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Sutures

Sutures. Tim Brandys MD FRCSC. Objectives. At the end of this teaching session the student will recognize the following: The importance of suture needle design for performance of different tasks. The importance of differences in suture material for different tasks.

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Sutures

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  1. Sutures Tim Brandys MD FRCSC

  2. Objectives At the end of this teaching session the student will recognize the following: • The importance of suture needle design for performance of different tasks. • The importance of differences in suture material for different tasks. The student will demonstrate the ability to make appropriate needle and suture material selections for different tasks.

  3. Sutures Why do we care ?

  4. Purpose of Suturing Close the wound and provide exogenous support of wound during healing.

  5. Wound Healing • How long does it take ? • Healing: week 1 wound tensile strength 15-20% week 12 - 80%

  6. Everything you wanted to know about sutures but were afraid to ask!

  7. History • Earliest reports of Suture date back the Ancient Egyptians in 3000 BC • Oldest Known Suture was found in a Mummy from 1100 BC • First detailed Description of wound sutures is from the Indian sage Sushruta in 500 BC • Early Suture materials included :fibers from plants (Flax,Hemp,Cotton) or Animal products (hair,tendon,gut)

  8. History

  9. History • Lister –routine sterilization of sutures in the late 1800’s • 1930’S and 1950’s synthetic sutures (polyesters,polyglycolic acid) • Silk and gut sutures are the only remnants of ancient sutures still in use today

  10. The Basics

  11. Different needles –Different Uses

  12. Needle Anatomy • Point • Body • Swage

  13. Taper point Spatula Point Conventional Cutting Reverse Cutting Needle types • Taper atraumatic passes through tissue by stretching it. Vascular ,bowel,liver,etc • Cutting • Conventional cutting • Reverse Cutting • Traumatic • Dense tissues skin ,fascia

  14. Needle Curvature • 3/8 Circle • ½ circle • Straight needle

  15. Suture Material What ,When ,Why and Where do use different suture material ?

  16. The BASICS

  17. Suture Characteristics Size: • Diameter size indicated by number of zeros • Example :7/0 small, number 2 large

  18. Suture Characteristics Tensile Strength: • Weight required to break divided by cross sectional area (not same as absorption time) Strength Matters

  19. Suture Characteristics Memory • Ability suture to regain original form after tying a knot Elasticity • Ability to regain original form after stretch.

  20. Suture Characteristics • Natural /Synthetic • Monofilament/Multifilament • Absorbable/Non absorbable

  21. Natural vs. Synthetic • Natural Max Reactivity • Gut • Silk • Synthetic Braided • Polysorb*/Vicryl • Dexon*II/S • Synthetic monofilaments • Biosyn*/Monocryl • Maxon*/PDS Reactivity - Minimum

  22. Monofilament One strand Superior tissue passage Reduced knot security Smooth surface Stiffer material

  23. Multifilament • Multiple strands, braids • coatings • Surface interstices - capillarity • Difficult tissue passage • Superior knot security • Supple strand

  24. Absorbable/Non absorbable • Absorbable –dissolves • Non absorbable- permanent

  25. Absorbable • Plain Gut Strength 7 days absorption 60 days • Chromic Gut Strength 14 days absorption 90 days

  26. Absorbable • Vicryl/Polysorb Strength 28 days Absorption 56-90 days

  27. Absorbable • Biosyn/Monocryl Strength 21 days Absorption 100 days

  28. Absorbale • Maxon/PDS 11 Strength 42 days Absorption 180 days

  29. Nonabsorbable • Silk • Nylon (Monosof) • Ticron • Prolene (Surgipro)

  30. Suture Selection • Suture & Needle selection depends on tissue type,tension exerted on wound and wound location.

  31. Suture Selection • Site of operation • Healing ability of tissues • Condition of the patient • Risk of infection • Post-operatives conditions

  32. What sutures would you choose and why? • Closure of abdominal wall fascia • Liagation of a blood vessel • Closure of oral mucosa • Subcuticular skin closure

  33. Suture ?

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  35. Suture ?

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  37. Suture ?

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