DISCUSS SUTURES IN

SURGERY
BY
DR SANI ABDULLAHI GIADE

OUTLINE
o INTRODUCTION
HISTORICAL BACKGROUND
DEFINITIONS
o QUALITIES OF AN IDEAL SUTURE
o CLASSIFICATION/STRENGTH
o TYPES/USES
o SUTURE SELECTION
o SUTURE ACCESSORIES(NEEDLES)
o STERILIZATION OF SUTURES
o SUTURE REMOVAL
o COMPLICATIONS
o RECENT ADVANCES
o CONCLUSION
o REFERENCES

INTRODUCTION
HISTORICAL BACKGROUND
Sutures are used to improve & speed healing
Hx dates back to 550-3000BC
Early sutures were Flax,Silk,Linen strips & cotton
Synthetic sutures are now available

DEFINITIONS
Suture is a material used to approximate living tissues or

xtures together
Ligature is a suture used to encircle a bld vessel to arrest or
control bleeding
Tensile strength is the ability of the material or tissues to
resist deformation or breakage
Elasticity is the ability of the material to regain its original
form or length after deformation
Pliability is the ability to adjust knot tension & to secure
knot
Memory is the inherent capability of suture to return or
maintain its original gross shape

QUALITIES OF AN IDEAL SUTURE

Sterile
Serve all purpose
Minimal tissue rxn
Easy to handle
Hold knot securely
High tensile strength
Favourable absorption profile
Resistant to infection
Available
Inexpensive

CLASSIFICATION OF SUTURES/STRENGTH
ABSORPTION

ABILITY
Absorbable

ORIGIN
Natural
Synthetic

Non-absorbable Natural
Synthetic

CONFIGURATION
Monofilament
Multifilament
Monofilament
Multifilament

TRAUMATIC & ATRAUMATIC

STRENGTH : Ranges from smallest(10/0) to largest(5)

TYPES/USES
ABSORBABLE NATURAL
Plain catgut:Derived from submucusa of sheep

intestine or serosa of beef intestine

Tensile strengh is maintained for 7-10d
Absorption complete by 70d
Used for ligating superficial bld vessels & subcut fatty
tissues
Chromic catgut:Treated with chromium salt
Tensile strength -10-14d
Absorption complete by 90d
Adv may be used in the presence of infection

ABSORBABLE - SYNTHETIC
Polyglactin 910 (vicryl):copolymer of lactide &

glycolide
Tensile strength is 65% at 14d
Absorption minimal at 40d & complete in 70d
Minimal tissue rxn
Used in general soft tissue approx/vessels ligation in
all surgical specialties
Other e.g
polydiaxone(PDS),polyglycolic(DEXON),Polyglecapr
one(monocryl)

NON-ABSORBABLE-NATURAL
Surgical silk: Derived from the cocoon of the silk worm

larvae
Has superior handling xtics
Trigger inflam rxns
Undergo proteolysis & undetected by 2yrs
Used in ligating maj bld ves,tendon repair etc
Surgical steel & wires
High tensile strength
Hold knots very well
Used in orthopaedic,Neurosurg,& Thoracic surg
Other e.g Virgin silk,cotton, linen

NON-ABSORBABLE - SYNTHETIC
Nylon:Is a polyamide polymer
81% tensile strength at 1yr & 66% at 11yrs
Elicits minimal tissue rxn
Has good memory
Pliable when moist
Premoistened form is used cosmetic plastic surgery
Its elasticity makes it useful for skin closure &

Herniorhapy
Other e.g;Polypropylene(prolene),Polyester
fiber(Mersilene/Dacron,Ethibond)

SUTURE SELECTION
Depends on surgeons training & preference
Smallest suture is preferable
Tensile strength of suture should not exceed that of

tissues
Aesthetics should be considered e.g head&neck
Mobility of the region e.g Limbs & trunk
Tension of the tissues to be sutured e.g major
musculocutaneous flaps
Non-absorbable considered in skin,fascia,tendon
Absorbable considered in rapidly healing tissues
Monofiliments preferable in contaminated wounds

SUTURE ACCESSORY-NEEDLES
Ideal surgical needle
High quality stainless steel
Smallest diameter possible
Stable in the grasp of needle holder
Sharp enough to penetrate tissues with minimal
resistance & trauma
Sterile & corrosive resistant

ANATOMY OF THE NEEDLE

POINT
Cutting;
Conventional cutting
Reverse cutting
Side cutting
Taper(round needle)
Blunt

BODY
Straight
Half curved
Curved
Compound curved

SWAGE
Channel swage
Drill swage
Nonswaged

STERILIZATION OF SUTURES
May affect suture properties to some extent
Gamma Radiation
Ethylene oxide;poisonous gas,is less attractive
Autoclave
Sutures are usually stored in sterile pack by the

manufacturers,their integrity must be checked b/4

use

SUTURE REMOVAL
Sutures on the superficial(skin) wounds are removed

after serving their fxn

Duration depends on the site;
Head & Face = 3-5d
Arms & Hands = 7-10d
Chest
=7-10d
Abdomen =7-1od
Lower limbs/feet =10-14d

COMPLICATIONS
Usually less if proper selection is followed
Failure
Undo
Tissue rxn
Infection
Abcess and sinus formation
scarring

RECENT ADVANCES
Staples & Clips
Formed from high quality stainless steel
New absorbable clips made of polydiaxone are

available
Staples are suitable for skin closure
Stapling gun for bowel anastomosis are popular
Skin Tapes & Adhesives e.g Dermabond
Non-suture methods of closing wound edges
Applied after adequate subcuticular closure
Minimal infection rate & no tissue rxn
EXPENSIVE

CONCLUSION
Human body is very delicate & important. When

surgeries are needed to improve our health is very

important to select a suitable suture. Today we know
a lots of biomaterials to select, but is important to
always think of biocompatibility.

REFERENCES
1) Post-graduate surgery, candidates guide M.A.R

Alfallouji,2nd edition
2) Principles & practice of surgery including
pathology in the Tropics, E.A.Badoe etal 3rd edition
3) Clinical surgery Alfred Cusheri etal 2nd edition
4) www.e.medicine.com

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