PERIOPERATIVE PERIOPERATIVE NURSINGNURSING

SUTUREBY MURSIDI H.A

WHAT IS SUTUREWHAT IS SUTURE ““a thread, wire, or other materials a thread, wire, or other materials

used in the operation of stitching used in the operation of stitching parts of the body together”parts of the body together”

““to suture is to unite by stitching to suture is to unite by stitching (sewing) until healing take place”(sewing) until healing take place”

Purposes – ligating bleeding vessels, Purposes – ligating bleeding vessels, suturing internal structures, wound suturing internal structures, wound closure and retraction purposesclosure and retraction purposes

Characteristic of Suture Materials

Physical characteristicPhysical characteristic Monofilament or MultifilamentMonofilament or Multifilament CapillarityCapillarity Predetermined diameter (caliber)Predetermined diameter (caliber) Good tensile strengthGood tensile strength Knot strengthKnot strength Maintained elasticityMaintained elasticity Memory capacityMemory capacity

Handling characteristicHandling characteristic Pliability (easily bends)Pliability (easily bends) Co-efficient of frictions (slip easily) – to prevent Co-efficient of frictions (slip easily) – to prevent

tissue drag, knot slippage and to facilitate knot tissue drag, knot slippage and to facilitate knot tyingtying

Tissue-reaction characteristicTissue-reaction characteristic Non-allergenicNon-allergenic Non-carcinogenicNon-carcinogenic Minimal tissue reactionsMinimal tissue reactions

Characteristic of Suture Materials

TYPES OF SUTURE MATERIALS ABSORBABLE SUTUREABSORBABLE SUTURE

““a sterile, flexible strand prepared from collagen a sterile, flexible strand prepared from collagen derived from healthy mammals or synthetic derived from healthy mammals or synthetic polymers”polymers”

Capable of being absorbed by living tissues Capable of being absorbed by living tissues through hydrolyzed or enzymatic processthrough hydrolyzed or enzymatic process

May be impregnated with coating, softening or May be impregnated with coating, softening or anti-microbial agentsanti-microbial agents

Varies in treatments, colour, sizes, packaging and Varies in treatments, colour, sizes, packaging and resistance to absorption according to purposesresistance to absorption according to purposes

Types of Absorbable suturesTypes of Absorbable sutures

COLLAGEN DERIVEDCOLLAGEN DERIVED Surgical GutSurgical Gut

SYNTHETIC DERIVEDSYNTHETIC DERIVED Coated VicrylCoated Vicryl MonocrylMonocryl PDSPDS

DERIVED FROM SILKWORM LARVADERIVED FROM SILKWORM LARVA Silk sutureSilk suture

NON-ABSORBABLE SUTURENON-ABSORBABLE SUTURE ““a strands of materials that effectively a strands of materials that effectively

resist enzymatic digestion in living tissue”resist enzymatic digestion in living tissue” May be uncoated or coated with substance May be uncoated or coated with substance

to reduce capillarity and frictionto reduce capillarity and friction Encapsulated by tissues around it during Encapsulated by tissues around it during

healinghealing Required removal of suture after wound Required removal of suture after wound

healinghealing

TYPES OF SUTURE TYPES OF SUTURE MATERIALSMATERIALS

SYNTHETIC DERIVED Ethilon (Nylon) Prolene Ethibond Monosof

SURGICAL WIRE Stainless steel wire

Types of Non-Absorbable sutures

INDIVIDUAL CHARACTERISTIC OF SUTURE

(collagen derived absorbable sutures)

SUTURE TYPES RAW MATERIALS INTERACTION USAGE

SURGICAL GUT

PLAIN(yellow)

COLLAGEN DERIVED

FROM MAMMALS

ABSORBABLE 7-10 DAYS

Ligate superficial Vessels, SC tissue,

oral mucosa,ophthalmology cases

CHROMIC

(brown) COLLAGEN DERIVED TREATED

WITH CHROMIUM

SALTS

ABSORBABLEWITHIN TWO

WEEKS

Fascia or peritoneumLarge vessels ties, muscle or mucosal

layers(blue)[dye]

SUTURE TYPES/COLOR

RAW MATERIALS INTERACTION USAGE

CoatedVICRYL

MONOCRYL

BRAIDED

(violet)[undyed]

MIXTURES OF LACTIC

AND GLYCOLIC

ACID POLYMERS

AND CALCIUM

STEARATE

ABSORBED BY SLOW

HYDROLYSIS IN TISSUES 2 – 3 WEEKS

Ligate or suture tissues for

approximation

MONO-FILAMENT

(Clear)

PDS MONO-FILAMENT

(Clear)SYNTHETIC POLYMERS

UP TO THREE MONTHS

Fascial closure, elderly or oncologic

patients

INDIVIDUAL CHARACTERISTIC OF SUTURE

(synthetic absorbable sutures)

SUTURE TYPES/COLOR

RAW MATERIALS INTERACTION USAGE

ETHILONNylon

MONO-FILAMENT

(Green)

POLYAMIDE POLYMER

NON-ABSORBABLE

REMAINS ENCAPSULATED

IN BODY TISSUES

Skin Closure, retention, plastic

surgery, ophthalmology and

micro surgery

PROLENEPoly-

Propylene

MONO-FILAMENT

(Blue)

POLYMER OF

PROPYLENE

Abdominal surgery,

General plastic and Cardio-

vascularsurgery

ETHIBONDPolyester

Fibre

BRAIDED(Green/White)

POLYSTERFIBRE WITH

POLYBUTILATE

INDIVIDUAL CHARACTERISTIC OF SUTURE

(synthetic non-absorbable sutures)

SUTURETYPES/COLOR

RAW MATERIALS INTERACTION USAGE

SILK BRAIDED(Black)

PROTEIN FIBRE SPUN

BY SILKWORM

VERY SLOWLY ABSORBED

AND DISSAPEAR AFTER FEW

YEARS

Most body tissues for ligating and

suturing

STEELWIRE

MONO OR MULTI-

FILAMENT(Silver)

AN ALLOY OF IRON

(Stainless orSilver wire)

NON-ABSORBABLE

General and skin closure, tendon

repaired, cranioplasty

INDIVIDUAL CHARACTERISTIC OF SUTURE

(SILK AND SURGICAL WIRE)

MONOFILAMENT SUTURES

PROLENE

CHROMIC GUT

PLAIN GUT

STEEL WIRE

SILK

POLYPROPYLENE

BRAIDED/MULTIFILAMENTS SUTURES

NYLON VICRYL

SILK

SILK

CHROMIC GUT

CHROMIC GUT

TENSILE STRENGTH AND DIAMETER Refer to knot pull strength of the suture rather

than straight pull strength Suture diameter refer to the size of the strand

(heavy size 7 to fine size of 11-0) SUTURE LENGTH

Standardized length - 50 or 60 inches Precut length – 17,18 or 24 inches

SUTURE PACKAGING Sealed in a primary inner packet with inside dry

and outer, see-through peel-back packet – sterilized

Sterility maintained until opened or date of expiry arrived

IDENTIFCATION OF SUTUREIDENTIFCATION OF SUTURE

SUTURELENGTH

SUTURESIZE

SUTURENAME

NEEDLESIZE &SHAPE

BATCHNUMBER

PRODUCT NAME

SUTURES COLOUR CODING PACKAGESSUTURE COLOUR CODE

PLAIN GUT YELLOWCHROMIC GUT BROWNSILK LIGHT BLUENYLON GREENPROLENE ROYAL BLUEVICRYL PURPLEETHIBOND ORANGEPDS GREYSTAINLESS STEEL SILVER

COLOUR CODING AND PACKAGES OF SUTURES

METHOD 1 – Retrieval by scrub person Hold the packet flaps between extended thumbs Rolls hands outward to peel outer packet apart Exposed inner packet (suture) are then grasp by

scrub person METHOD 2 – “Flipping” suture packet

Standing a safe distance from sterile trolley, the circulator rolls the flaps of the outer package backwards

Project (flips) the inner packet onto sterile trolley

ASEPTIC TRANSFER OF SUTURE

ASEPTIC SUTURE TRANSFER TECHNIQUE

FLIPPING TECHNIQUESUTURE RETRIEVAL TECHNIQUE

SURGICAL NEEDLESSURGICAL NEEDLES• Made of a steel alloy with high carbon content (stainless steel)• Varies in shape, size, point design and wire diameter

ANATOMY OF NEEDLE

BASIC PARTS OF SURGICAL NEEDLES

THE EYEROLLED END

ATRAUMATIC

REGULAR EYE

SPRING EYE

SPRING DOUBLE

THE BODY SHAPE 1/2 Circle 3/8 circle 1/4 Circle

5/8 Circle J shape compound

½ curve straight

BASIC PARTS OF SURGICAL NEEDLES

GENERAL USES OF NEEDLE ACCORDING TO IT’S SHAPE

BODY SHAPEBODY SHAPE COMMON USAGECOMMON USAGE

Straight Straight Flat or shallow depth of skin woundFlat or shallow depth of skin wound

Circle 3/8Circle 3/8 Shallow depth of skin woundShallow depth of skin wound

Circle ½ andCircle ½ and ½ curve½ curve

General purposes, interior of any General purposes, interior of any woundwound

Circle 5/8Circle 5/8 Deepest, smallest maneuvering room Deepest, smallest maneuvering room wounds such as vaginal hysterectomy, wounds such as vaginal hysterectomy, hemorrhoidectomyhemorrhoidectomy

Circle 1/4Circle 1/4 Same as 1/2 circleSame as 1/2 circle

J CurveJ Curve Deep inaccessible wound or flat woundDeep inaccessible wound or flat wound

THE POINT

BASIC PARTS OF SURGICAL NEEDLES

Blunt Point

Spatulated end

Taper cut

Cutting edge

COMMON USAGE OF ATRUMATIC NEEDLES

NEEDLE TYPESNEEDLE TYPES COMMON USECOMMON USETAPER POINT Soft tissue closure below skin surfaces, dura,

fascia, GI, muscle, nerve, pleura, vesselsBLUNT POINT Friable tissues, spleen, liver, kidneys, cervix

CUTTING EDGE Ligaments, tendons, calcified or fibrous tissue, thoracic, plastic, Ob & Gyn, scar tissue

REVERSE CUTTING

Skin closure, retention suture, S/C, ligaments or fibrous tissue, mucosa

TAPER CUT Bronchus, calcified tissues, nasal & oral cavity, periosteum, trachea, uterus, vessels

SPATULATED CURVED

Ophthalmic surgery for muscle and retinal repair, eyelid suturing

WORKING WITH SUTURES AND NEEDLES

MOUNTING THE MOUNTING THE NEEDLENEEDLE

THREADING THE THREADING THE NEEDLENEEDLE

PASSING THE PASSING THE NEEDLE HOLDER NEEDLE HOLDER WITH SUTUREWITH SUTURE

NEEDLES’ COUNTSNEEDLES’ COUNTS

WORKING WITH SUTURES AND NEEDLES

TYPES OF WOUND SUTURING

OTHER METHODS OF WOUND CLOSURE

SURGICAL STAPLERSURGICAL STAPLER

SKIN STRIPSSKIN STRIPS

& & SKIN GLUESKIN GLUE

TISSUE REACTION AFTER SUTURING

Suture act as a Suture act as a foreign substanceforeign substance

Begins when the Begins when the suture inflicts injury suture inflicts injury to the tissue during to the tissue during insertioninsertion

Increased factors Increased factors include include allergic, allergic, absorption period, absorption period, cell reactions and cell reactions and types of suturetypes of suture

Comparison of tissue resorption according to sutures

REMOVAL OF WOUND CLOSURE (SUTURE AND STAPLE)

THANK YOU