KNOTS & SUTURES Surgical suture

Definition:
basic maneuver in surgery with the purpose of bringing and holding in contact various anatomic structures

APROXIMATION, NOT STRANGULATION!!!

Sutures Classification:
Continuity:
1. interrupted 2. continuous

Technique:
1. manual 2. mechanical Time elapsed from the moment the wound was caused to its evaluation: 1. primary suture ( first 6-12 h ) 2. secondary suture: -early ( 6-7 days ) high susceptibility to infection, lacerated wounds -late (20-30 days ) controlled infectious process, granulation

Necessary materials
Wires Surgical needles Needle holders Scissors Clips Clip applicators Staplers Self-adhesive strips (Steri-Strip ) Surgical adhesives

Wires
Absorbability (biodegradability):
-absorbable: poly-p-dioxanone, polyglactin -non-absorbable: silk, nylon polypropilene, stainless (surgical) steel

Structure:

-monofilament : polyglycolic acid -multifilament : silk, nylon

Origin:
-natural: catgut , silk -synthetic: polyglicolic acid, polylactic acid

Size USP (United States Pharmacopoeia)

-6-0 = 0.07 mm: face, bile ducts, lips, penis, vessels -5-0 = 0.1 mm: hand, bowel -4-0 = 0.15 mm: scalp, chest, abdomen -3-0 = 0.2 mm: foot, sole -2-0 = 0.3 mm: skin with scars -0 = 0.35 mm -1 = 0.4 mm : abdominal muscular wall -2 = 0.5 mm

Surgical needles
By thread insertion: Eyed or reusable Swaged or atraumatic By point geometry: taper cutting reverse cutting blunt points for sewing friable tissues

Needles

By shape:

Needle holders

Stapler

Use of adhesives:

Steristrips

Advantages/ Disadvanteges
Continuous Quick Tight (air &water) More haemostatic Less suture material is used Interrupted Takes time Looser Less haemostatic More suture material is used

A knot slipping looses the suture Poor tension and approximation control

Safer It favors tension adjustment along the wound

Possible complications
Haemorrhage during or after the operation Haematoma Infections Wound delaceration Granuloma Necrosis Hyperpigmentation Overgrow of fibrous tissue in scars/ keloids

Removing sutures
Scalp: 6-8 days Chest and abdomen: 8-10 days Hand : 10-14 days Conditions which delay healing : 1421 days -chronic steroids consume -diabetes

BRAKE

Interrupted suture
Indications :
- Lacerations - Strained areas , over the joints - Skin, fascia, vessels, nerves, gastrointestinal tract, urinary tract -easy to apply -anatomical security

-it allows the adjustment of tension in

the wound

Simple crossed suture

Safer than the simple interrupted suture Tension resistance Used for skin closure

Horizontal mattress suture/ U suture

Indications: Areas with high tension or wounds with strongly irrigated edges
-appositional or eversion suture depending on how tight it is -it can strangle the vascular system haemostasis

Vertical mattress/Blair Donatti suture

Indications: Tissues with great tension -approximates
both superficial profound tissues

and

-appositional or eversion suture depending on how tight the suture is -the risk of strangling the vascular system is lower

BRAKE

Simple continuous suture

Indications: Long, straight cuts Tissues with no tension Skin, subcuticular, fascia, gastrointestinal and urinary tract
-quick -saves wire -reduced tissue reaction -airtight and watertight -wound tension difficult to control -it cracks if the knot is inadequate or done

wrong

Ford interlocking suture (continuous blanket stitch)

Indications: skin -appositional suture -similar to the simple continuous suture -allot safer if the knot fails -difficult to remove

Thank you!