Second, the suture material can be classified according to the actual structure of the material. Needle type needle shape symbol needle type and needle shape are shown in this subhead. The pursuit of the ultimate repair has led to many repair methods being described. In sensitive areas, like a tongue laceration, use the interrupted sutures with buried knots. Sutures are made from both manmade and natural materials. Suture materials and suturing techniques presented by dr. Dental suturing materials and techniques juniper publishers. Suture materials, needle types, suturing techniques. This catalogue contains information about the full range of smi suture materials with details of all. The amount of time this takes depends on the material, but also the location of. Meyle suture materials and suture techniques figs 4a and 4b model of passing a surgical needle with reverse cutting edge through the gingival tissue.
Surgical gut these sutures are derived from naturally occurring iintroductionntroduction even today, there is a search for ideal suture material. Pdf suture materials and suture techniques researchgate. They find their use mostly in very distal finger tip replantations, in small children, and in lymph vessel anastomoses. The material may not be completely absorbed at this point, but it will have lost the majority of its initial tensile strength. Natural sutures include silk and catgut sutures whereas all other sutures are synthetic in nature. After inserting the needle, the tissue closes tightly around the suture material, which in turn forms a sort of leakproof barrier which prevents outside contaminants from entering the wound. The pds suture knots must be properly placed to be secure. Selection of a surgical suture material is based on its biologic interaction with the wound and its mechanical. The pulley suture is a modification of the vertical mattress suture. There are both natural and synthetic absorbable sutures. Common suture materials and suggested indications for. Suture classification and selection sutures are normally classified in three different ways. Monocryl, vicryl, pds are broken down by the body over time by processes such as hydrolysis and enzymatic degradation.
Surgical knot tying manual united states surgical, 150 glover avenue, norwalk, connecticut 06856. After a hemostat or other similar type of surgical. Healing characteristics of the tissues, which are to be approximated. Suture selection should be based on knowledge of the physical and biological properties of suture materials, an assessment of the healing rate of a particular tissue and local conditions in the wound. Surgical suture, types of sutures, sizes, how to suture. Stitches placeddeep inside the wound always requires the use of dissolvable absorbable sutures, whereas stitches visible on the skin placed superficially may use dissolvable or non.
Surgical suture materials are used in the closure of most wound types. Sutures are used either for apposing tissues or for ligation, and a variety of different types of suture material is currently available. Pdf sutures are used either for apposing tissues or for ligation, and a variety of. Choose shortest instrument that will comfortably reach operative site if cutting suture or nontissue material, avoid using fine. This epithelization can result in permanent suture tracts and cyst formation. Surgical sutures are known to potentiate the development of wound infection. And a few tips for the problemfree removal of sutures from. Natural suture materials include silk, linen, and catgut, which is actually the dried and treated intestine of a cow or sheep.
Surgical suture is a medical device used to hold body tissues together after an injury or surgery. Bacterial adherence to sutures was quantitatively measured using radiolabeled bacteria. The key instruments and materials used for intraoral suturing are presented. History of the suture materials and classical literature. Many types of instruments forceps, instruments for holding tissue needle holders scissors retractors which instrument to use. The physical and biological properties of the suture materials. As with any suture material, adequate knot security requires the accepted surgical technique of flat and square ties. A variety of suture exists in size strength and durability. Nonabsorbable sutures, on the other hand, maintain their strength for longer than 60 days. In general, the higher suture number indicates a lower crosssectional diameter of the suture, however because the usp grading system is based on suture strength, as opposed to. This allows the suture to more easily pass through tissues. Free tie or freehand ligatures are single strands of suture material used to ligate a vessel, duct, or other structure. Surgical sutures can also be divided into two types on the basis of raw material origin i. Braided sutures consist of several small threads braided together.
Sutures are divided into two general categories, namely, absorbable and nonabsorbable. Basic suturing techniques by cape town emergency medicine. Auxiliary materials suture needles 35 technological and commercial characteristics of suture needles 35 suture needle anatomy 39 optical microscopic analysis of suture needles on the market 50 sutures. Types of suture materials absorbable catgut, polydioxanone, polyglycolic. Download free acrobat reader dc software, the only pdf viewer that lets you read, search, print, and interact with virtually any type of pdf file.
Over the past five decades we have seen numerous iterations of suture repair methods for tendon. Information about suture materials and needles is im portant, as inappropriate. Suture materials are broken down into two main categories. Regular nonabsorbable sutures a nonabsorbable suture resists the bodys attempt to dissolve it. Single strand absorbable sutures are called monofilament while multiple strand types are called multifilament absorbable sutures. Ethilon nylon, silk, prolene polypropylene lasts longer than 60 days. Section iii addresses the topic of diagnostic pathology, providing a wellreasoned.
Nonabsorbable surgical suture material that is relatively unaffected by the biological activities of the body tissues and is therefore permanent unless removed plasticity measure of the ability to deform without breaking and to maintain a new form after relief of the deforming force pliability. The choice of suture is determined by a balance of the various characteristics of suture materials most appropriate for the specific wound closure situation. There are many circumstances in which sutures are used to repair tissue and facilitate healing. The ideal suture should allow the healing tissue to recover sufficiently to keep the wound. Physical construction of suture suture is any strand of material used to approximate the tissue edges and give artificial support while the tissue heals naturally. Suture materials can be broadly classified as naturally. A number of different shapes, sizes, and thread materials have been developed over its millennia of history. Description suture also known as stitches a piece of thread like material use to secure wound edges or body partstogether after an injury or surgery. They are also available in the form of either absorbable or nonabsorbable sutures. Rodent surgical incisions closure guidelines and recommendations. There are many different types of suture materials, including both natural and synthetic materials, those that can or cannot be absorbed by the body, and those that are braided or consist of a single strand.
Pdf material properties of common suture materials in. Material suture materials are designated by color and construction characteristics eg undyed braided, violet braided, etc. Important considerations in wound closure are the type of suture, the tying technique, and the configuration of the suture loops. Suture materials suture materials can be classified into two broad categories. The most common closure patterns are simple interrupted and simple continuous. Threads of natural, synthetic, or metallic material intended to sew a wound or incision together i. Figs 4a and 4b model of passing a surgical needle with reverse cutting edge through the gingival tissue.
Traditionally used for closure of subcutaneous tissues or injuries to the tongue or nailbed. Most important, it touches on some of the critical decisions which must be made on a daily basis to help ensure proper wound closure. When considering a type of suture, there are three things that you need to consider. At the time of removal, the strips can simply be pulled off, and the suture material pulled through. Instead of the technique i describe in my video on the start and finish to the embedded running subcuticular suture, i simply run the suture and then use steri strips to tack down each end of the suture material on either side of the wound. Throughout antiquity many materials have been used to approximate wounds. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Synthetic sutures are made from a variety of textiles such as nylon or polyester, formulated specifically for surgical use.
Common suture materials and suggested indications for their use table of when to use different types of sutures examples synthetic or natural suggested indications absorbable monofilament catgutchromic catgut natural rarely used pds polydioxanonemonocryl polycaprone glycolide maxon polyglyconate synthetic buried dermal sutures or continuous subcuticular suture absorbable. Identify proper suture material as indicated by wound. This comprehensive compilation of the suture repair techniques will describe the. The amount of time this takes depends on the material, but also the location of insertion and the individual patient characteristics. This information should be indicated somewhere on the packaging of the suture. These types of sutures are typically used in skin closure and in wounds where there is risk of infection. These sutures are easier to tye than monofilament sutures but have small interstices in the suture material that eventually can harbour bacteria. Sutures, tissue adhesives, staples, and skinclosure tapes are options in the outpatient setting. Suture classification as per the united states pharmacopeia usp is based on the diameter of any given suture material necessary to produce a certain tensile strength. Suture materials can be broadly classified as naturally occurring and. Each type is further classified into whether the strands making the suture are single or multiple. Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures.
Further it is classified based on sutures absorption ability and the origin of raw material. Application generally involves using a needle with an attached length of thread. Basic surgical needle types and their characteristics. The techniques that you use, the suture material you use, and the specific type of needle you use will vary depending on whether you are closing a simple laceration on the foot, a complex laceration on the face, a gastrointestinal anastomosis, a vascular anastomosis, or closing a median sternotomy. The purpose of this study was to investigate whether the capability of bacteria to adhere to various types of sutures has a significant effect on their ability to cause infections. The needle should pass from the free tissue to the fixed side. Vicryl polygalactin 910, chromic gut degraded in tissue in less than 60 days. Consider suture removal children, location of wound, type of suture. Sutures for microvascular surgery are now exclusively made of nylon or polypropylene and are available through the range of 8. Even today, there is a search for ideal suture material. Essentials of skin laceration repair american family. Keep in mind that the knots may take a bit longer to resorb due to the increased amount of suture material. Surface sutures to closely approximate the epidermal edges providing the best possible cosmetic result.
A detailed description and heavily illustrated guide to suturing follows. Skin laceration repair is an important skill in family medicine. A lubricant is applied on the surface of braided suture material to lower the tissue drag and allow better knotability. Residents ssutures and suturing techniques in skin. This type of needle is specially designed for separating tissue fibers rather than cutting them. The selection of a suture material by a surgeon must be based on a sound knowledge of the. The simple interrupted pattern is typically used for closing a body cavity andor skin as it minimizes the risk of dehiscence splitting open. Before catgut became the standard surgical suture material. Conjunctival and vaginal mucosal sutures remaining in place for extended periods may be associated with localized irritation. Length suture length is shown in both inches and the. Basic suturing skills and techniques boston college. Absorbable suture materials suture is considered to be absorbable if it loses its tensile strength by 60 days after implantation. Absorbable sutures undergo degradation and loss of tensile strength within 60 d whereas, the. This technique will avoid irritating the area with the 2 free ends left by a normal interrupted suture.