SUTURE MATERIALS AND SUTURE MATERIALS AND TECHNIQUESTECHNIQUES

PROF. SREEJOY PATNAIK

The Ideal Suture The Ideal Suture MaterialMaterial

•Can be used in any Can be used in any tissuetissue

•Easy to handleEasy to handle•Good knot securityGood knot security•Minimal tissue Minimal tissue reactionreaction

The Ideal Suture The Ideal Suture MaterialMaterial•Unfriendly to bacteriaUnfriendly to bacteria

•Strong yet smallStrong yet small

•WonWon’’t tear through t tear through tissuestissues

•CheapCheap

WhatWhat’’s It Used for?s It Used for?

•To bring tissue edges together and To bring tissue edges together and speed wound healing (=tissue speed wound healing (=tissue apposition)apposition)

•Orthopedic surgery to help stabilize Orthopedic surgery to help stabilize jointsjoints– Repair ligamentsRepair ligaments

•Ligate vessels or tissuesLigate vessels or tissues

Types of NeedlesTypes of Needles

• Eyed needlesEyed needles–More TraumaticMore Traumatic–Only thread Only thread through oncethrough once

–Suture on a Suture on a reelreel

–Tends to Tends to unthread unthread itself easilyitself easily

Types of NeedlesTypes of Needles

•Swaged-on Swaged-on needlesneedles– Much less Much less traumatictraumatic

– More expensive More expensive suture suture materialmaterial

– SterileSterile

Points of NeedlesPoints of Needles

•TaperTaper– AtraumaticAtraumatic– Internal Internal organsorgans

Points of NeedlesPoints of Needles

•CuttingCutting• Cutting edge on Cutting edge on inside of inside of circlecircle

•SkinSkin•TraumaticTraumatic

Points of NeedlesPoints of Needles

•Reverse Reverse CuttingCutting

• Cutting edge on Cutting edge on outside of outside of circlecircle

•SkinSkin•Less traumatic Less traumatic than cuttingthan cutting

Cutting vs Reverse Cutting vs Reverse CuttingCutting

•CuttingCutting

•Reverse Reverse cuttingcutting

Shapes of NeedlesShapes of Needles

• 3/8 circle3/8 circle• 1/2 circle1/2 circle• StraightStraight• SpecialtySpecialty

Characteristics of Suture Characteristics of Suture MaterialMaterial

•Absorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable

•Monofilament Vs. MultifilamentMonofilament Vs. Multifilament

•Natural or SyntheticNatural or Synthetic

Absorbable SuturesAbsorbable Sutures

•InternalInternal•Intradermal/ Intradermal/ subcuticularsubcuticular

•Rarely on skinRarely on skin

Non-absorbable SutureNon-absorbable Suture

•Primarily SkinPrimarily Skin– Needs to be removed laterNeeds to be removed later

•Stainless steel = exceptionStainless steel = exception– Can be used internally Can be used internally

•LigatureLigature•OrthopedicsOrthopedics

– Can be left in place for long periodsCan be left in place for long periods

Reading the Suture Reading the Suture LabelLabel

• CompanyCompany

Needle

Size Order Code

NameAlso:

LENGTH

NEEDLE SYMBOL

COLOR

Absorbable or Non

ChoosingChoosingAbsorbable Vs. Absorbable Vs. NonabsorbableNonabsorbable

• How long you How long you need it to workneed it to work

• Do you want to Do you want to see the animal see the animal again for suture again for suture removalremoval

Monofilament Vs. Monofilament Vs. MultifilamentMultifilament

•memorymemory easy to handle easy to handle•less tissue dragless tissue drag more tissue more tissue dragdrag

•doesndoesn’’t wickt wick wicks/ bacteria wicks/ bacteria•poor knot securitypoor knot security good knot good knot securitysecurity

•- - tissue reactiontissue reaction ++tissue tissue reactionreaction

Natural Vs. SyntheticNatural Vs. Synthetic

•Natural:Natural:– GutGut– Chromic GutChromic Gut– SilkSilk– CollagenCollagen

• All are All are absorbableabsorbable

Gut/ Chromic GutGut/ Chromic Gut

• Made of submucosa Made of submucosa of small of small intestinesintestines

• MultifilamentMultifilament

• Breaks down by Breaks down by phagocytosis: phagocytosis: inflammatory inflammatory reaction commonreaction common

Gut/ Chromic GutGut/ Chromic Gut

• Chromic: tanned, lasts Chromic: tanned, lasts longer, less reactivelonger, less reactive

• Easy handlingEasy handling

• Plain: 3-5 days Plain: 3-5 days • Chromic: 10-15 daysChromic: 10-15 days

• Bacteria love this Bacteria love this stuff!stuff!

Collagen and SilkCollagen and Silk

• Natural suturesNatural sutures

• VERY reactive, VERY reactive, absorbableabsorbable

• Ophthalmic Ophthalmic surgery onlysurgery only

Vicryl (Polyglactin Vicryl (Polyglactin 910)910)•Braided, synthetic, absorbableBraided, synthetic, absorbable•Stronger than gut: retains strength Stronger than gut: retains strength 3 weeks3 weeks

•Broken down by enzymes, not Broken down by enzymes, not phagocytosisphagocytosis

•Break-down products inhibit Break-down products inhibit bacterial growthbacterial growth– Can use in contaminated wounds, unlike Can use in contaminated wounds, unlike other multifilamentsother multifilaments

Dexon and PGADexon and PGA

•Polymer of glycolic acidsPolymer of glycolic acids•Braided, synthetic, absorbableBraided, synthetic, absorbable•Broken down by enzymesBroken down by enzymes•Both PGA and dexon have Both PGA and dexon have increased tissue drag, good increased tissue drag, good knot securityknot security

•Both are stronger than gutBoth are stronger than gut

PDS (polydioxine)PDS (polydioxine)

•Monofilament (less drag, worse Monofilament (less drag, worse knot security – lots of knot security – lots of ““memorymemory””))

•Synthetic, absorbableSynthetic, absorbable•Very good tensile strength Very good tensile strength (better than gut, vicryl, dexon) (better than gut, vicryl, dexon) which which lasts monthslasts months

•Absorbed completely by Absorbed completely by 182 days182 days

MMaxon (polyglyconate)axon (polyglyconate)

•MMonofilament- onofilament- mmemoryemory•Synthetic AbsorbableSynthetic Absorbable•Very little tissue dragVery little tissue drag•Poor knot securityPoor knot security•Very strongVery strong

NONABSORBABLE SUTURESNONABSORBABLE SUTURES

•Natural or SyntheticNatural or Synthetic•Monofilament or multifilamentMonofilament or multifilament

                           

NYLONNYLON

•SyntheticSynthetic•Mono or MultifilamentMono or Multifilament•MemoryMemory•Very little tissue reactionVery little tissue reaction•Poor knot securityPoor knot security

Polymerized CaprolactumPolymerized Caprolactum

•Vetafil, Braunamid, SupramidVetafil, Braunamid, Supramid•Multifilament suture with protein Multifilament suture with protein coatingcoating

•SyntheticSynthetic•Good knot security, easy handlingGood knot security, easy handling•Not very reactiveNot very reactive•DonDon’’t use in contaminated woundt use in contaminated wound•Usually comes on a reelUsually comes on a reel

PolypropylenePolypropylene

•Prolene, SurgileneProlene, Surgilene•Monofilament, SyntheticMonofilament, Synthetic•WonWon’’t lose tensile strength over t lose tensile strength over timetime

•Good knot securityGood knot security•Very little tissue reactionVery little tissue reaction

Stainless SteelStainless Steel

•Monofilament Monofilament •Strongest !Strongest !•Great knot securityGreat knot security•Difficult handlingDifficult handling•Can cut through tissuesCan cut through tissues•Very little tissue reaction, Very little tissue reaction, wonwon’’t harbor bacteriat harbor bacteria

Suture SizesSuture Sizes

•Sized #5-4-3-2-1-0-00-000-0000…30-0Sized #5-4-3-2-1-0-00-000-0000…30-0– BIGGER >>>>>>>>>>>>>>>>SMALLERBIGGER >>>>>>>>>>>>>>>>SMALLER

•00 = 2-0, 00 = 2-0, ““two oughttwo ought””

•SA : 0 through 3-0 (Optho 5-0 >>7-SA : 0 through 3-0 (Optho 5-0 >>7-0)0)

•LA : 0 through 3LA : 0 through 3

Suture Sizes (cont)Suture Sizes (cont)

•Stainless Steel Stainless Steel – In gauges (like needles)In gauges (like needles)

•Smaller gauge = bigger, strongerSmaller gauge = bigger, stronger•Larger gauge= smaller, finerLarger gauge= smaller, finer

– 26 gauge = 26 gauge = ““oughtought””– 28 gauge = 2-028 gauge = 2-0

Skin StaplesSkin Staples

•Very common in human medicineVery common in human medicine•ExpensiveExpensive•Very easyVery easy•Very secureVery secure•Very little tissue reactionVery little tissue reaction•Removal = Removal =

– Special tool requiredSpecial tool required

Tissue AdhesiveTissue Adhesive

• Nexaband, Vetbond, Nexaband, Vetbond, and othersand others

• Little strengthLittle strength

• Should not be Should not be placed between placed between skin layers or skin layers or inside bodyinside body

Suture PatternsSuture Patterns

Knot StrengthKnot Strength

•Generally 4 Generally 4 ““throwsthrows”” for >90% knot for >90% knot security (nylon may need 5)security (nylon may need 5)– Less Less ““throwsthrows”” = more likely to untie = more likely to untie itselfitself

•Stainless steel = exception againStainless steel = exception again– 2 2 ““throwsthrows”” = 99% knot security = 99% knot security

Simple InterruptedSimple Interrupted

Simple Interrupted Suture

Simple ContinuousSimple Continuous

Ford InterlockingFord Interlocking

SubcuticularSubcuticular

http://cal.vet.upenn.edu/surgery/index.html