Suture Selection

 Sutures hold tissue together until the

natural process of wound healing has
taken place
 All sutures are foreign bodies and impact
on wound healing
 Suture Selection
 Absorbable sutures elicit more
inflammatory reaction than non-absorbable
sutures
 Natural sutures absorbed by proteolytic
enzymes induce more inflammation than
synthetic ones absorbed by hydrolysis.
 Suture selection
 Monofilaments usually require more knots
to prevent slippage
 Braided sutures handle easily and knot
easily
 Braided suture may harbor bacteria
 Suture selection
 Suture size is reflected in “0’s”
 4.0 vicryl is “0000”
 Number one vicryl is “#1”
 O vicryl is “0”
 The more “0” the finer the stitch
 00000 fine
 0000
 000
 00
0
1
2 thick
 Suture selection
 Use the smallest size suture that can hold
the tissue together during the healing
process
 Fascia heals slowly - use bigger, stronger
suture
 Mucosa heals quickly, use smaller stuff
 Suture Selection
 Memory - tendancy to return to original
shape (untied!)
 Plasticity - expand when stretched and
don’t return to original length (loosen with
edema)
 Elasticity - ability to return to former length
(doesn’t loosen with edema)
 Suture Selection
 Fluidabsorption and capillary action - the
tendency for a suture to absorb water and
to wick infection
 Absorbable suture
Gut
 Tensile strength for 4-5 days only
 High tissue reactivity
 Poor tensile strength for a given suture
diameter
 Monofilament
Uses: tubal ligation, ligation of blood vessels
 Absorbable Suture
Chromic gut
 Tensile strength for 2 to 3 weeks
 High tissue reactivity
 Poor tensile strength for a given tissue
diameter
 Monofilament
Uses: episiotomy repair, uterine closure,
closure of peritoneum
 Absorbable Suture
Poly-sugars
 Dexon, Vicryl, Polysorb
 Synthetic polymers with modest tissue reactivity
 Tensile strength for 2 to 3 weeks
 10% strength at 28 days
 Low elasticity - may cut soft tissue
 Braided - handle well but wick fluid
 Good for subcuticular closure and fascia
 Absorbable Suture
PDS Maxon

 Monofilament
 Delayed absorption
 59% strength at 28 days
 Minimal tissue reaction
 Less suture abscesses and cut through
than vicryl
 Complete absorption by 180 days
 Absorbable Suture
Monocryl Biosyn
 Virtuallyinert in tissue
 Tensile strength for 2 to 3 weeks
 Less suture absesses
 Great for mucosa and skin closures
 Permanent Suture
Silk
 Second only to gut for tissue inflammation
 Braided
 Besthandling of any suture
 Lowest tensile strength of any suture
 Weaker when wet
 Permanent Suture
Nylon
 Surgilon, Ethilon, Dermalon
 Inert
 Pronounced memory - lots of knots
Uses- skin closure, sewing in JP draines
 Permanent Suture
Polypropylene
 Prolene, Surgilene, Surgipro
 Inert
 High placticity - expands to prevent strangulation,
but loosens when edema subsides (use with
steri-strips)
 Will stretch when pulled
 Elastic - requires extra knots
Uses- wound closure
 Permanent suture
Braided polyester
 Ticron,Tevdek, Ethibond
 Greater tensile strength than other
permanent sutures
 Good hadling with secure knots
Use: pelvic reconstruction
Fascia Strength and Healing Time
 Clamp rule
 Mosquito 4.0
 Kelley use 3.0
 Mayo use 2.0
 Haneny use 0
 Staples
 Cost more
 Faster
 Less tissue reactivity and infection
 Good cosmesis
 Require more infrastructure
Needles
Needle
Loading
7 mm drilled
3 mm for laser
Needles break at point
and at swage
Needle types
 Use taper for general
closure
 Cutting needles for
skin
 Needles - what to ask for
 General closure
 GI needle
 Cutting needle
 Keith needle
 Free or Mayo needle
 Surgical Knots
 Two types of knots
 Flat
 Sliding

 Most OB/GYNs use sliding knots

 Flat knots
 Square
 Granny
 Surgeon’s

 Equaltension is applied to both tails

 Hands cross when laying down knots
 Sliding knots
 Alternatethrows (like a square)
 Same direction - slide easier

 One suture is held tight and the other is

passed
 Arms don’t cross when laying knots down