Sutures

Types of sutures

depends on the character of the work and the nature of the operation. For instance, deep work in the pelvis requires a much longer suture than would be necessary in suturing an area closer to the surface of a wound. Experience and judgment, along with the desire of the surgeon, must be the determining factors in details of sutures. Alternatively, there are different kinds of sutures. Each classification is unique and has its own respective function.

Assessment of the suture line: ¨ Stitched too tight or too loose ¨ Too many or too few stitches ¨ Suture holes not equidistant for the edges so that the bite is not uneven, or uneven spacing between sutures ¨ Inversion or eversion of tissue edges ¨ Edges of tissue overlapping and heaped on each other. Types of stitch: Simple interrupted suture Inserted singly through each side of the wound and tied with a surgeon’s knot. Several of these may be used at short intervals ( 4—8mm apart) to close large wounds and share tension. Easy to keep clean, can be replaced singly and will evert edges of the flap. Horizontal mattress suture Evert the mucosal or skin margins, thereby bringing greater areas of raw tissue into contact. Useful for closing wounds over bony deficiencies such as oro-antral fistulae or cyst cavities. Vertical mattress suture Specially designed for use in the skin. Pass through at two levels: (i) Deep—provides support and adduction of wound surface (ii) Superficial—draw edges together and evert them Continuous suture Disadvantaged that if they cut out at one point the whole suture will slacken. Advantage—only two knots present. ¨ Simple continuous— applies pull on the wound obliquely ¨ Continuous blanket stitch—more firm and stable. Gives traction on the wound edges at right angles to the wound ¨ Purse string suture—useful as a deep suture for wounds of the skin of the face. I.

Length And Kinds The length of sutures naturally varies considerably. Each suture

II.

II. Absorbable Sutures 1. Surgical Gut Surgical guts are also known as a catgut and is made from the submucous layer of a sheep's intestine. Once cleaned, dried and twisted into threads of various sizes they are prepared for use by special processes, that include innumerable inspections of gauze and tensile strength and scrupulous sterilization. The length of time for complete absorption of surgical gut in a wound varies according to the action of certain hardening agents. 2. 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, but becomes part of the tissue after the wound has healed. III. The Non-absorbable Sutures

Many styles of clips are available for the purpose of holding the edges of the tissue in approximation. They tend to produce This is prepared from the thread spun by some scarring when used in the skin, but the silkworm larva in making its cocoon. It may be used when the wound is infected. may be twisted or braided, and it comes in sizes comparable with surgical gut. 8. Silkworm Gut 1. Silk

- 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. 5. Dacron This is a synthetic polyester fiber that has greater tensile strength, minimal tissue reaction, maximal visibility, nonabsorbent and non-fraying qualities. 6. Linen This is made of twisted line thread; it has sufficient tensile strength but is rarely used as suture material. 7. Silver Wire Clips

This is made from the fluid secreted by the silkworm when they are ready to form their cocoons. The disadvantage is that they must be soaked in normal saline for about 10 minutes before use to make them pliable. 9. Mesh This type of suture is made of stainless steel, usually used for hernia repairs and large defects. It is rarely used. 10. Tantalum This is a bluish bray metal that is nonirritating to the body tissues. It is used because of its high tensile strength and its inert reaction to tissues.