Suture Lecture

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SUTURE MATERIALS AND SUTURE MATERIALS AND TECHNIQUES TECHNIQUES

Transcript of Suture Lecture

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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