Types of sutures

1. Non-absorbable sutures: Generally used to close skin, and must be removed after wound healing is complete. These sutures are fine/thin, hassle-free, unlikely to leave marks, unlikely to get infected, and may be removed by the patient (on the 7th or 8th day.). The non-absorbable sutures are "non- reactive" to the body's immune response, so they need to be removed when placed through the skin. Types of non-absorbable sutures 1. Synthetic (nylon and polypropylene, which are inert), 2. Silk (animal protein) and cotton. 3. Non-dissolving stitches are usually coloured blue or black to make them more visible against the blood red of a wound. They have a smooth surface that usually allows them to be removed easily
The Non-absorbable Sutures 1. Silk This is prepared from the thread spun by the silkworm larva in making its cocoon. It may be twisted or braided, and it comes in sizes comparable with surgical gut. - High tensile strength - Relatively inexpensive - Less tissue reaction 2. Cotton This is made from cotton fibers. The strands are twisted and used for both internal and external suture. It should always be used wet for maximal strength. 3. Nylon - Monofilament - Multifilament - Braided - The chief disadvantage is that a triple knot must be tied 4. Wire This material has maximal flexibility and tensile strength, yet causes little or no local reaction in the tissue in which it is placed.

Linen This is made of twisted line thread. minimal tissue reaction. 8. Phagocytes carried by the blood. . it is not visible. 6. 2. 9. Absorbable sutures should not be exteriorized. maximal visibility. Tantalum This is a bluish bray metal that is non-irritating to the body tissues. They work better when used on internal surgery (buried inside) where the body can break them down easier. Absorbable (self-dissolving) sutures These are degraded by the body's enzymatic pathways through a reaction against "foreign" material. It is rarely used. usually used for hernia repairs and large defects. Silver Wire Clips Many styles of clips are available for the purpose of holding the edges of the tissue in approximation. it has sufficient tensile strength but is rarely used as suture material. They tend to produce some scarring when used in the skin. but may be used when the wound is infected. 10.stream attack and destroy the stitch material. Silkworm Gut This is made from the fluid secreted by the silkworm when they are ready to form their cocoons. non-absorbent and non-fraying qualities.5. They are not intended to be used on the surface of the skin. It is used because of its high tensile strength and its inert reaction to tissues. Mesh This type of suture is made of stainless steel. The disadvantage is that they must be soaked in normal saline for about 10 minutes before use to make them pliable. and if scar tissue should develop. Absorbable sutures can also be used to close skin but only in a subcuticular or completely buried pattern. 7. Dacron This is a synthetic polyester fiber that has greater tensile strength.

The length of time for complete absorption of surgical gut in a wound varies according to the action of certain hardening agents. but absorbed in a shorter period (5 days). Excites considerable inflammatory reaction and tends to potenciate infections. The strength of the sutures varies according to their size. * Vicryl / Dexon (Polyglactin): Dissolves slower than catgut. so one must use what is required and no more Absorbable Sutures 1.absorbable. * Vicryl Rapide: Similar substance to Vicryl. Sutures also come either as monofilament or braided: * Monofilament sutures cause less reaction than do braided sutures but require more ties to assure an adequate maintenance of the knot compared to braided suture. a 6-0 suture is more delicate and has less strength than a 4-0 suture. . which can be determined by a uniformly applied number. The surgeon uses as many stitches as necessary to approximate the wound edges. Monofilament sutures are usually non. Also used in areas where suture removal might jeopardize the repair such as with small children who might not easily cooperate with suture removal. For example. Once cleaned. Surgical Gut Surgical guts are also known as a catgut and is made from the submucous layer of a sheep's intestine. dried and twisted into threads of various sizes they are prepared for use by special processes. It loses strength rapidly and it's of little use in modern surgery. cotton and Mersilene. Used below the surface of the skin. Recent development. Plain catgut dissolves more quickly than the type treated with chromium salts. and should leave least scarring.Types of self-dissolving sutures: * Catgut (old technology): Natural fibre made from the submucosa of the bovine intestine. but causes less of a reaction on implantation. worth asking your surgeon about. * Braided suture usually incites a greater inflammatory response but requires fewer ties to maintain the knot integrity. Every stitch becomes a foreign body and becomes the source of an additional wound. Unfortunately this is not a very soft material and may be slightly irritating while the stitches are in place. These include silk. * Monocryl: The least reactive substance of this group. that include innumerable inspections of gauze and tensile strength and scrupulous sterilization.

2. Conventional cutting needle 3. Polyglycolic acid (Dexon) 2. Deep (dermal or buried) Absorbable Sutures 1. Force required for a knot to slip 3. Curved 3/8 of circle (preferred needle in most cases) 4. Suture types recommended for skin closure 1. Elasticity 1. Curvature 1. Monofilament (less risk of infection) 2. Curved 2/8 of circle 3. Degree suture stretches and return to original length 5. Reverse cutting needle (preferred in most cases) B. Nylon (Ethilon) . Fascia Lata This muscle connective tissue of beef has been used in reconstructive orthopedic surgery and for the repair of hernias. It is not a true absorbable suture. Straight needle 2. Related to suture size (see below) 2. Polydioxanone (PDS) 3. Related to weight required to break a suture 2. Tissue reactivity (inflammatory response to suture) 1. Knot strength 1. Tensile Strength 1. Configuration 1. Curved 5/8 of circle 2. Needles 1. Suture Characteristics 1. Superficial. Polyglactin-910 (Vicryl) 4. Needle Tip 1. High memory: Suture stiff. unties 6. Polyglecaprone 25 (Monocryl) 2. difficult handling. monofilament Nonabsorbable Sutures 1. but becomes part of the tissue after the wound has healed. Braided multifilament (easier to handle and tie) 4. Reaction peaks in first 2 to 7 days A. Curved 4/8 of circle 5. Tapered (used in vascular sutures) 2. Memory or suture stiffness 1.

Superficial Nonabsorbable Suture: 5-O 2. Foot or sole . Extremity. Deep: Dermal Absorbable Sutures 3. Nose. Deep: Brow. Nose. Back 6. Size O: Largest suture 4. Suture indications by location (see suture types above) 1. abdomen).2. Lip. Extremities 1. Deep: Scalp. Size 7-O: Smallest Suture 1. Face. Deep Absorbable Suture: 3-O or 4-O 3. Size 3-O 1. Superficial Nonabsorbable Suture: 4-O or 5-O 2. Ear. Abdomen. Absorbable Suture: 3-0 or 4-0 2. Penis 2. Lip 1. Mucosal Lacerations (mouth. Superficial facial lesions: 6-0 nylon 2. Size 2-O 5. Skin: Superficial monofilament Nonabsorbable Suture 2. Scalp. Higher skin tension areas: 4-0 nylon 2. Hand. Polypropylene (Prolene) C. Annotation for suture size indications below 1. Abdomen. Face. Skin: Eyelid. Low skin tension areas: 5-0 nylon 2. Extremity 2. Size 5-O 1. Abdomen. Size 4-O 1. back. Deep Absorbable Suture: 5-O 4. Skin: Ear. Foot. Superficial Nonabsorbable Suture: 6-O 5. Superficial Nonabsorbable Suture: 6-O 2. Skin: Scalp. Suture Size (See suture types above) 1. Brow. Tongue or genitalia) 1. Lip. Chest. Nose. Eyelid 1. General 1. Oral. Hand 1. Foot 7. Brow. Lip. Size 6-O 1. Face D. Face. Lid. Chest. Torso (chest. Eyebrow. Deep: Chest. Skin: Foot 2. Hand 8. Deep Absorbable Suture: 5-O 6. Penis 9. Skin: Scalp. Other superficial skin lesions 1.

Condition delaying Wound Healing: 14 to 21 days 1. Nose. Eyebrow. Extremities: 12-14 days 7. Deep Absorbable Suture: 4-O 7. Penis 1. Face. Superficial Nonabsorbable Suture: 3-O or 4-O 2.1. Ear: 10-14 days 4. Eyelid. Chest and abdomen: 8-10 days 5. Diabetes Mellitus . Superficial Nonabsorbable Suture: 5-O or 6-O E. Foot and sole: 12-14 days 9. Back: 12-14 days 6. Follow with papertape or steristrips 3. Scalp: 6-8 days 2. Penis: 8-10 days 10. Suture removal timing 1. Lip: 3-5 days 1. Chronic Corticosteroid use 2. Hand: 10-14 days 8.

Sign up to vote on this title
UsefulNot useful