Suture materials & suturing techniques dr.ayesha

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  • CONTENTSIntroduction History Definition Goals of suturing Suture materials - Introduction - Requisites of ideal suture - Classification - Selection of suture material - Absorption of suture material - Biological response of body to suture. Suture armamentarium- needles, needle holder, scissor Principles of suturing Suturing Techniques Knots Suture Removal Other methods of wound closure
  • Suture means to sew or seam. In surgery suture is the act of sewing or bringing tissue together and holding them in apposition until healing has taken place. A suture is a strand of material used to ligate blood vessels and to approximate tissues together. INTRODUCTION
  • HISTORY History of the Surgical Suture I dress the wound, God heals it. Ambroise Pare, surgeon 16th century
  • The act of sewing is probably older then Homo sapiens, because Neanderthal man wore some sort of clothing.
  • HISTORY Perhaps the worlds oldest suture was placed by an embalmer on the body of a twenty first dynasty mummy about 1100 B.C.
  • A south American method of wound closure used large black ants which bite the wound edges together and the ants body is then twisted off leaving the head in place. East African tribes ligated blood vessels with tendons and closed wounds with acacia throns
  • The first detailed description of a wound suture and suture materials used in it is by the Indian physician Sushruta, written in 500 BC.
  • Galen, the physician to Roman gladiators in the second century A.D. used silk for hemostasis. Andreas Vesalius first advocated the suture of all fresh wounds as well as severed tendon and nerves.
  • Joseph Lister (1827-1912) discovered that bacteria present in suture strands cause wound infection. He disinfected sutures with carbolic acid. He made sterile sutures possible to bury it in clean wounds without infection.
  • Sometime around 30 A.D., a medical encyclopedia was written by a Roman named Aurelius Cornelius Celsus. His work, De Re Medicina, tells the reader that sutures should be soft, and not over twisted, so that they may be more easy on the part. He is also credited with first substantiated mention of ligating by recommending it as a secondary means of stopping a hemorrhage.
  • Rhazes of Arabia was credited in 900 A.D. with first employing kit gut to suture abdominal wounds. The Arabic word kit means a dancing masters fiddle, the musical strings of which kit string were made up of sheep intestines. Over the years kit was confused with kitten or cat, and the misuse of the term was propagated.
  • DEFINITIONS DEFINITION: suture material is an artificial fibre used to keep wound together until they hold sufficiently well by themselves by natural fibre (collagen) which is synthesized and woven into a stronger scar Suture is a Stitch/Series of Stiches made to secure apposition of the edges of a Surgical/Traumatic wound (Wilkins) Any Strand of Material utilised to ligate blood vessels or approximate Tissues (Silverstein L.H 1999)
  • GOALS OF SUTURING Suturing is performed to Provide adequate tension Maintain hemostasis Provide support for tissue margins Reduce post-op pain Prevent bone exposure Permit proper flap position
  • The basic purpose of a suture is to hold severed tissues in close approximation until the healing process provides the wound with sufficient strength to withstand stress without the need for mechanical support. Since wounds do not gain strength until 4-6 days after injury, the tissues are approximated till then by sutures.
  • The amount of tension or pull the suture can withstand before breaking is important. Tensile St diameter of suture If the diameter of suture is doubled, T.S is quadrupled.
  • Suture material should be atleast as strong as the tissues in which they are used. By the end of 2nd week, when most skin sutures are removed, the wound would have attained 3%- 7% of final Tensile St. 3rd week 20% of T.S 4th week 50% of T.S Wounds will never regain more than 80% of Tensile St. of intact skin
  • REQUISITES OF AN IDEAL SUTURE Tensile st: adequate material strength will prevent suture breakdown & use of proper knots for the material used will prevent untying or knot slippage. Tissue biocompatibility: sutures made from organic material will evoke a higher tissue response than synthetic sutures. tissue reaction amount & size of suture material.
  • Low capillarity: multifilament type soak up tissue fluid by capillary action providing a rich medium for microbes increasing chances of inflammation & infection. Good handling & knotting properties: ease of tying & a thread type that permits minimal knot slippage also influence thread selection. Sterilization without deterioration of properties: most sutures available in packages are sterilized by dry heat & ethylene oxide gas.
  • Non allergic, non electrolytic and non carcinognic Its use should be possible in any operation. Low cost It should not fray, should slide through tissues readily & knot should not slip after tying.
  • It should be readily visualized , should not shrink & should not be extruded from the wound. On break down ,it should not release toxic agents. It should disappear without excessive reaction once its task is completed.
  • CLASSIFICATION OF SUTURE MATERIALS According to source: 1. Natural 2. Synthetic 3. Metallic
  • According to structure 1. Monofilament 2. Multifilament According to fate: 1. Absorbable (undergo degradation and lose T.S. < 60 days) 2. Non absorbable ( maintain T.S > 60 days) According to coating: 1. Coated 2. Uncoated
  • NATURAL Absorbable Catgut Chromic catgut Collagen Fascia lata kangaroo tendon Beef tendon Cargile membrane Non Absorbable Silk Silk worm gut Linen Cotton Ramie Horse hair
  • SYNTHETIC Absorbable Polyglycolic Acid Polyglactic Acid Polyglactin 910(Vicryl) Polydioxanone(PDS) Polyglecaprone 25 Non Absorbable Nylon/ polyamide PolyPropylene Polyesters Polyethelene Polybutester Polyvinylidene fluoride / PVDF Sutures
  • Monofilament Multifilament
  • MONOFILAMENT Advantages Smooth surface Less tissue trauma No bacterial harbours No capillarity Disadvantages Handling and knotting Stretch Any nick or crimp in the material leads to breakage.
  • MONOFILAMENT Absorbable Surgical Gut- Plain, Chromic Polydiaxanone Polyglactin 910 Non Absorbable Polypropylene Polyester Nylon/polyamide Polyvinylidene fluoride / PVDF Sutures
  • MULTI FILAMENT Advantages Strength Soft and pliable Good handling Good knotting Disadvantages Bacterial harbours Capillary action Tissue trauma
  • MULTIFILAMENT Absorbable Polyglactin 910 Polyglycolic Acid Non Absorbable Silk Cotton Linen
  • MONOFILAMENT Handling Difficult Smooth & strong No Wicking Thinner MULTIFILAMENT Handling easy Low Strength Wicking is a Problem Thicker
  • Metallic SS Tantalum Gold Silver Aluminium
  • Non absorbable sutures are categorized by the United States Pharmacopeia (USP) as Class I - Silk or synthetic fibers of monofilaments with twisted or braided construction Class II - Cotton or linen fibers, coated natural or synthetic fibers in which the coating does not contribute to T.S Class III - Metal wire of monofilament or multifilament construction.
  • SELECTION OF SUTURE MATERIAL A variety of suture materials and suture/needle combinations is available. The choice of suture for a particular procedure is based on the known physical and biologic characteristi