SUTURE MATERIALS AND SUTURE MATERIALS AND TECHNIQUESTECHNIQUES

The Ideal Suture MaterialThe Ideal Suture Material

• Can be used in any Can be used in any tissuetissue

• Easy to handleEasy to handle

• Good knot securityGood knot security

• Minimal tissue Minimal tissue reactionreaction

The Ideal Suture MaterialThe Ideal Suture Material

• Unfriendly to bacteriaUnfriendly to bacteria

• Strong yet smallStrong yet small

• Won’t tear through tissuesWon’t tear through tissues

• CheapCheap

What’s It Used for?What’s It Used for?

• To bring tissue edges together and speed To bring tissue edges together and speed wound healing (=tissue apposition)wound healing (=tissue apposition)

• Orthopedic surgery to help stabilize jointsOrthopedic surgery to help stabilize joints– Repair ligamentsRepair ligaments

• Ligate vessels or tissuesLigate vessels or tissues

Types of NeedlesTypes of Needles

• Eyed needlesEyed needles– More TraumaticMore Traumatic– Only thread Only thread

through oncethrough once– Suture on a reelSuture on a reel– Tends to Tends to

unthread itself unthread itself easilyeasily

Types of NeedlesTypes of Needles

•Swaged-on Swaged-on needlesneedles– Much less Much less

traumatictraumatic– More expensive More expensive

suture materialsuture material– SterileSterile

Points of NeedlesPoints of Needles

•TaperTaper– AtraumaticAtraumatic– Internal organsInternal organs

Points of NeedlesPoints of Needles

•CuttingCutting• Cutting edge on Cutting edge on

inside of circleinside of circle

• SkinSkin

• TraumaticTraumatic

Points of NeedlesPoints of Needles

•Reverse Reverse CuttingCutting

• Cutting edge on Cutting edge on outside of circleoutside of circle

• SkinSkin

• Less traumatic Less traumatic than cuttingthan cutting

Cutting vs Reverse CuttingCutting vs Reverse Cutting

• CuttingCutting

• Reverse Reverse cuttingcutting

Shapes of NeedlesShapes of Needles

• 3/8 circle3/8 circle

• 1/2 circle1/2 circle

• StraightStraight

• SpecialtySpecialty

Characteristics of Suture Characteristics of Suture MaterialMaterial

• Absorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable

• Monofilament Vs. MultifilamentMonofilament Vs. Multifilament

• Natural or SyntheticNatural or Synthetic

Absorbable SuturesAbsorbable Sutures

• InternalInternal

• Intradermal/ subcuticularIntradermal/ subcuticular

• Rarely on skinRarely on skin

Non-absorbable SutureNon-absorbable Suture

• Primarily SkinPrimarily Skin– Needs to be removed laterNeeds to be removed later

• Stainless steel = exceptionStainless steel = exception– Can be used internally Can be used internally

•LigatureLigature

•OrthopedicsOrthopedics

– Can be left in place for long periodsCan be left in place for long periods

Reading the Suture LabelReading the Suture Label

• CompanyCompany

Needle

SizeOrder Code

NameAlso:

LENGTH

NEEDLE SYMBOL

COLOR

Absorbable or Non

ChoosingChoosingAbsorbable Vs. NonabsorbableAbsorbable Vs. Nonabsorbable

• How long you need How long you need it to workit to work

• Do you want to see Do you want to see the animal again the animal again for suture removalfor suture removal

Monofilament Vs. MultifilamentMonofilament Vs. Multifilament

• memorymemory easy to handle easy to handle

• less tissue dragless tissue drag more tissue drag more tissue drag

• doesn’t wickdoesn’t wick wicks/ bacteria wicks/ bacteria

• poor knot securitypoor knot security good knot good knot securitysecurity

• - - tissue reactiontissue reaction ++tissue reactiontissue reaction

Natural Vs. SyntheticNatural Vs. Synthetic

•Natural:Natural:– GutGut– Chromic GutChromic Gut– SilkSilk– CollagenCollagen

• All are absorbableAll are absorbable

Gut/ Chromic GutGut/ Chromic Gut

• Made of submucosa Made of submucosa of small intestinesof small intestines

• MultifilamentMultifilament

• Breaks down by Breaks down by phagocytosis: phagocytosis: inflammatory inflammatory reaction commonreaction common

Gut/ Chromic GutGut/ Chromic Gut

• Chromic: tanned, lasts Chromic: tanned, lasts longer, less reactivelonger, less reactive

• Easy handlingEasy handling

• Plain: 3-5 days Plain: 3-5 days • Chromic: 10-15 daysChromic: 10-15 days

• Bacteria love this stuff!Bacteria love this stuff!

Collagen and SilkCollagen and Silk

• Natural suturesNatural sutures

• VERY reactive, VERY reactive, absorbableabsorbable

• Ophthalmic Ophthalmic surgery onlysurgery only

Vicryl (Polyglactin 910)Vicryl (Polyglactin 910)

• Braided, synthetic, absorbableBraided, synthetic, absorbable

• Stronger than gut: retains strength Stronger than gut: retains strength 3 3 weeksweeks

• Broken down by enzymes, not Broken down by enzymes, not phagocytosisphagocytosis

• Break-down products inhibit bacterial Break-down products inhibit bacterial growthgrowth– Can use in contaminated wounds, unlike Can use in contaminated wounds, unlike

other multifilamentsother multifilaments

Dexon and PGADexon and PGA

• Polymer of glycolic acidsPolymer of glycolic acids

• Braided, synthetic, absorbableBraided, synthetic, absorbable

• Broken down by enzymesBroken down by enzymes

• Both PGA and dexon have increased Both PGA and dexon have increased tissue drag, good knot securitytissue drag, good knot security

• Both are stronger than gutBoth are stronger than gut

PDS (polydioxine)PDS (polydioxine)

• Monofilament (less drag, worse knot Monofilament (less drag, worse knot security – lots of “memory”)security – lots of “memory”)

• Synthetic, absorbableSynthetic, absorbable

• Very good tensile strength (better Very good tensile strength (better than gut, vicryl, dexon) which than gut, vicryl, dexon) which lasts lasts monthsmonths

• Absorbed completely by Absorbed completely by 182 days182 days

MMaxon (polyglyconate)axon (polyglyconate)

• MMonofilament- onofilament- mmemoryemory

• Synthetic AbsorbableSynthetic Absorbable

• Very little tissue dragVery little tissue drag

• Poor knot securityPoor knot security

• Very strongVery strong

NONABSORBABLE SUTURESNONABSORBABLE SUTURES

• Natural or SyntheticNatural or Synthetic

• Monofilament or multifilamentMonofilament or multifilament

                           

NYLONNYLON

• SyntheticSynthetic

• Mono or MultifilamentMono or Multifilament

• MemoryMemory

• Very little tissue reactionVery little tissue reaction

• Poor knot securityPoor knot security

Polymerized CaprolactumPolymerized Caprolactum

• Vetafil, Braunamid, SupramidVetafil, Braunamid, Supramid

• Multifilament suture with protein coatingMultifilament suture with protein coating

• SyntheticSynthetic

• Good knot security, easy handlingGood knot security, easy handling

• Not very reactiveNot very reactive

• Don’t use in contaminated woundDon’t use in contaminated wound

• Usually comes on a reelUsually comes on a reel

PolypropylenePolypropylene

• Prolene, SurgileneProlene, Surgilene

• Monofilament, SyntheticMonofilament, Synthetic

• Won’t lose tensile strength over timeWon’t lose tensile strength over time

• Good knot securityGood knot security

• Very little tissue reactionVery little tissue reaction

Stainless SteelStainless Steel

• Monofilament Monofilament

• Strongest !Strongest !

• Great knot securityGreat knot security

• Difficult handlingDifficult handling

• Can cut through tissuesCan cut through tissues

• Very little tissue reaction, won’t Very little tissue reaction, won’t harbor bacteriaharbor bacteria

Suture SizesSuture Sizes

• Sized #5-4-3-2-1-0-00-000-0000…30-0Sized #5-4-3-2-1-0-00-000-0000…30-0– BIGGER >>>>>>>>>>>>>>>>SMALLERBIGGER >>>>>>>>>>>>>>>>SMALLER

• 00 = 2-0, “two ought”00 = 2-0, “two ought”

• SA : 0 through 3-0 (Optho 5-0 >>7-0)SA : 0 through 3-0 (Optho 5-0 >>7-0)

• LA : 0 through 3LA : 0 through 3

Suture Sizes (cont)Suture Sizes (cont)

• Stainless Steel Stainless Steel – In gauges (like needles)In gauges (like needles)

•Smaller gauge = bigger, strongerSmaller gauge = bigger, stronger

•Larger gauge= smaller, finerLarger gauge= smaller, finer

– 26 gauge = “ought”26 gauge = “ought”– 28 gauge = 2-028 gauge = 2-0

Skin StaplesSkin Staples

• Very common in human medicineVery common in human medicine

• ExpensiveExpensive

• Very easyVery easy

• Very secureVery secure

• Very little tissue reactionVery little tissue reaction

• Removal = Removal = – Special tool requiredSpecial tool required

Tissue AdhesiveTissue Adhesive

• Nexaband, Vetbond, Nexaband, Vetbond, and othersand others

• Little strengthLittle strength

• Should not be Should not be placed between skin placed between skin layers or inside bodylayers or inside body

Suture PatternsSuture Patterns

Knot StrengthKnot Strength

• Generally 4 “throws” for >90% knot Generally 4 “throws” for >90% knot security (nylon may need 5)security (nylon may need 5)– Less “throws” = more likely to untie Less “throws” = more likely to untie

itselfitself

• Stainless steel = exception againStainless steel = exception again– 2 “throws” = 99% knot security2 “throws” = 99% knot security

Simple InterruptedSimple Interrupted

Simple Interrupted Suture

Simple ContinuousSimple Continuous

Ford InterlockingFord Interlocking

SubcuticularSubcuticular

http://cal.vet.upenn.edu/surgery/index.html