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SUTURES

This is a review lecture for final year students attached to the University unit &
students preparing for exams. This is not meant for initial study.
Prepared by Dr Dale Maharaj, Lecturer, UWI (updated 23.10.05)
THE RECONSTRUCTIVE LADDER

Direct wound closure:


1. Induction of anaesthesia
2. Wound irrigation
3. Shaving and prepping the wound
4. Wound debridement
5. Wound closure
Closure options:
Staples
Tape
Adhesive
Sutures

2000 B.C. Egyptians used


linen to close wounds

SUTURES
The ideal suture:
1. Biologically inert cause no tissue reaction, non-carcinogenic, non-allergenic
2. High tensile strength
3. Multi-purpose - (can be used for any tissue)
4. Easy to handle
5. Knot securely
6. Dissolve in body fluids and lose strength at the same rate that the tissue gains
strength
7. Resistant to infection and sterile
No ideal suture exists
Suture Characteristics
Natural vs synthetic
Absorbable vs non-absorbable
Monofilament vs braided
Knot strength - Amount of force necessary to cause a knot to slip
Memory - Inherent ability of suture to return to original gross shape (easier to
become untied)
Tensile strength ability to resist breakage

Size

Natural vs Synthetic Sutures


Natural sutures can be made of collagen from intestines
Natural sutures usually elicit significant inflammation
Absorbable Sutures
Provides temporary wound support
Absorption occurs by 1.enzymatic degradation (natural)
2.hydrolysis (synthetic)
Rate of absorption altered by: 1. Coating eg chromic
2. Tissues sutured ( in infection)
3. Exposure to fluid eg gastric/pancreatic fluid
Non-absorbable sutures
Mild tissue reaction
Suture encapsulation by fibrin

Can act as a nidus for stone formation in the biliary tree or urinary
bladder
Useful for vascular anastomoses
Monofilament versus multifilament sutures
Property
Tensile strength
Coefficient of friction
Tying
Infection

Monofilament
Less (less tissue damage)
Easier to remove
Easier
Harbour less bacteria

Multifilament
Stronger
Can injure tissue

Size
United States Pharmacopeia classification system:
The more zeros the smaller the diameter: 1,2-0,3-0 7-0 (small)
Commonly used sutures in GH-POS
ABSORBABLE
1.Cat-gut
Collagen material from sheep intestinal submucosa
Stored in solution to prevent drying
Unpredictable rate of absorption
Can be coated with chromic salt to increase absorption time
Marked tissue reaction

Pulled off the European


market due to theoretical risk
of prion infection mad cow
disease

Collagen
Absorbable
Tissue inflammation
Grows- swells and stretches
Unpredictable
Tensile strength weak

Relatively poor tensile strength


Poor knot security

Useful for rapidly healing tissues eg superficial blood vessels and subcutaneous
fatty tissue.

2. Vicryl (polyglactin)
Hydrolysed
Braided
Synthetic
Coated- allows easy handling, tying and less tissue drag
Avoid dyed suture in skin (leads to tattooing)
NON-ABSORBABLE
1. Prolene (polypropylene)
Monofilament infection & tissue drag
Maintains knots and tensile strength for 2 years
Minimal tissue reaction
2. Silk

3 Ms

Made by silkworms
Non-absorbable but degraded by proteolysis after 2 years
Severe inflammatory reaction not used for skin
Used to ligate vessels

3 general rules: 1. non-absorbable suture in skin, fascia, and tendons (slowly healing tissues), while
mucosal wounds (rapidly healing tissues) closed with absorbable sutures
2. monofilament sutures preferable in contaminated wounds
3. match the tensile strength of the suture and tissue.

Suture removal timing :


Scalp: 6-8 days
Face, Eyelid, Eyebrow, Nose, Lip: 3-5 days
Chest and abdomen: 8-10 days
Back: 12-14 days
Extremities: 12-14 days
Hand: 10-14 days
Condition delaying wound healing: 14 to 21 days eg Corticosteroid use and
Diabetes Mellitus