Suture Workshop
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Transcript of Suture Workshop
Suture Workshop
Presented by Joanna Jarvis and Craig Atkinson
Presentation Contents
•HistoryHistory
•Suture classification and selectionSuture classification and selection
•NeedlesNeedles
•Suture labelSuture label
Workshop Contents
•Suture presentation Suture presentation
•Basic Suture Techniques VideoBasic Suture Techniques Video
•Knot tying & suture exercisesKnot tying & suture exercises
•Evaluation. Delegate bagsEvaluation. Delegate bags
HISTORY
The origins of surgery can be traced back many centuries. Through the ages, practitioners have used a wide range of materials and techniques for closing tissue……..
1650 BC – 2000’s AD
In the tenth century BC, the ant was held over the wound until it seized the wound edges in its
jaws. It was then decapitated and the ant's death grip kept the wound closed.
AntsAnts
Thorns
The thorn, used by African tribes to close tissue, was passed through the skin on either side of the wound.
A strip of vegetable fibre was then wound around the edge in a figure eight.
Sterilised Catgut
The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading
through the eye of the needle before use.
Swaged On Needles
Post World War II brought the swaged-on needle. The thread fits into the hollow end of the needle, allowing it to pass through tissue
without the double loop of thread that exists with a conventional needle, reducing tissue trauma.
Suture Classification and SelectionSuture Classification and Selection
Suture ClassificationSuture Classification
• NaturalNatural or or SyntheticSynthetic (man made) (man made)
• MonofilamentMonofilament or or MultifilamentMultifilament (braided) (braided)
• Absorbable Absorbable or or Non-AbsorbableNon-Absorbable
The Ideal Suture
• Minimal tissue reaction• Smoothness - minimum tissue drag• Low Capillarity• Max tensile strength• Ease of handling - Minimum memory • Knot security
• Consistency of performance
• Predictable performance• Cost effectiveness
Multifilament (braided)Multifilament (braided)
Suture ClassificationSuture Classification
MonofilamentMonofilament
Braided v Monofilament
Has capillary actionIncreased infection riskLess smooth passageLess tensile strengthBetter handlingBetter knot security
No capillary actionLess infection riskSmooth tissue passageHigher tensile strengthHas memoryMore throws required
• These are absorbed within the living tissueThese are absorbed within the living tissue
• Two main characteristics are:Two main characteristics are:
•Tensile strength retention Tensile strength retention
•Absorption rateAbsorption rate
Absorbable SuturesAbsorbable Sutures
Maxon: Day 14: 75% Absorption: 180 daysMaxon: Day 14: 75% Absorption: 180 days
Caprosyn: Day 10: 30% Absorption: 56 daysCaprosyn: Day 10: 30% Absorption: 56 days
Absorbable Sutures
Caprosyn Biosyn Maxon Polysorb Dexon II
MATERIAL
60% Glycolide
10% caprolactone
10% Trimethylene carbonate
10% Lactide
60% Glycolide
26% Trimethylene carbonate
14% Dioxanone
Poly-glyconate
90% Polyglycolic acid
10% Polylactic Acid
100% Polyglycolic acid
STRUCTURE Monofilament MonofilamentMono-
filamentBraided Braided
COATING NA NA NA
Caprolactone / Glycolide, Calcium stearoyl lactilate
Polycaprolactone
SIGNIFICATE TENSILE STRENGTH
10 Days 21 days 42 Days 21 Days 21 Days
ABSORPTION PROFILE
56 Days 90-110 Days180-210
Days56-70 Days 60-90 Days
Characteristics of Non-Absorbable Sutures
• Permanent• Only used when long term support is required• Removed when used for skin (e.g. in A+E)• Tissue reaction generally low (except silk)• However silk, linen and even nylon will lose tensile strength over
a period of time• True non-absorbable sutures include polyester, polyethylene,
polybutester, polypropylene and steel
Suture Size
5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0
Thick Thin
USP (United States Pharmacopoeia)
A+E
General
Suture Selection
Bowel: 2/0 - 3/0Fascia: 1 - 0Ligatures: 0 - 3/0Pedicles: 2 - 0Skin: 2/0 - 5/0Arteries: 2/0 - 8/0Micro surgery 9/0 - 10/0Corneal closure: 9/0 - 10/0
Suture Handling
1. Package MemoryGrasp strand close to needle and at end of strand
and gently stretch2. Opening suture foilTear in direction indicated to gain best needle
exposure3. Arming needleArm needles 2/3rds distance between tip and swage
Closure using Clips
Closure using Caprosyn
Needles
Needle point Geometry
Taper-Point•Suited to soft tissue•Dilates rather than cuts
Reverse cutting
•Very sharp•Ideal for skin•Cuts rather than dilates
Conventional Cutting
•Very sharp•Cuts rather than dilates•Creates weakness allowing suture tearout
Taper-cutting
•Ideal in tough or calcified tissues•Mainly used in Cardiac & Vascular procedures.
Needle Point Geometry
Blunt•Also known as “Protect Point”•Mainly used to prevent needle stick injuries i.e. for abdominal wall closure.
Premium point spatula
•Ophthalmic Surgery
Spatula•Ophthalmic Surgery
DermaX*•NEW: ½ The Penetration force•½ The Penetration force•Superior Cosmetic Effect
Needle CurvatureNeedle Curvature
The Right Needle Choice
• The appropriate needle choice for any situation is…………….
……………The needle that will cause least possible trauma to the tissue being sutured
Summary of Needles
1. Needles are made of steel alloy (Surgalloy) with a Nucoat coating so they stay sharp for multiple passes through tissue
2. Different needle points for different tissues
3. Choose the needle that will cause the least trauma
Suture Label
The Suture Packaging
STRAND SIZE
MATERIAL
STRAND LENGTH
PRODUCT CODE
NEEDLE CODE
WITH LIFE SIZE
PICTURE OF
NEEDLE
NEEDLE LENGTHCOLOUR
POINT TYPE
NEEDLE CIRCLE
Knot Tying & SuturingKnot Tying & Suturing