Suture Workshop

Presented by Joanna Jarvis and Craig Atkinson

Presentation Contents

•HistoryHistory

•Suture classification and selectionSuture classification and selection

•NeedlesNeedles

•Suture labelSuture label

Workshop Contents

•Suture presentation Suture presentation

•Basic Suture Techniques VideoBasic Suture Techniques Video

•Knot tying & suture exercisesKnot tying & suture exercises

•Evaluation. Delegate bagsEvaluation. Delegate bags

HISTORY

The origins of surgery can be traced back many centuries. Through the ages, practitioners have used a wide range of materials and techniques for closing tissue……..

1650 BC – 2000’s AD

In the tenth century BC, the ant was held over the wound until it seized the wound edges in its

jaws. It was then decapitated and the ant's death grip kept the wound closed.

AntsAnts

Thorns

The thorn, used by African tribes to close tissue, was passed through the skin on either side of the wound.

A strip of vegetable fibre was then wound around the edge in a figure eight.

Sterilised Catgut

The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading

through the eye of the needle before use.

Swaged On Needles

Post World War II brought the swaged-on needle. The thread fits into the hollow end of the needle, allowing it to pass through tissue

without the double loop of thread that exists with a conventional needle, reducing tissue trauma.

Suture Classification and SelectionSuture Classification and Selection

Suture ClassificationSuture Classification

• NaturalNatural or or SyntheticSynthetic (man made) (man made)

• MonofilamentMonofilament or or MultifilamentMultifilament (braided) (braided)

• Absorbable Absorbable or or Non-AbsorbableNon-Absorbable

The Ideal Suture

• Minimal tissue reaction• Smoothness - minimum tissue drag• Low Capillarity• Max tensile strength• Ease of handling - Minimum memory • Knot security

• Consistency of performance

• Predictable performance• Cost effectiveness

Multifilament (braided)Multifilament (braided)

Suture ClassificationSuture Classification

MonofilamentMonofilament

Braided v Monofilament

Has capillary actionIncreased infection riskLess smooth passageLess tensile strengthBetter handlingBetter knot security

No capillary actionLess infection riskSmooth tissue passageHigher tensile strengthHas memoryMore throws required

• These are absorbed within the living tissueThese are absorbed within the living tissue

• Two main characteristics are:Two main characteristics are:

•Tensile strength retention Tensile strength retention

•Absorption rateAbsorption rate

Absorbable SuturesAbsorbable Sutures

Maxon: Day 14: 75% Absorption: 180 daysMaxon: Day 14: 75% Absorption: 180 days

Caprosyn: Day 10: 30% Absorption: 56 daysCaprosyn: Day 10: 30% Absorption: 56 days

Absorbable Sutures

Caprosyn Biosyn Maxon Polysorb Dexon II

MATERIAL

60% Glycolide

10% caprolactone

10% Trimethylene carbonate

10% Lactide

60% Glycolide

26% Trimethylene carbonate

14% Dioxanone

Poly-glyconate

90% Polyglycolic acid

10% Polylactic Acid

100% Polyglycolic acid

STRUCTURE Monofilament MonofilamentMono-

filamentBraided Braided

COATING NA NA NA

Caprolactone / Glycolide, Calcium stearoyl lactilate

Polycaprolactone

SIGNIFICATE TENSILE STRENGTH

10 Days 21 days 42 Days 21 Days 21 Days

ABSORPTION PROFILE

56 Days 90-110 Days180-210

Days56-70 Days 60-90 Days

Characteristics of Non-Absorbable Sutures

• Permanent• Only used when long term support is required• Removed when used for skin (e.g. in A+E)• Tissue reaction generally low (except silk)• However silk, linen and even nylon will lose tensile strength over

a period of time• True non-absorbable sutures include polyester, polyethylene,

polybutester, polypropylene and steel

Suture Size

5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0

Thick Thin

USP (United States Pharmacopoeia)

A+E

General

Suture Selection

Bowel: 2/0 - 3/0Fascia: 1 - 0Ligatures: 0 - 3/0Pedicles: 2 - 0Skin: 2/0 - 5/0Arteries: 2/0 - 8/0Micro surgery 9/0 - 10/0Corneal closure: 9/0 - 10/0

Suture Handling

1. Package MemoryGrasp strand close to needle and at end of strand

and gently stretch2. Opening suture foilTear in direction indicated to gain best needle

exposure3. Arming needleArm needles 2/3rds distance between tip and swage

Closure using Clips

Closure using Caprosyn

Needles

Needle point Geometry

Taper-Point•Suited to soft tissue•Dilates rather than cuts

Reverse cutting

•Very sharp•Ideal for skin•Cuts rather than dilates

Conventional Cutting

•Very sharp•Cuts rather than dilates•Creates weakness allowing suture tearout

Taper-cutting

•Ideal in tough or calcified tissues•Mainly used in Cardiac & Vascular procedures.

Needle Point Geometry

Blunt•Also known as “Protect Point”•Mainly used to prevent needle stick injuries i.e. for abdominal wall closure.

Premium point spatula

•Ophthalmic Surgery

Spatula•Ophthalmic Surgery

DermaX*•NEW: ½ The Penetration force•½ The Penetration force•Superior Cosmetic Effect

Needle CurvatureNeedle Curvature

The Right Needle Choice

• The appropriate needle choice for any situation is…………….

……………The needle that will cause least possible trauma to the tissue being sutured

Summary of Needles

1. Needles are made of steel alloy (Surgalloy) with a Nucoat coating so they stay sharp for multiple passes through tissue

2. Different needle points for different tissues

3. Choose the needle that will cause the least trauma

Suture Label

The Suture Packaging

STRAND SIZE

MATERIAL

STRAND LENGTH

PRODUCT CODE

NEEDLE CODE

WITH LIFE SIZE

PICTURE OF

NEEDLE

NEEDLE LENGTHCOLOUR

POINT TYPE

NEEDLE CIRCLE

Knot Tying & SuturingKnot Tying & Suturing