Sutures And Needles

SUTURES AND NEEDLES Terminologies: Suture – any materials used to sew, stitch or hold tissue together until healing occurs. Ligature – commonly known as tie, is a material that is tied around a blood vessel to occlude the lumen. Primary Suture line – refer to the main layers of the tissue which must be stitched in closing an incision. Stay or Tension Sutures – sutures placed in an incision as a secondary measure of reinforcement where coughing or undue pressure or strain may cause the incision to separate. Tensile Strength – the amount of tension of pull that strand will withstand before in breaks when knotted. Suture Ligature – a ligature which is threaded on a needle Uses of a Suture: • To tie off a clamped vessels to prevent bleeding. • To approximate tissue until healing is complete. Types of Suture: Absorbable – these sutures are digested by body enzymes during the wound healing – process. The most commonly used absorbable sutures are surgical gut (catgut) collagen and synthetic Non-absorbable – this is collagen derived from the submucosa of sheep intestines or the serosa of beef intestines. It is digested by body enzymes and absorbed by – tissues; thus no permanent foreign body remains. The rate of absorption is influenced by: Types of Surgical Gut Surgical Gut – this is collagen derived from the submucosa of sheep intestines or the serosa of beef intestines. It is digested by body enzymes and absorbed by tissues; thus no permanent foreign body remains. The rate of absorption is influenced by: 1.Type of Tissue Surgical gut is absorbed much more rapidly in serous or mucous membrane and absorbed slowly in subcutaneous fat. 2.Condition of the Tissue It can be used in the presence of infection and even the knots are absorbed. However, absorption takes place much more rapidly in the presence of infection. 3.General Health Status of the patient Surgical gut may be absorbed more rapidly in undernourished or diseased tissue, but in old or debilitized or delibitated patients it may remain for a long time. 4.Types of surgical gut Plain gut is untreated but chromic gut is treated to provide greater resistance to absorption. A. Plain - It is digested relatively quickly, usually in 5-10 days because the collagen strands are untreated to resist absorption. - It is used to ligate small vessels and to suture subcutaneous fat. - It is natural yellowish tan in color. B.Chromic – It is treated in a chromium salt solution to resist absorption by the tissues – It is used to ligation of larger vessels. – It is used usually absorbed in 14-120 day – It is dark in color.

Types of Synthetic Absorbable Polymers 1.Dexon – has a minimal absorption in 30 day 2.Vicryl Non-Absorbable Sutures These sutures are made from various materials that are not affected by the digesting enzymes. They remain encapsulated when buried in tissues and in removed post-operatively when used as skin suture. 1.Silk • Not a true non-absorbable material • Loss much of its tensile strength after about 1 year and usually disappear after 1-2 or more years. • Gives good support to wound during early ambulation and generally promotes healing a little more rapidly than surgical gut. • Used frequently in serosa of the gastrointestinal tract and close fascia in the absence of infection. • May be used in anastomosing major vessels, especially in your children. • Kinds: 1. surgical silk 2. virgin silk 3. derma silk • Loss its tensile strength if wet, therefore do not moisten before use. • Black color 2.Surgical Cotton a. One of the weakest the non-absorbable material, but gains tensile strength when wet. Therefore, moisten it before handling to the surgeon. Tensile strength is increased by 10% by moisture. Moisture prevents clinging to the surgeon’s gloves . b. May be used in most body tissue for ligating and suturing but it offers no advantages over silk. 3.Dacron 4.Nylon 5.Polythylene 6.Li-cron 7.Havdek 8.Stainless steel Factors Influencing the Choice of the Types of Suture 1.Desired length of time the sutures are to remain in place. 2.Type of tissue to be sutured. Some tissue absorb suture faster than others. 3.Nutritional status of the patient. The absorbable suture will faster in a malnourished, older, anemic or obese patient. 4.Disease condition rate in increased when infection is present. Common Suturing Technique 1.Continuous – a running stitch that is tied only at the end of incision. This is used to close the peritoneum, muscle, fascia, subcutaneous tissue. 2.Interrupted – each stitch is taken and tied up separately. 3.Purse String – a continuous suture is placed around a lumen and tightened, drawstring fashion to close the lumen. This is used when inverting the stump of the appendix. 4.Subcuticular – a continuous suture is placed beneath the epithelial layer of the skin in short lateral stitched. It leaves a minimal scar.

5.Traction – may be used to retract a structure to the side of the operative field, out of the way. 6.Mattress – a variation of the simple interrupted stitch, and is made by taking a second bite with the needle through the tissue. Manner of Threading Sutures • Certain lengths have been found to be advantageous for various types of stitching. A suture strand that is too long is difficult to handle. Excessive length offers greater opportunity for contamination of this strand as it can be dragged across the operative field. If the suture strand is too short. It may slip from the eye of the needle or it may be difficult to knot. a. Single – one length of suture is threaded on needle, one long end and one short end. The short end is 1/3 of the long one. b. Double – both end of the suture is the same in length. • Varieties of Ligature 1.Free tie 2.Tie on the carries or carrier tie 3.Tie on the spool, winder, or reels Points to Remember in Suture Technique • There should be a suture routine in each operating room; an allowance must be made for changes according to the need soft the surgeon. • Prepare ligatures first according to their use. Then prepare the others sutures in the order in which they will be used, in so far as possible. • Be conservative and economical. • Handle suture materials as little as possible. • Know the size of the suture that is handed to the surgeon and keep a close eye on the surgery to anticipate the number and length of the additional suture the surgeon will used. • Be ready with suture scissors or a clamp depending on whether the surgeon will cut or hold the suture with a clamp, after the suture is past. • Checks each suture for knots before handling to the surgeon. A knot can destroy a line of an important anastomosis by widening the aperture through which the suture has passed. • Hand the suture and holder to the surgeon in each functional position. The suture ends should be hanging at the back of the palm, completely free from the handle of the holder. • Place strands in suture book with ends extended for enough for rapid extraction. Characteristics of a Good Needle • Strong enough so it does not break easily • Rigid enough to prevent excessive binding yet flexible enough to prevent breaking after binding. • Sharp enough to penetrate tissue with minimal resistance, yet not stronger than the tissue it penetrates. • Approximately the same diameter as the suture material it carries to minimize trauma in passage through tissue. • Appropriate in shape and size for the type condition and accessibility of the tissue to be sutured. • Free from corrosion and burns to prevent and tissue trauma. Classification of Needles 1.According to the Eye a. Regular eyed – threaded like ordinary sewing needle b. Eyeless or swayed – atraumatic, also known as dulex, atroloo c. French or Spring Eye – there is slit from the end of the needle to the eye, through which is the suture is drawn to thread it. 2.According to Shape, of shaft, cutting or non-cutting a. Non-cutting – these are rounded bodied and are use on tissue that offers a small amount of resistance to the needle as it passes thru.

- used to suture the viscera, peritoneum, muscle a. Cutting – these make a slight tear in tissue, and the suture tends to cut it a little more. -used for tough tissues that a round needle cannot well go through such as tendon, peritoneum, fascia, subcutaneous and skin. 3.According to Shaft or Body a. Straight – used primarily for skin closures b. Curved – used inside for quickly recovery of the point of needle. Needle Care During the Operation • In order to keep or prevent losses of needle, one should always keep the suture book always closed. • After handling a suture with needle to the surgeon, thread another one of the same kind immediately. • Account for each used by the surgeon. Be certain of receiving the empty needle back before handling another to the surgeon. Needle Care After the Operation • All needles (used, unused, broken) must be accounted for after each operation. • After all the needles have been accounted for: • Make sure that all needles have been removed from the suture hook before discarding into the soiled linen hamper. Points to Remember in Using Surgical Needles • Thread needle from inside curve towards outside. • Straight needles are not used on needle holders • Select a needle strong enough and large enough for tissue in which it is to be used • If the needle breaks, locate both pieces. • To prevent needle, breakage, the needle holder should be placed approximately 1/3 of the distance from the eye. The needle should be near the end of the needle holder. • Select a needle holder with appropriate size jaws for the size needle to be used. An extremely small needle requires a needle holder with very fine tipped jaw. • Select an appropriate length needle holder for the area of the tissue to be sutured. When the surgeon works deep inside the abdomen, chest or pelvic cavity, a longer needle holder will be needed then on superficial areas.