Principles of Wound Closure

1. Obliteration of dead space

2. Even distribution of tension along
incision
3. Approximation and eversion of the
epithelium
4. Maintenance of tensile strength
across the wound until tissue
strength is adequate
Ideal suture characteristics
• Sterile

• All-purpose

• Minimal tissue injury or tissue reaction

• Easy to handle
Ideal suture characteristics
• Holds securely when knotted

• High tensile strength

• Favorable absorption profile

• Resistant to infection
 Essential suture characteristics
• Sterility

• Uniform diameter and size

• Pliability

• Uniform tensile strength

• Free from irritants or impurities

“No suture possesses all
desirable characteristics.”
Kinds of sutures
• Absorbable or non-absorbable

• Natural or synthetic

• Multifilament or monofilament
Absorbable suture materials
1. Natural
A. Collagen
B. Surgical gut
• Plain
• Fast absorbing
• Chromic
Absorbable suture materials
2. Synthetic
A. Polyglactin (Safil)
B. Poliglecaprone
C. Polydioxanone (Monoplus)
Non-absorbable suture material
1. Natural
A. Surgical silk (Silkam)
B. Surgical cotton
C. Surgical steel
Non-absorbable suture material
2. Synthetic
A. Nylon (Dafilon)
• Monofilament
• Braided
B. Polybutester
C. Polyester fiber (PremiCron/Synthofil/Meraline)
• Coated
• Uncoated
D. Polypropylene (Premilene)
 Absorbable Suture Characteristics
Properties Gut Polyglycolic acid Polyglactin Polydioxanone Polytrimethylene Poliglecaprone
carbonate

Handling Fair Fair-good Good Poor Good Excellent

Knot security Poor Fair-good Fair Poor Good Good

Tensile Low High hydrolysis at High Moderate High hydrolysis at High hydrolysis at
strength proteolysis at 90-120 days hydrolysis at hydrolysis a 180- 180 -120 days 90 – 120days
60-90days, 60-90days 210days
unpredictable

Coefficient of High Medium Low Low Low

friction
 Absorbable Suture Characteristics

Properties Gut Polyglycolic acid Polyglactin Polydioxanone Polytrimethylene Poliglecaprone

carbonate

Memory Low Low Low High Low Low

Tissue High Low - moderate Low - moderate Low Low Low

reactivity
Uses Sutures in Buried sutures Buried sutures Buried sutures in Buried sutures in Buried sutures
mucosal wounds requiring wounds requiring
tissues, longer dermal longer dermal
vessel support support
ligation

other Low elasticity, clear Low elasticity, Clear or violet Clear or green High elasticity,
or green clear or violet clear
 Nonabsorbable Suture Characteristics

Properties Silk Nylon, Nylon, Polyester Polypropelene Polybutester

Monofilament Multifilament

Handling Excellent Poor Fair-good Good Poor Good

Knot security Excellent Poor Fair-good Good Poor Fair-good

Tensile Low High High High Moderate High

strength

Coefficient of High Low High High Very Low Very Low

friction
 Nonabsorbable Suture Characteristics

Properties Silk Nylon, Nylon, Polyester Polypropelene Polybutester

Monofilament Multifilament
Memory Low High Medium Medium High Low
Tissue High Low Moderate Low- Low Low
reactivity Moderate
Uses Sutures in Percutaneous Minimal use in Minimal use Percutaneous Percutaneous
mucosal sutures, buried dermatologic in sutures, buried sutures, running
tissues or sutures if surgery dermatologic sutures if subcuticular
conjunctiv prolonged dermal surgery prolonged closures
e or support is dermal support
intertrigino needed is needed,
us zones running
to elevate subcuticular
or retract closures
tissues
other Black Black, green or Green or High plasticity, High plasticity,
clear clear blue or clear blue or clear
 Needles
• Wound closure and healing are
affected by the initial tissue injury,
needle penetration and
subsequent suture passage
Anatomy of a needle
• POINT

• BODY

• SWAGE/ EYE
Ideal surgical needle characteristics
• High-quality stainless steel

• Smallest diameter possible

• Stable in the grasp of the needle

holder

• Capable of implanting suture material

through tissue with minimal trauma
Ideal surgical needle characteristics
• Sharp enough to penetrate tissue with
minimal trauma and minimal resistance

• Sterile and corrosion-resistant

Needle Point
• Tapered

• Blunt

• Reverse cutting

• Taper cut (trocar point)

• Conventional cutting
edge
Suture Selection: General Principles
• Select the smallest suture

• Tensile strength of the suture should

never exceed that of the tissue

• The relative loss of suture strength

over time should be slower than the
gain of tissue tensile strength
Suture Selection: General Principles
• Aesthetic concerns are at a premium
in the head and neck

• In contaminated tissues, suture

selection is imperative.
BASIC WOUND SUTURING
1. Simple Continuous

• also known as “running” suture

• used mainly for tension-free wounds
• cause less scarring and faster to
perform
• higher risk of dehiscence
• commonly used to secure the
perimeter of a split or full thickness
skin graft
2. Simple Interrupted

• most common
• easy to place, provide great tensile
strength and are less likely to
compromise blood circulation
• need longer time to be placed
• higher risk of causing “railroad track”
scars
3. Vertical and Horizontal
Mattress

• used when the wound edges are not

close enough to each other to allow
tension free healing
• used in areas where a cosmetic result
is important
• disadvantage: surface scarring (can
be avoided by early removal)
4. Continuous Subcuticular

• provide the advantage that no second

visit is needed (slowly degraded by
the tisssues)
• disadvantage: foreign material will
disturb the normal healing process
• used only where there is an absence
of tension at the skin level
5. Inverted Simple
Interrupted

• subcutaneous suturing technique

• performed to release tension from the
wound surface
• minimal disturbance in skin healing
Thank You!!