SUTURES, NEEDLES AND SUTURING TECHNIQUES

Nenette C. Almario BSN 4B

Suture
Definition

Purpose

A suture is a piece of thread-like material used to stitch or approximate tissues, and hold the wound together until healing takes place. any strand of material used to ligate bleeders or used to approximate tissue. any materials used to sew, sick or hold tissue together until healing process occurs.

to hold a wound together in good apposition until such time as the natural healing process is sufficiently well established to make the support from the suture material unnecessary and redundant.

The SUTURE Labels

Classification of Suture Material

Absorbable

Capable of being absorbed by living mammalian tissue, through processes of hydrolysis or enzymatic digestion

Classification of Suture Material

Non Absorbable

Effectively resist enzymatic digestion in living tissue and are enacapsulated or walled off by the body internally, or need to be removed, externally

Kinds of Suture
Monofilament

Multifilament

Made of single strand of material

Made of several strands of suture that are twisted or braided together

Suture

Tissue Absorbab Reaction le/Non Absorbab le

Braided

Non Braided

Suture Strength

Primary indication

Chromic Catgut Nylon

Last 3 4 weeks the most Loses 20% per year Lasts 4 6 months Lasts about 1 month

Polydioxanon e Polyglycolic acid (Dexon)

Prolene

Lasts a long time

Loses strength within one

Silk

Suture Material Biosyn

Absorbable

Description

Color: Violet, to increase visibility; also available undyed Strong absorbable suture during the critical wound healing period Indicated for use in general soft tissue for approximation or ligation, as well as in ophthalmic surgery but not for use in cardio or neuro surgery Chromic Gut Derived form the serosal layer of beef (bovine) treated with chromic salt solution AVOID opening packet until use (will dry out and break) Used for internal ligation Not used on peritoneum, fascia or contaminated areas Not to be used on urinary or biliary tract (could cause stone

Suture Material Polyglycolic Acid (Dexon)

Absorbable

Description

Available in the undyed natural beige color, green, voilet or bicolor Applications on tissues that require long term tensile strength such as stomach and vascular procedures Smaller sizes are used in ophthalmic surgery

Plain Gut Derived form the serosal layer of beef (bovine) intestines Packaged in a solution of 89% isopropanol, 10% water and 1%triethanolamine Fast absorption Used on hemostasis Ligation of small vessels

Suture Material Biosyn

Absorbable

Description

Color: Violet, to increase visibility; also available undyed Strong absorbable suture during the critical wound healing period Indicated for use in general soft tissue for approximation or ligation, as well as in ophthalmic surgery but not for use in cardio or neuro surgery Chromic Gut Derived form the serosal layer of beef (bovine) treated with chromic salt solution AVOID opening packet until use (will dry out and break) Used for internal ligation Not used on peritoneum, fascia or contaminated areas Not to be used on urinary or biliary tract (could cause stone

II. SURGICAL NEEDLES

Definition, Classification and Characteristics

Surgical Suture Needles

Needed to carry the suture material through tissue with the least amount of trauma

Classifications of a Surgical Needle

Traumatic

Atraumatic

Needles with holes or eyes which are separate from their suture thread. The suture must be threaded on site, as it is done at home.

Comprised of an eyeless needle attached to a specific length of suture thread.

Ideal Characteristics of a Needle

Anatomy of a Surgical Needle

Point: Surgicalto the shape end that connects the Swage: Point, needlesthe of the entire several point Parts:Refers Body and Swage in needle Body: Attachment at are available types. Usage is based thread.tissue the needle will needle to the surgical on the be used to penetrate.

Needle Tips
Tapered

These tips are used for soft tissues, characteristically they are rounded and produce the smallest hole minimizing trauma

Needle Tips
Cutting

These tips are used for skin repair; triangular in shape and useful in puncturing tough tissue but produces a larger hole than tapered tips. Cutting tips are not used intra-abdominally due to the risk of blood vessel or delicate tissue damage.

Needle Tips
Blunt

These needle tips have no cutting edge and are used for friable tissues such as the liver where cutting and piercing would be detrimental

Needle Shapes
Curved: Used for skin used surgical needles, curved needle are made in several Straight: Most commonly closure in some surgeries, can be used for suturing configurations, this includes a needle holder, as for skin the suturing without requiring the use of the half curved (used long as closure, rare),area offers (microsurgery and ocular procedures), 3/8, and 5/8 (cardiovascular, oral and good visibility. nasal surgery), circle (skin closure, GI, GU, and respiratory surgeries)

COMMON SUTURING TECHNIQUES

Running or Continuous Stitch

The "Running" stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema during the wound healing process. However, there is a greater potential for malapproximation of wound edges than with the interrupted stitch.

Interrupted Stitch
Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximatio n of wound edges can be achieved with this technique than with the running stitch.

Mattress Stitch
A double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge. Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue.

Purse String
A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as a hernia or an appendiceal stump.

Smead Jones or Far and Near

A double loop technique alternating near and far stitches. Commonly used for approximatin g fascial edges

Continuous Locking or Blanket Stitch

A selflocking running stitch