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Sutures

The document outlines the phases of wound healing, the problems associated with surgical wounds, and the characteristics of ideal sutures. It classifies sutures into absorbable and non-absorbable types, detailing various materials, their advantages, and disadvantages. Additionally, it discusses specific absorbable sutures like catgut, polyglycollic acid, polyglactic acid, polydioxanone, and polygleocaprone, along with non-absorbable sutures such as silk, nylon, polypropylene, polyester, and PTFE.

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Pascal Turkson
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11 views

Sutures

The document outlines the phases of wound healing, the problems associated with surgical wounds, and the characteristics of ideal sutures. It classifies sutures into absorbable and non-absorbable types, detailing various materials, their advantages, and disadvantages. Additionally, it discusses specific absorbable sutures like catgut, polyglycollic acid, polyglactic acid, polydioxanone, and polygleocaprone, along with non-absorbable sutures such as silk, nylon, polypropylene, polyester, and PTFE.

Uploaded by

Pascal Turkson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Sutures

H. K. ADUFUL
DEPARTMENT OF SURGERY
UGMS
Wound healing
 Three phases of wound healing are recognised
 The lag phase 1 -4 days
 Inflammatory stage when debris are removed by phagocytosis
and components of collagen synthesis assembled
 The wound lacks strength and is supported by sutures
 The Proliferative stage 5 -20 days
 Collagen is laid down and 30% of pre-injury strength is gained.
 Remodelling stage 21 days to 1 year and over
 Absorption and replacement of collagen
 Fascia regains 70% of its strength
 Small bowel/bladder etc regain normal bursting in 3 weeks
 Stomach 50% in 14 days and colon 100 days to achieve full
strength
 Skin regains 70% of strength in 120 days
 Arteries do not regain strength completely
Problems of surgical wounds
 Wound failure
 Early wound failure (eg. Burst abdomen,
anastomotic leaks) factors including technique
 Late wound failure (incisional hernia,
aneurysms)
 Type of suture
 Wound infection
 Increased intra-abdominal pressure etc
 Wound infection
 Pain
Suture characteristics
 The ideal suture material will display the
following
 Physically and chemically unaffected tissue fluids
 Do not evoke an inflammatory response
 Not induce allergic reaction
 Must not promote infection
 Not be carcinogenic
 Must tolerate the stress it will be subject to
 Must be sterilisable
 Must be cost effective
Properties of sutures ideal for
surgery
 Predictable performance
 Pliable for ease of handling and knoting
 High uniform tensile strength, permitting
use of finer sizes
 Sterile and ready for use
 Consistently uniform diameter per size
Classification of sutures
Absorbable Non absorbable

Natural Catgut Silk


Plain Cotton
chromic
Linen

Synthetic Polyglycollic acid Polyamide (Nylon)


(dexon) Polypropylene (prolene)
Polyglactic acid Polytetrafluoroethylene
(vicryl) (PTFE)
Polydioxanone Teflon
(PDS) Polyester
Polygleocaprone
(Monocryl)
Classification of sutures
Absorbable Non
absorbable
Monofilament Polydioxanone Nylon
Polygleocaprone Prolene
PTFE
Stainless steel
Braided Dexon Nylon
Vicryl Silk
Cotton
Linen
Absorbable sutures
 Catgut
 Made from sheep and cattle submucosa
 Tanned with chromic acid to produce chromic catgut which
increases its period of its absorption
 Advantages
 Excellent handling
 Good for small bowel and bladder anastomosis
 Cheap sterilizable
 Disadvantages
 Induces severe inflammatory response
 Little strength after 8-9 days for plain and 21 days for chromic
 Variabe and unpredictable strength in the face of infection.
 Doubtful in the transmission of prions
 Its use has diminished greatly in parts of the world
Absorbable sutures
 Polyglycollic acid (Dexon) Synthetic
 Polymerised glycolide
 Braided
 Absorbed by hydrolysis
 Advantages
 Lasts longer than catgut
 Looses all strength by 30 days
 Suitable for bowel anastomosis and subcuticular
skin closure
 Handles well
 Disadvantages
 Not suitable for fascia
Absorbable sutures
 Polyglactic acid (Vicryl)
 Polymer of glycolic and lactic acid
 Braided
 Absorbed by hydrolysis
 Advantages
 Absorption commences after 40 days and is
complete from 60-90 days
 Mild inflammatory response
 Useful for most soft tissue apposition
 Can be used for subcutaneous skin closure
 Diasadvantages
 Cannot be used to close fascia except in children
Absorbable sutures
 Polydioxanone (PDS)
 Absorbable monofilament
 Synthetic polymer absorbed by hydrolysis
 Advantages
 Almost inert and approaches the perfect suture
 Retains tensile strength for 56 days
 Absorbed in 180 days
 Used for abdominal and thoracic closure
 Subcutaneous/subcuticular closure
 Colon and rectal surgery
 Can be made into clips
 Disadvantages
 Expensive
 Doubtful when prolonged approximation under stress
Absorbable sutures

 Polygleocaprone (Monocryl)
 Absorbable monofilament
 Copolymer of glycolide and caprolactone
 Advantages
 Almost inert
 Retains tensile strength for 21 days
 Absorbed in 90-120 days
 Subcut. Skin, GIT surgery, muscle
 Disadvantages
 Not advised in neural tissue, cardiovascular and
microsurgery
 Not for closure of fascia
Nonabsorbable sutures
 Silk
 Natural protein fibre from silk worm
 Nonabsorbable and braided
 Advantages
 Easy to handle
 Cheap
 Strong
 Used for ligation and serosal sutures in deep
abdominal surgery
 Disadvantages
 Intense inflammatory response
 Prolongs infection due to harbouring of bacteria in
braids
 Fully broken down in 2 years hence not for arterial
repair
Nonabsorbable sutures
 Polyamide (Nylon)
 Nonabsorbable
 Braided or monofilament
 Advantages
 Maintains 80-85% strength at 1 year
 Degrades at 15-20% per year
 Braided handles well
 Closure of fascia, skin
 Disadvantages
 Difficult to handle due to problems with memory
hence several throws required to maintain knots
 Not good for arterial repair or reconstruction
Nonabsorbable sutures

 Polypropylene
 Polymer of propylene
 Monofilament
 Advantages
 Permanent tensile strength
 Inert
 Remains permanently
 Useful in cardio-vascular surgery, general surgery,
etc
 Disadvantages
 Expensive
Nonabsorbable sutures

 Polyester
 Nonabsorbable, braided
 Synthetic
 Advantages
 Permanent tensile strength
 Remains in tissue permanently
 Used mainly in cardiovascular, and general surgery
 Disadvantages
 Expensive
 May promote infection
Nonabsorbable sutures

 Polytetrafluoroetylene (PTFE)
 Nonabsorbable
 Extruded polymer of tetrafluoroethelene
 Advantages
 Inert
 Permanent tensile strength
 Stays permanently
 Used in vascular surgery
 Disadvantages
 Expensive
Absorbable sutures
Sutures and their nature Advantages Disadvantages

Catgut Excellent handling Induces severe inflammatory response


Made from sheep and cattle submucosa Good for small bowel and bladder Little strength after 8-9 days
Tanned with chromic acid anastomosis Variabe and unpredictable strength in
Cheap sterilizable the face of infection.
Doubtful in the transmission of prions
Polyglycollic acid Lasts longer than catgut Not suitable for fascia
Polymerised glycolide Looses all strength by 21 days
Braided Suitable for bowel anastomosis and
Absorbed by hydrolysis subcuticular skin closure
Handles well
Polyglactic acid (Vicryl) Absorption commences after 40 days
Polymer of glycolic and lactic acid and is complete from 60-90 days
Braided Mild inflammatory response
Absorbed by hydrolysis

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