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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.

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

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

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

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

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