Suture, Needles, Staplers, Wound Closure Techniques, &

Wound Closure DevicesST230

Concorde Career College

Objectives

• Define the term suture as a noun and as a verb.

• List the specifications for suture material and describe the importance of each.

• Describe the suture selection process.

Objectives

• List and describe the ideal characteristics for suture material and surgical needles.

• Identify the types and sizes of suture material, provide examples of each, and describe the type of tissue usage appropriate for each type.

Objectives

• Identify the types and sizes of surgical needles, provide examples of each, and describe the type of tissue usage appropriate for each type.

• Describe suture packaging, list the information found on the suture package, and explain its importance.

Objectives

• Identify types of stapling and ligating devices and provide examples of when each may be utilized.

Objectives

• Identify types of alternative wound closure materials, tissue adhesives, and tissue repair and replacement materials and provide examples of when each may be utilized.

Definition

Suture

Noun

Definition

Suture

Verb(It’s what you do…)

Brief Suture History

• 3000 BCE - Linen strips and animal sinew (tendon) were used to close wounds with needles made of bone

• 600 BCE - Cotton, leather, horsehair, and bark fiber from trees was used to close wounds

Brief Suture History

• Lister (late 1800s) was the first to use a bacteriocide (carbolic acid) on suture

• Suture manufacture and sterilization started in the early 20th Century

• First synthetic absorbable suture was produced in the 1960s

Brief Suture History

Sinew(wolverine)

Brief Suture History

Suture Needle(buffalo bone)

Specifications for Suture Material

• Must be sterile and sterile technique must be used when handling

• Uniform tensile strength• Uniform size• Appropriate diameter for tissue type• Provide knot security• Cause minimal foreign body tissue reaction

Suture Selection

• Characteristics of the suture material

• Age• Weight• Allergy status• General tissue condition

• Surgical site disease• Comorbid condition(s)• Surgeon preference• Suture availability• Cost• Mentor influence

Ideal Suture Characteristics

• Pliable• Easy to tie secure knots• Tensile strength (will not fray or break)• Glide through tissue effortlessly• Inert• Nonallergenic• Inexpensive

Tensile Strength

Tensile strength of absorbable and non-absorbable sutures is critical both during and after surgical procedures. Breaking strength and elongation can be measured using either a "straight pull" test or a "knot pull" test.

Types of Suture Material

• Natural

• Absorbable

• Monofilament

• Synthetic

• Nonabsorbable

• Multifilament

Types of Suture Material

Natural

Raw SilkMagnified 1300 X

Types of Suture Material

Synthetic

Nylon

Types of Suture Material

Absorbable

Plain

Types of Suture Material

Nonabsorbable

Silk

Types of Suture Material

Monofilament

Types of Suture Material

Multifilament

Twisted

Types of Suture Material

Multifilament

Braided

Suture Packaging

Suture Sizes

Ideal Needle Characteristics

• Stainless steel (corrosion resistant)• Slim without compromising strength• Stable in the needle holder• Carries suture through tissue with minimal tissue

trauma• Sharp• Sterile• Inexpensive

Needle Eye Types

1. Open2. Closed3. Swaged4. Swaged (CV)

Needle Sizes & Types

Needle Sizes & Types

Needle Sizes & Types

Microsurgical suture with needle

Anatomy of a Needle

– Eye– Point– Body– Shape– Chord Length

Needle Points

– Taper – most internal tissues

– Cutting – Skin and other tough tissues

– Reverse Cutting – Tendon sheath, bone, cornea, other tough tissues

– Blunt – Liver and other friable tissues

Commonly Used Needle Codes (Ethicon)

• CP• CT• CTX• CV• FS• FSL• FSLX• KS

• MO• SH• TF• OS• UR• PS• RB• S

Suture Handling

Needle holder is clamped onto the

needle approximately 1/3 the distance from the swage to the point

Suture Handling

Suture is removed from the package placing

tension on the swage

Suture Handling

Needle holder correctly armed

Suture Handling

Passing the armed needle holder

Suture Handling

Rapid (control) Release

Step 1

Suture Handling

Rapid (control) Release

Step 2

Simple Suture

• Interrupted• Running (continuous)

Mattress Suture

• Vertical• Horizontal

Suturing Techniques

Retention Suture

Suturing Techniques

Figure of Eight Suture

Suturing Techniques

Tendon Suture(Connell’s Technique)

Tie Terms

• Free-tie – Place a suture (no needle) into the surgeons

hands• Stick-tie

– Suture on a needle (use a needle holder)• Tie on a pass

– Place the suture (no needle) on an instrument (tonsil/right angle)

• Ligate– To tie

Stapling Devices

Skin Stapler

Surgical Skin Stapler

Skin Staples - Shape

Skin Stapler

Skin staples in place

Skin Stapler

Skin Staple Remover

Surgical Staplers

Linear Stapler

Surgical Staplers

Linear Cutter

Assorted Size Staples

Surgical Staplers

Linear Cutter

Meckel’s Diverticulectomy

Surgical Staplers

Linear Cutter

Duodenal Division

Surgical Staplers

Linear Cutter

Side-to-Side Anastomosis

Ligating Clip Applier

Ligating Clips

Ligating Clips

Clip Applier

• Automated Ligating Clip Applier

Surgical Staplers

Intraluminal Stapler

Surgical Staplers

Intraluminal Stapler

Schematic

Surgical Staplers

Intraluminal Stapler

Anvil in Position

Surgical Staplers

Intraluminal Stapler

Placement

Surgical Staplers

Intraluminal Stapler

Preparation for attachment of stapler

segments

Meshes/Fabrics

Meshes/Fabrics

Stainless Steel Mesh

Fine Weave

Meshes/Fabrics

Stainless Steel Mesh

Loose Weave

Meshes/Fabrics

2” x 3” Mesh

$305.00

Meshes/Fabrics

Polypropylene Mesh Configurations

(Knitted)

Ventral Herniorrhaphywith Polypropylene

Mesh Implant

Tissue Adhesives

Tissue Adhesives

Tissue Adhesive(Skin)

Tissue Adhesives

Liquid Bandage