Umm Al-Qua UniversityUmm Al-Qua UniversityPharmacy CollagePharmacy Collage

Pharmaceutics DepartmentPharmaceutics Department

Presented ByPresented By Manal AlShareefManal AlShareef

SurgicalSurgical : : used in surgery.used in surgery.

SurgerySurgery is a medical procedure involving an is a medical procedure involving an incision with instruments; performed to repair incision with instruments; performed to repair damage or arrest disease in a living body. damage or arrest disease in a living body.

SuturesSutures ( (stitchesstitches): ): are materials used to are materials used to close a wound. They are used in an attempt close a wound. They are used in an attempt to improve and speed healing. Pulling the to improve and speed healing. Pulling the edges of a wound together and stitching edges of a wound together and stitching help in healing process. Sutures are used to help in healing process. Sutures are used to close cuts from injuries or surgery. They close cuts from injuries or surgery. They are commonly used on the skin, internal are commonly used on the skin, internal tissues, organs, and blood vessels. tissues, organs, and blood vessels.

Goals of SuturingGoals of Suturing

To closing dead space.To closing dead space. Supporting and strengthening wounds until Supporting and strengthening wounds until

healing increases their tensile strength.healing increases their tensile strength. Minimizing the risks of bleeding and Minimizing the risks of bleeding and

infectioninfection..

Sutures PropertiesSutures Properties

They must be strong ► They must be strong ► Do not breakDo not break Non-toxic and Non-toxic and hypoallergenichypoallergenic ► ► Avoid Avoid

adverse reactions in the bodyadverse reactions in the body Flexible ► Flexible ► Can be tied and knotted easilyCan be tied and knotted easily They must lack the "They must lack the "wick effectwick effect", ► ", ►

Sutures must not allow fluids to penetrate Sutures must not allow fluids to penetrate the body through them from outside, the body through them from outside, which could easily cause infectionswhich could easily cause infections

Suture TypesSuture Types

Suture Types

Degradation properties

Material Source

No. of material strand or filaments

Absorbable Sutures

Non-Absorbable

Sutures Natural Sutures

Synthetic Sutures

Monofilament sutures

Multifilament sutures

(BraidedBraided )

Sutures Divided up on Their Sutures Divided up on Their Degradation PropertiesDegradation Properties

Absorbable VSAbsorbable VS Non Absorbable Sutures Non Absorbable SuturesAbsorbable Sutures Absorbable Sutures Non Absorbable SuturesNon Absorbable Sutures

It is Degraded via It is Degraded via inflammatory response, 10 inflammatory response, 10 days – 8 weeksdays – 8 weeks often used internallyoften used internally Ex. Ex. Vicryl (polyglactic acid), Vicryl (polyglactic acid), monocryl (poliglecaprone 25), monocryl (poliglecaprone 25), Polydioxanone (PDS), Polydioxanone (PDS), Chromic & CatgutChromic & CatgutADVANTAGEADVANTAGE

Broken down by bodyBroken down by bodyNo Foreign body leftNo Foreign body left

DISADVANTAGEDISADVANTAGETime of Wound Support ↓Time of Wound Support ↓Can cause inflammation Can cause inflammation

It is Not degradable and It is Not degradable and permanentpermanent often used externallyoften used externally Ex. Ex. Nylon, polypropylene Nylon, polypropylene (prolene), Stainless steel & (prolene), Stainless steel & Silk (not truly permanent as Silk (not truly permanent as can break down over many can break down over many years)years)ADVANTAGEADVANTAGE

Permanent Wound SupportPermanent Wound Support causes less scarring causes less scarring

•DISADVANTAGEDISADVANTAGEForeign body leftForeign body leftSuture SinusSuture Sinusmust be removedmust be removed

Sutures Divided up on Their Sutures Divided up on Their Source of MaterialSource of Material

Different types of materials can be used to close a wound depending upon the style of wound, location and depth in the body. The material can be special glue, staples, animal protein or thread like materials. Usually , the suture material comprises

•Polymers

•Silk

•Nylon

•Fibers

•Stainless steel wire, …etc

Natural sutures VS Synthetic Natural sutures VS Synthetic SuturesSutures

Natural suturesNatural suturesSynthetic suturesSynthetic sutures

• • BiologicalBiological

• • Causes inflammatory reactionCauses inflammatory reaction

• • Examples are……Examples are……

• • Catgut connective from cow or Catgut connective from cow or sheepsheep

• • Silk from silkworm fibersSilk from silkworm fibers

• • Chromic catgut treated with Chromic catgut treated with chromium saltchromium salt

SilkSilk CatgutCatgut

• • Synthetic polymer fibersSynthetic polymer fibers

• • Not cause inflammatory Not cause inflammatory responseresponse

• • Examples are…. Examples are…. PolypropylenePolypropylene • • NylonNylon

• • MonocrylMonocryl

• • VicrylVicryl

• • PDS PDS PolyesterPolyester

• • polypropylenepolypropylene

Sutures Divided up on Their Sutures Divided up on Their No. of Material Strand or No. of Material Strand or

FilamentsFilaments

Monofilaments VSMonofilaments VS Non Multifilament Sutures Non Multifilament Sutures

Monofilaments SuturesMonofilaments SuturesMultifilament SuturesMultifilament SuturesSingle strand of suture materialSingle strand of suture material Used in minimal tissue traumaUsed in minimal tissue trauma Smooth tying but needs more knotsSmooth tying but needs more knots Harder to handle Harder to handle

Ex.Ex. nylon, monocryl, prolene, PDS nylon, monocryl, prolene, PDSDISADVANTAGEDISADVANTAGE

Handling and KnottingHandling and KnottingStretch ability and bending-Stretch ability and bending-PLIABILTYPLIABILTY

PolypropylenePolypropylene

Fibers are braided or twisted togetherFibers are braided or twisted together Causes more tissue resistanceCauses more tissue resistance Easy to handle and tie with fewer knotsEasy to handle and tie with fewer knots

Ex.Ex. vicryl, silk, and chromic vicryl, silk, and chromicADVANTAGEADVANTAGE

Strength Strength PolyesterPolyester

Soft and PliableSoft and PliableGood HandlingGood Handling

•DISADVANTAGEDISADVANTAGECapillary ActionCapillary ActionTissue TraumaTissue TraumaTissue Drag Tissue Drag SilkSilk Tissue CuttingTissue CuttingHarbors bacteriaHarbors bacteria

Choice of SutureChoice of Suture

Familiarity and availabilityFamiliarity and availability Ease of handlingEase of handling Tissue characteristics, Location and layersTissue characteristics, Location and layers Knowledge of physical and biological Knowledge of physical and biological

characteristics of the suturecharacteristics of the suture Patient factors-infection, debility, obesityPatient factors-infection, debility, obesity

Antimicrobial SuturesAntimicrobial Sutures

There is a recent development in wound There is a recent development in wound closure involves the use of sutures coated closure involves the use of sutures coated with antimicrobial substances to reduce the with antimicrobial substances to reduce the chances of wound infection.chances of wound infection.

While long-term studies are not yet While long-term studies are not yet available.available.

preliminary results indicate that these preliminary results indicate that these sutures are effective at keeping bacteria out sutures are effective at keeping bacteria out of wounds.of wounds.

Sizes of SuturesSizes of Sutures Suture sizes are defined by the (Suture sizes are defined by the (U.S.P.U.S.P.) which is) which is the official the official

compendium for the suture industrycompendium for the suture industry. . Sutures were originally manufactured ranging in size from Sutures were originally manufactured ranging in size from #1#1

(smallest)to (smallest)to #6#6.. #4#4 suture would be roughly the diameter of a tennis racquet suture would be roughly the diameter of a tennis racquet

string.string. The manufacturing techniques, derived at the beginning from The manufacturing techniques, derived at the beginning from

the production of musical strings, did not allow thinner the production of musical strings, did not allow thinner diameters. diameters.

As the procedures improved, As the procedures improved, #0#0 was added to the suture was added to the suture diametersdiameters

later, thinner and thinner threads were manufactured, which later, thinner and thinner threads were manufactured, which were identified as were identified as #00#00 ( (#2-0#2-0 or or #2/0#2/0) to ) to #000000#000000 ( (#6-0#6-0 or or #6/0#6/0).).

Atraumatic needlesAtraumatic needles are manufactured in all shapes for most are manufactured in all shapes for most sizes.sizes.

The actual diameter of thread for a given U.S.P. size differs The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.depending on the suture material class.

U.S.P.U.S.P.DesignationDesignation

CollagenCollagenmetric diametermetric diameter

(mm)(mm)

Synthetic Synthetic absorbableabsorbable

metric diametermetric diameter(mm)(mm)

Non-absorbableNon-absorbablemetric diametermetric diameter

(mm)(mm)

American wire American wire gaugegauge

11-011-0 0.010.01

10-010-00.020.020.020.020.020.02

9-09-00.030.030.030.030.030.03

8-08-00.050.050.040.040.040.04

7-07-00.070.070.050.050.050.05

6-06-00.10.10.070.070.070.0738-4038-40

5-05-00.150.150.10.10.10.135-3835-38

4-04-00.20.20.150.150.150.1532-3432-34

3-03-00.30.30.20.20.20.229-3229-32

2-02-00.350.350.30.30.30.32828

000.40.40.350.350.350.3526-2726-27

110.50.50.40.40.40.425-2625-26

220.60.60.50.50.50.523-2423-24

330.70.70.60.60.60.62222

440.80.80.60.60.60.621-2221-22

550.70.70.70.720-2120-21

660.80.819-2019-20

771818

Surgical Needles for use with Surgical Needles for use with SuturesSutures

There are several shapes of surgical needles: straight, half curved or ski, 1/4 circle, 3/8 circle, 1/2 circle, 5/8 circle,

compound curve

U.S.P. Needle Pull SpecificationsU.S.P. Needle Pull SpecificationsU.S.P. Suture SizeU.S.P. Suture SizeAverage MinimumAverage Minimum

(kgf)(kgf)Individual MinimumIndividual Minimum

(kgf)(kgf)

11-011-00.0070.0070.0050.005

10-010-00.0140.0140.0100.010

9-09-00.0210.0210.0150.015

8-08-00.0500.0500.0250.025

7-07-00.0800.0800.0400.040

6-06-00.1700.1700.0800.080

5-05-00.2300.2300.1100.110

4-04-00.4500.4500.2300.230

3-03-00.6800.6800.3400.340

2-02-01.1001.1000.4500.450

001.5001.5000.4500.450

111.8001.8000.6000.600

22++1.8001.8000.7000.700

Removal of SuturesRemoval of Sutures

For a permenant sutures: For a permenant sutures: "Different parts of the body heal at different "Different parts of the body heal at different

intervals. Common time to remove stitches will intervals. Common time to remove stitches will vary: facial wounds 3–5 days; scalp wound 7–10 vary: facial wounds 3–5 days; scalp wound 7–10 days; limbs 10–14 days; joints 14 days; trunk of days; limbs 10–14 days; joints 14 days; trunk of the body 7–10 days. the body 7–10 days.

"Not all stitches must be removed. If a small area "Not all stitches must be removed. If a small area remains unhealed, notify the health care remains unhealed, notify the health care practitioner. Then if ordered, remove sutures practitioner. Then if ordered, remove sutures from the healed area onlyfrom the healed area only."."