suture lecture
TRANSCRIPT
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SUTURE MATERIALS AND SUTURE MATERIALS AND TECHNIQUESTECHNIQUES
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The Ideal Suture MaterialThe Ideal Suture Material
• 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
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The Ideal Suture MaterialThe Ideal Suture Material
• Unfriendly to bacteriaUnfriendly to bacteria
• Strong yet smallStrong yet small
• Won’t tear through tissuesWon’t tear through tissues
• CheapCheap
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What’s It Used for?What’s It Used for?
• To bring tissue edges together and speed To bring tissue edges together and speed wound healing (=tissue apposition)wound healing (=tissue apposition)
• Orthopedic surgery to help stabilize jointsOrthopedic surgery to help stabilize joints– Repair ligamentsRepair ligaments
• Ligate vessels or tissuesLigate vessels or tissues
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Types of NeedlesTypes of Needles
• Eyed needlesEyed needles– More TraumaticMore Traumatic– Only thread Only thread
through oncethrough once– Suture on a reelSuture on a reel– Tends to Tends to
unthread itself unthread itself easilyeasily
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Types of NeedlesTypes of Needles
•Swaged-on Swaged-on needlesneedles– Much less Much less
traumatictraumatic– More expensive More expensive
suture materialsuture material– SterileSterile
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Points of NeedlesPoints of Needles
•TaperTaper– AtraumaticAtraumatic– Internal organsInternal organs
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Points of NeedlesPoints of Needles
•CuttingCutting• Cutting edge on Cutting edge on
inside of circleinside of circle
• SkinSkin
• TraumaticTraumatic
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Points of NeedlesPoints of Needles
•Reverse Reverse CuttingCutting
• Cutting edge on Cutting edge on outside of circleoutside of circle
• SkinSkin
• Less traumatic Less traumatic than cuttingthan cutting
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Cutting vs Reverse CuttingCutting vs Reverse Cutting
• CuttingCutting
• Reverse Reverse cuttingcutting
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Shapes of NeedlesShapes of Needles
• 3/8 circle3/8 circle
• 1/2 circle1/2 circle
• StraightStraight
• SpecialtySpecialty
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Characteristics of Suture Characteristics of Suture MaterialMaterial
• Absorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable
• Monofilament Vs. MultifilamentMonofilament Vs. Multifilament
• Natural or SyntheticNatural or Synthetic
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Absorbable SuturesAbsorbable Sutures
• InternalInternal
• Intradermal/ subcuticularIntradermal/ subcuticular
• Rarely on skinRarely on skin
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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
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Reading the Suture LabelReading the Suture Label
• CompanyCompany
Needle
SizeOrder Code
NameAlso:
LENGTH
NEEDLE SYMBOL
COLOR
Absorbable or Non
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ChoosingChoosingAbsorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable
• How long you need How long you need it to workit to work
• Do you want to see Do you want to see the animal again the animal again for suture removalfor suture removal
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Monofilament Vs. MultifilamentMonofilament Vs. Multifilament
• memorymemory easy to handle easy to handle
• less tissue dragless tissue drag more tissue drag more tissue drag
• doesn’t wickdoesn’t wick wicks/ bacteria wicks/ bacteria
• poor knot securitypoor knot security good knot good knot securitysecurity
• - - tissue reactiontissue reaction ++tissue reactiontissue reaction
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Natural Vs. SyntheticNatural Vs. Synthetic
•Natural:Natural:– GutGut– Chromic GutChromic Gut– SilkSilk– CollagenCollagen
• All are absorbableAll are absorbable
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Gut/ Chromic GutGut/ Chromic Gut
• Made of submucosa Made of submucosa of small intestinesof small intestines
• MultifilamentMultifilament
• Breaks down by Breaks down by phagocytosis: phagocytosis: inflammatory inflammatory reaction commonreaction common
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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 stuff!Bacteria love this stuff!
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Collagen and SilkCollagen and Silk
• Natural suturesNatural sutures
• VERY reactive, VERY reactive, absorbableabsorbable
• Ophthalmic Ophthalmic surgery onlysurgery only
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Vicryl (Polyglactin 910)Vicryl (Polyglactin 910)
• Braided, synthetic, absorbableBraided, synthetic, absorbable
• Stronger than gut: retains strength Stronger than gut: retains strength 3 3 weeksweeks
• Broken down by enzymes, not Broken down by enzymes, not phagocytosisphagocytosis
• Break-down products inhibit bacterial Break-down products inhibit bacterial growthgrowth– Can use in contaminated wounds, unlike Can use in contaminated wounds, unlike
other multifilamentsother multifilaments
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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 increased Both PGA and dexon have increased tissue drag, good knot securitytissue drag, good knot security
• Both are stronger than gutBoth are stronger than gut
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PDS (polydioxine)PDS (polydioxine)
• Monofilament (less drag, worse knot Monofilament (less drag, worse knot security – lots of “memory”)security – lots of “memory”)
• Synthetic, absorbableSynthetic, absorbable
• Very good tensile strength (better Very good tensile strength (better than gut, vicryl, dexon) which than gut, vicryl, dexon) which lasts lasts monthsmonths
• Absorbed completely by Absorbed completely by 182 days182 days
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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
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NONABSORBABLE SUTURESNONABSORBABLE SUTURES
• Natural or SyntheticNatural or Synthetic
• Monofilament or multifilamentMonofilament or multifilament
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NYLONNYLON
• SyntheticSynthetic
• Mono or MultifilamentMono or Multifilament
• MemoryMemory
• Very little tissue reactionVery little tissue reaction
• Poor knot securityPoor knot security
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Polymerized CaprolactumPolymerized Caprolactum
• Vetafil, Braunamid, SupramidVetafil, Braunamid, Supramid
• Multifilament suture with protein coatingMultifilament suture with protein coating
• SyntheticSynthetic
• Good knot security, easy handlingGood knot security, easy handling
• Not very reactiveNot very reactive
• Don’t use in contaminated woundDon’t use in contaminated wound
• Usually comes on a reelUsually comes on a reel
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PolypropylenePolypropylene
• Prolene, SurgileneProlene, Surgilene
• Monofilament, SyntheticMonofilament, Synthetic
• Won’t lose tensile strength over timeWon’t lose tensile strength over time
• Good knot securityGood knot security
• Very little tissue reactionVery little tissue reaction
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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, won’t Very little tissue reaction, won’t harbor bacteriaharbor bacteria
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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, “two ought”00 = 2-0, “two ought”
• SA : 0 through 3-0 (Optho 5-0 >>7-0)SA : 0 through 3-0 (Optho 5-0 >>7-0)
• LA : 0 through 3LA : 0 through 3
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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 = “ought”26 gauge = “ought”– 28 gauge = 2-028 gauge = 2-0
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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
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Tissue AdhesiveTissue Adhesive
• Nexaband, Vetbond, Nexaband, Vetbond, and othersand others
• Little strengthLittle strength
• Should not be Should not be placed between skin placed between skin layers or inside bodylayers or inside body
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Suture PatternsSuture Patterns
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Knot StrengthKnot Strength
• Generally 4 “throws” for >90% knot Generally 4 “throws” for >90% knot security (nylon may need 5)security (nylon may need 5)– Less “throws” = more likely to untie Less “throws” = more likely to untie
itselfitself
• Stainless steel = exception againStainless steel = exception again– 2 “throws” = 99% knot security2 “throws” = 99% knot security
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Simple InterruptedSimple Interrupted
Simple Interrupted Suture
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Simple ContinuousSimple Continuous
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Ford InterlockingFord Interlocking
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SubcuticularSubcuticular
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http://cal.vet.upenn.edu/surgery/index.html