Suture Selection

Sutures hold tissue together until the

natural process of wound healing has

taken place
All sutures are foreign bodies and impact
on wound healing

Suture Selection
Absorbable sutures elicit more

inflammatory reaction than nonabsorbable sutures

Natural sutures absorbed by proteolytic
enzymes induce more inflammation than
synthetic ones absorbed by hydrolysis.

Suture selection
Monofilaments usually require more knots

to prevent slippage
Braided sutures handle easily and knot
easily
Braided suture may harbor bacteria

Suture selection
Suture size is reflected in 0s
4.0 vicryl is 0000
Number one vicryl is #1
O vicryl is 0
The more 0 the finer the stitch

 00000

fine

0000
000
00
0
1
2

thick

Suture selection
Use the smallest size suture that can hold

the tissue together during the healing

process
Fascia heals slowly - use bigger, stronger
suture
Mucosa heals quickly, use smaller stuff

Suture Selection
Memory - tendancy to return to original

shape (untied!)
Plasticity - expand when stretched and
dont return to original length (loosen with
edema)
Elasticity - ability to return to former length
(dosent loosen with edema)

Suture Selection
Fluid absorption and capillary action - the

tendency for a suture to absorb water and

to wick infection

Absorbable suture
Gut

Tensile strength for 4-5 days only

High tissue reactivity

Poor tensile strength for a given suture

diameter
Monofilament
Uses: tubal ligation, ligation of blood vessels

Absorbable Suture
Chromic gut

Tensile strength for 2 to 3 weeks

High tissue reactivity

Poor tensile strength for a given tissue

diameter
Monofilament
Uses: episiotomy repair, uterine closure,
closure of peritoneum

Absorbable Suture
Poly-sugars

Dexon, Vicryl, Polysorb

Synthetic polymers with modest tissue reactivity
Tensile strength for 2 to 3 weeks
10% strength at 28 days
Low elasticity - may cut soft tissue
Braided - handle well but wick fluid
Good for subcuticular closure and fascia

Absorbable Suture
PDS Maxon

Monofilament

Delayed absorption
59% strength at 28 days
Minimal tissue reaction
Less suture abscesses and cut through

than vicryl
Complete absorption by 180 days

Absorbable Suture
Monocryl Biosyn

Virtually inert in tissue

Tensile strength for 2 to 3 weeks

Less suture absesses
Great for mucosa and skin closures

Permanent Suture
Silk

Second only to gut for tissue inflammation

Braided
Best handling of any suture
Lowest tensile strength of any suture
Weaker when wet

Permanent Suture
Nylon

Surgilon, Ethilon, Dermalon

Inert

Pronounced memory - lots of knots

Uses- skin closure, sewing in JP draines

Permanent Suture
Polypropylene

Prolene, Surgilene, Surgipro

Inert
High placticity - expands to prevent
strangulation, but loosens when edema subsides
(use with steri-strips)
Will stretch when pulled
Elastic - requires extra knots
Uses- wound closure

Permanent suture
Braided polyester

Ticron, Tevdek, Ethibond

Greater tensile strength than other

permanent sutures
Good hadling with secure knots
Use: pelvic reconstruction

FasciaStrengthandHealingTime

Clamp rule
Mosquito 4.0
Kelley use 3.0
Mayo use 2.0
Haneny use 0

Staples
Cost more
Faster
Less tissue reactivity and infection
Good cosmesis
Require more infrastructure

Needles

Needle
Loading
7 mm drilled
3 mm for laser
Needles break at point
and at swage

Needle types

Use taper for general

closure
Cutting needles for
skin

Needles - what to ask for

General closure
GI needle
Cutting needle
Keith needle
Free or Mayo needle

Surgical Knots
Two types of knots

Flat
Sliding

Most OB/GYNs use sliding knots

Flat knots
Square
Granny
Surgeons
Equal tension is applied to both tails
Hands cross when laying down knots

Sliding knots
Alternate throws (like a square)
Same direction - slide easier
One suture is held tight and the other is

passed
Arms dont cross when laying knots down