subcuticular skin
closure, cardiovascular surgery, opthalmic
surgery
Stainless steel
• Synthetic monofilament
• Raw material – alloy of nickel, iron, chromium
• Tensile strength infinite
• Non absorbable
• Minimal tissue reaction
• Should not be used in prostheses of different
metal
• Used in closure of sternotomy wounds
PTFE (Gore-Tex)
(Polytetrafluoroethylene)
• Synthetic monofilament
• Non absorbable
• Minimal tissue reaction
• Used as a conduit in vascular reconstructive
surgery.
**In grafts that start and end above the knee,
vein and PTFE show similar patency. In grafts
that cross the knee, veins tend to remain patent
longer. Infection is also less likely with vein.
Synthetic polyfilament
• Braided nylon
• Polyester
• Braided stainless steel
• Polyester (ethibond)
Braided stainless steel
POLYESTER (ethibond)
• Braided and dyed
green for optimum
visibility
• Indicated for soft tissue
approximation including
use in cardiovascular,
ophthalmic and
neurological
procedures.
• Highly adherent coating
act as a lubricant
POLYESTER ( mersilene)
• Synthetic polyfilament
non absorbable
suture
• Sterile surgical suture
composed of
polyethylene
terephthalate
SURGICAL NEEDLES
IDEAL CHARACTERISTICS
1. Made of high quality stainless steel.
2. As slim as possible without compromising
strength.
3. Stable in the grasp of a needle holder.
4. Able to carry suture material through tissue-
minimal trauma.
5. Sharp enough to penetrate tissue with
minimal resistance.
6. Rigid to resist bending, ductile to resist
breaking during surgery.
7. Sterile and corrosion-resistant – no
microorganisms, no foreign materials.
ANATOMY OF THE NEEDLE
POINT
• This portion of the needle extends from the tip to the maximum cross-section of the
body.

• Types
– Cutting & Spatula - Cornea
– Reverse cutting
– Side cutting
– Precision – Plastic Surgery
– Taper
– Blunt – SLKC
– Round-bodied - VIC
BODY
• This part of the needle incorporates the
majority of the needle length.
• The body of the needle is important for
interaction with the needle holder and the
ability to transmit the penetrating force to
the point.
• The needle factors that affect this
interaction include needle diameter and
radius, body geometry, and stainless steel
alloy.
BODY
• Types :

• STRAIGHT
• HALF-CURVED
• CURVED
• COMPOUND CURVED
• J-SHAPED
 Straight – easily accessible tissue that can
be manipulated by hand. Also skin closure
of abdominal wounds and tendon/ GI tract
repair

 Curved – predictable path through tissue


and requires less space for maneuvering
than straight needle.
 Half-curved – rarely used in skin closure
because of difficulty to handle.

 Compound curved – originally designed


for anterior segment ophthalmic surgery.
May facilitate vessel approximation in
microvascular surgery

 J-shaped – useful in low-approach


femoral hernia repair
SIZE INDICATIONS
• 6/0: around the eyes

• 5/0: elsewhere on the face

• 4/0: neck, hands, fingers, toes

• 3/0 or 2/0: gut anastomosis

• Microsurgery: 7/0 – 10/0, nerves, microvascular,


eyes
APPLICATION
1. Conventional cutting - skin, sternum.

2. Reverse cutting - fascia, ligament, skin,


oral mucosa, tendon sheath.

3. Micro-point reverse cutting - eye.

4. Precision point cutting - skin (plastic or


cosmetic).
5. Side-cutting spatula - eye (primary
application), microsurgery, opthalmic.

6. Blunt - kidney, liver, spleen, cervix.

7. Round-bodied - vessels, intestine, soft


tissue.

8. Taper - bronchus, periosteum


THANK YOU!!!

SHUBH DIVALI!!!