You are on page 1of 7

Surgical sutures

Ideal suture should be:

 Easy to handle
 Have minimally reaction in tissue
 Inhibits bacterial growth
 Holds securely when knotted
 Resist shrinking in tissue
 Is noncapillary, nonallergenic, noncarcinogenic and nonferromagnetic
 Absorbs with minimal reaction after tissue has healed

NOTE: Such an ideal suture does not exist.

CHARACTERISTICS OF SUTURES

 Suture size

The smallest diameter suture that will adequately hold the mending wounded tissue should be used in
order to minimize trauma as the suture passed through the tissue. And also to reduce the amount of
foreign material left in the wound. A suture should not be stronger than the sutured tissue.

The most commonly used standard for suture size is the USP (United States Pharmacopoeia), which
denotes dimension from 10-0 the smallest and 7 the largest.

 Flexibility

The flexibility of suture is determined by its torsional stiffness and diameter, which influence its handling
and use.

 Surface characteristic

The surface characteristics of suture influence the ease with which is pulled through tissues (i.e., the
amount of friction or ″drag″) and the amount of trauma caused.

 Capillarity

Capillarity is the process by which fluid and bacteria are carried into the interstices of multifilament
fibers. Capillary suture materials should not be used in contaminated or infected sites. Coating reduces
capillarity of some sutures.

 Knot tensile strength

Knot tensile strength is measured by the force that suture strand can withstand before it breaks when
knotted.

 Relatively knot security

The knot-holding capacity of suture material is the strength required to untie or break a defined knot by
loading the part of the suture that forms the loop.
Sutures material may be classified:

o According to their origin:


a) organic
b) synthetic
c) metallic

o According to their behavior in tissue:


a) absorbable (phagocytized or hydrolyzed)
b) nonabsorbable

o According to their structure


a) monofilament
b) multifilament

► Monofilament vs. Multifilament ◄

Monofilament sutures:

Monofilament sutures are made of a single strand of material.

Advantage

o have less tissue drag than multifilament suture,


o do not have interstices that may harbor bacteria.

Disadvantage

o with thicker threads the wiriness that is a characteristic of all monofilament threads impairs
handling and in particular renders knot-tying more difficult,

o care should be used in handling because nicking or damaging them with forceps or needle holder
weakens them and predispose them to breakage.

Multifilament suture

Multifilament sutures are made of several strands of suture that are twisted or braided together.

Advantage

o are more pliable and flexible than monofilament sutures,


o results in considerably better knot holding security.

Disadvantage

o the longitudinal orientation of the individual filaments within the thread results in relatively high
capillarity, but the capillarity of braided threads is less than that of twisted threads.
o have a rough surface that impairs passage through tissue.

Multifilament threads are generally coated. The coating smoothes out the irregular surface and thus
facilitates passage through tissue without impairing knot-holding security. Coated multifilament threads
are less stiff and wiry than monofilament threads. The coating also reduces capillarity.
►some types of the suture materials (table 1) ◄

Surgical needles

Surgical needles are divided in two groups:

 Traumatic needles
 Atraumatic needles

Traumatic needles (picture 1) - are needles with holes or eyes which are supplied to the hospital
separate from their suture thread. In traumatic needles with eyes, the thread comes out of the needle's
hole on both sides. When passing through the tissues, this type of suture rips the tissue to a certain
extent, thus the name traumatic.

Picture 1. Traumatic needles

Atraumatic needles with sutures (picture 2) - comprise an eyeless needle attached to a specific length
of suture thread. Important thing is that the suture end of a swaged needle is smaller than the needle
body.

With
attached
suture
thread

Picture 2. Atraumatic needle


Needles shapes:

 Straight – skin, nervs, GI tract, tendons, blood vessels, etc.

 Halfcurved – skin (rarely used one),

 Curved – according to curve degree are divided:


o 1/4 circle – eye, microsurgery,
o 3/8 circle – used for the most body structures,
o 1/2 circle - used for the most body structures,
o 5/8 circle – urinary and reproductive system.

 Combine needle – anterior segment of the eye.

Straight needle Halfcurved neddle


Combine needle

1/4 circle 3/8 circle 1/2 circle 5/8 circle

Point and body shape:

 Taper – taper point and round or quadrangular body (cross section) – aponeurosis, muscles,
nerves, peritoneum, blood vessels, valves.
 Blunt - blunt point and flat body (cross section) – bowels, kidney, spleen, liver.
 Triangular – triangular point and flat or quadrangular body (cross section). If the cutting side of
triangular is upward this type of needle is called conventional (skin, sternum), and if it’s
downward reverse cutting (fascia, ligaments, skin, tendons).
 Tapercut - small triangular cutting point and flat body (cross section) – fascia, ligaments, uterus,
oral cavity and etc.

Taper Blunt

Conventional Reverse cutting

Tapercut
TYPES OF SUTURE
Sutures may be described as being natural v.s. synthetic, absorbable v.s. non-absorbable,
and monofilamentv.s. braided.
An ideal suture would be inexpensive, easy to work with, strong and non-reactive with high knot
security. However, no single suture has all these qualities so we have to choose from dozens of
options. A number of generalizations may be made about suture materials.
 Virtually all suture materials will be absorbed with time. Non-absorbable sutures are
defined as those which retain their tensile strength after 60 days in situ.
 Synthetic sutures tend to cause less reactivity (inflammation) and carry less infection risk
than do comparable natural sutures.
 Braided sutures tend to be more reactive and carry higher infection risk than do
comparable monofilament sutures.
The majority of accidental wounds in skin will be closed with a monofilament, non-absorbable,
synthetic suture such as Polypropylene or Nylon.

Type Strength Durability Comments

resorbable

monocryl

vicryl (braided) strong slowly absorbed used for oral lacerations or


subcutaneous sutures

gut weak rapidly absorbed very reactive; rarely used

nonresorbable

prolene strong permanent used for skin suturing; slippery

nylon permanent used for skin suturing; slippery

silk permanent used for oral wounds; reactive

stainless steel very strong permanent used for bone; difficult to work with

SIZE OF SUTURE
Suture size will be determined by the size of the wound, the amount of tensile
strength required in the closure and the need for cosmesis. Larger (thicker) sutures
will be chosen for large wounds which are under stress and do not require cosmetic
results. Suture size is denoted by a O system with higher numbers indicating sutures
of lesser diameter and strength.
 Examples of commonly used suture sizes include:
3-0 Closure of fascia, subcutaneous tissue, high stress wounds.
4-0 Closure of low stress wounds i.e. digits, scalp.
5-0/6-0 Cosmetic closure of wounds on the face.
RATIONALE

The main purpose of surgical suture is wound closure.A scrub nurse is responsible to know the anatomy
and physiology of the skin and tissue, medical terminology teaches the wordage used while in a medical
environment. This must have ability helps you to talk and understand the unique language that will be
spoken in the surgical room. Suturing is an important component of wound care, repairing moderate to
serious injuries such as lacerations, as well as wounds resulting from surgery or other procedures.
Suturing provides speed wound healing, and improves tissue function and appearance. Every layer of
the skin has its own specific suture, knowing this layer will not only enhance our knowledge. To lessen
the cause of trauma and tearing on the wound site.

You might also like