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SUTURE IN SURGERY

Oleh :
Andrie Febriansyah, S.Ked
Tri Rahayu Marbaniati, S.Ked
Desti Omega Rohyadi, S.Ked

Pembimbing
dr. ASWEDI PUTRA, Sp.OT, FICS

Introduction
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, usually suture material
is an artificial fibre
A suture is a strand of material used
to ligate blood vessels and to
approximate tissues together.

approximate tissues
together

Ligature ligate blood vessels


to arrest or control

bleeding

Goals of suturing:
1- Provide an adequate tension of wound closure
without dead space but loose enough to
obviate tissue ischemia and necrosis.
2- Maintain hemostasis.
3- Permit primary intention healing
4- Reduce postoperative pain
5- Provide support for tissue margins until they
have healed and the support no longer needed
6- Prevent bone exposure resulting in delayed
healing and unnecessary resorption
7- Permit proper flap position

suture
Ideal suture material
All-purpose, composed of material which
could be used in any surgical procedure (the
only variables being size and tensile
strength)
Sterile
Nonelectrolytic, noncapillary, nonallergenic,
and noncarcinogenic
Nonferromagnetic, as is the case with
stainless steel sutures
Easy to handle

suture
Ideal suture material
Minimally reactive in tissue and not
predisposed to bacterial growth
Capable of holding securely when
knotted without fraying or cutting
Resistant to shrinking in tissues
Absorbed with minimal tissue reaction
after serving its purpose
Doesnt exist!

Classification of suture
materials

According to source :
1. Natural
-biological origin
-cause intense inflammatory reaction
ex : - catgut (purified collagen fibers from
intestine of healthy sheep or cows)
- Chromic coated catgut
- Silk

2. Synthetic Suture:
-. Synthetic polymers

According to the structure :

Grossly appears as single strand of suture material; all fibers run


parallel
Minimal tissue trauma
Resists harboring microorganisms
Ties smoothly
Requires more knots than multifilament suture
Possesses memory
Examples:
Monocryl, PDS, Prolene, Nylon

According to fate :
1.Absorbable
.Degraded and eventually eliminated in one of two ways:
Via inflammatory reaction utilizing tissue enzymes
Via hydrolysis
Examples:
Catgut
Chromic
Vicryl
Monocryl
PDS
Internal
Intradermal/ subcuticular
Rarely on skin

2. Non-absorbable
Not degraded, permanent
Only used when long term support is
required
Remove when used for skin
Tissue reaction generally low (except silk)
True non absorbable sutures include
polyester, polythylene, polypropylene and
steel
(*not a truly permanent material; known to
be broken down over a prolonged period
of timeyears)

Non-Absorbable Sutures
Monofilament Polypropylene:
Polyester Fiber: Mersilene,
Dacron, Ethibond, Ti.cron
Monofilament Nylon: Ethilon,
Dermalon
Braided Nylon: Nurolon,
Surgilon
Silk
Surgical Stainless Steel Wire

Suture Size:
Sized according to diameter with 0 as
reference size
Numbers alone indicate progressively larger
sutures (1, 2, etc)
Numbers followed by a 0 indicate
progressively smaller sutures (2-0, 4-0,
etc)
Smaller -------------------------------------Larger
.....3-0...2-0...10...0...1...2...3.....

Suture material summary

THANK YOU