15. Sutures, Needles, and Techniques

15.

Sutures, Needles, and Suture Techniques Modern Suture Materials: § Greatest tensile strength for a given size § Easy to handle § Minimal tissue reactivity (inflammation) § Sterile, safe, and secure packaging Suture Selection § Surgical specialization § Clinical experience § Tension on the wound § Number of layers of closure § Anticipated timing of suture removal § Patient factors (age, weight, overall health status, and presence of infection) § Suture Size: Smaller the size à Less tensile strength Numeric Classification: § The lower the suture size number, the larger (thicker) the diameter and the higher (greater, stronger) the tensile strength. § The higher the suture size number, the smaller (thinner) the diameter and the lower (less, weaker) the tensile strength. § As the number of 0s in the suture size increases, the diameter of the strand decreases; size 5-0 has smaller diameter than size 4-0 Use the smallest diameter suture that will adequately hold the mending wounded tissue. § Minimizes trauma and mass of foreign material Force (pounds) which the suture strand can withstand before it breaks when knotted. § Increased tensile strength of suture needed for increased tissue strength Optimal Suture Qualities: § High uniform tensile strength (permits use of finer sizes) § High tensile strength retention in vivo, holding the wound securely throughout the critical healing period, followed by rapid absorption

Monofilament vs Multifilament Strands Monofilament Sutures (Unbraided) § Single strand of material § Less resistance passing through tissue § Resist harboring organisms (decreased infection) § Extreme care when handling as crushing or crimping can nick or create a weak spot in the strand Multifilament Sutures (Braided) § Several filaments (strands) twisted together § Greater tensile strength, pliability, and flexibility § Disadvantage is “wick effect” that can allow bacterial penetration between strands Absorbable vs Nonabsorbable Sutures Absorbable Sutures § Dissolved by the body § Do not require removal § Collagen of mammals or synthetic polymers § Polyfilament (braided) § Monofilament (unbraided) § Various half-lives and strengths

Non-absorbable sutures § § § § §

Made from nonbiodegradable materials Not dissolved by the body Ultimately encapsulated or walled off by the bodyʼs fibroblasts Removed if on skin surface Permanent if buried

Suture Package Labels

Surgical Needles Â

Suture Techniques

Suggested Reading: Ethicon Wound Closure Manuel (2004)