Surgical Suture : Types, Stitches, Needle , More - OT Tech Guide
What is surgical suture ?
The strand of material used to approximate or tie off the tissues is called a suture.
There are a variety of materials available that can be used for sewing. Your doctor will choose a material that is appropriate for the wound or procedure.
What is an ideal suture?
An ideal suture material should have following qualities:-
•It should penetrate easily and allow a secure knot.
• It should not be allergic
• It should have good and predictable tensile strength and performance.
• It should be cheap.
• It should not shrink, be sterile, and not produce a tissue reaction.
According to structure , nature and their properties we can classify suture into different types.
Types of suture according to Structure:
1) Monofilament sutures
Non-braided structure , smooth and enter well in tissue but break easily if compressed by the grip of the instrument so needs skilled knotting.
2) Multifilament sutures
Braided structure , strong with better knotting quality but , they are liable to become colonized with the bacteria because of larger surface area.8
Types of suture according to nature :
1) Natural
2) synthetic
Types of suture according to their ki properties:
The suture depending upon their tissue behaviour may be classified as :
A) Absorbable sutures .
B) Non- absorbable sutures.
A) Absorbable sutures
Types of absorbable sutures-
1) Catgut - This natural monofilament suture is used to repair internal soft tissue wounds or lacerations. Intestines should not be used for cardiovascular or neurological procedures. The body reacts most strongly to this suture and often scars. It is not commonly used outside of gynecologic surgery.
Two types of Catgut -
Plain Catgut - lost 50% in 3-5 days
Chromic Catgut - lost 50% in 5-7 days.
2) polyglactin 910 ( vicril ) - This synthetic braided suture is good for repairing injuries to hands or face. It should not be used for cardiovascular or neurological procedures.Takes 14 days to lost 50%.
3) polyglycolic Acid ( Dexon) - This synthetic homopolymer braided suture has wide very wide use. It is used is approx very kind of surgery like general , plastic , gynecology , pediatrics etc. Takes 20 days to lost 50% but disappear completely.
4) polydioxanone (PDS) - This synthetic monofilament suture can be used for many types of soft tissue wound repair (e.g. abdominal closures) as well as pediatric cardiac procedures. Takes 28 days to lost 50% but very useful in the slow healing tissue.
B) Non - Absorbable suture-
Non-absorbable sutures will need to be removed by your doctor at a later date, or in some cases left in place permanently.
Types of non- absorbable sutures-
1) Silk - A multifilament natura suture. Used in tying off larger vessels , intestinal anastomosis , vascular anastomosis, general used for suturing skin. Take 2 years to lost completely.
2) Linen / thread - A natural braided suture.
3) Nylon - A natural monofilament suture can be use in suturing skin , closure of the abdominal wall , microsurgery etc. Take 2 years to lost completely.
4) polypropylene ( prolene) - A synthetic monofilament suture can be use as a propene mesh for hernia repair , arterial surgery , bile duct surgery , skin closure etc.
5) polyester - A synthetic braided suture.
Size of sutures
The sizes of the threads are wide ranging, from 7 to the very fine size 11/0. Sizes are labelled in descending and ascending order. The size 1 is taken as the initial size, and then it gets thicker from 1 up (2,3,4,5,6&7) and so for 1/0 to 7/0 the size is reduced and it gets thinner and thinner.
Suture And stitches
Suture is a medical device which is used to close wound or incision during surgery.
Stitching is a technique used by doctor or medical staff to close wound or incision.
Sutures are also attached to a needle. The needle can have many different characteristics. It can be of different sizes and also have a cutting or non-cutting edge. Larger needles can close more tissue with each stitch, while smaller needles are more likely to reduce scarring.
Indication for suturing :-
•Clean wounds with minimal skin loss allowing closure with minimal tension.
•Securing drains/lines against loss (e.g. central lines, intercostal drains)
•Surgical closure.
Just as there are many different types of sutures, there are also many different suture techniques. Some of them are:
1) Interrupted Stitches.
2) Continuous Simple Stitches.
3) Continuous Locking Stitches.
4) Mattress Stitches.
Suture Removal
When your sutures are removed will depend on where they are on your body but some general guidelines are as follows :
Wound Adult(days) child(days)
Face 4-5 3-4
Scalp. 6-7. 5-6
Trunk. 7-10. 6-8
Arm ( not joint). 7-10. 5-9
Leg ( not joint). 8-10. 6-8
Joints. 8-14. 7-12
Plam. 7-12. 7-10
Sole of foot. 7-12. 7-10
Dorsum of hand. 7-9. 5-7
Basics of the Needle
The shape of the needle is very important when deciding which suture material to use. There are a variety of forms as detailed below. It is important to know where the cutting action of the needle one intends to use is on the needle itself. Each needle has a sharp point, but in addition there may be sharpened sides that also cut, or even spatulate needles that help dissect and preserve tissue planes. It is also important to know which side of the needle is blunt to avoid dissecting or cutting into tissue or in unintended directions. The table below contains frontal drawings to help the surgeon better visualize the needle tip and tip, and the sides, which may be blunt or sharp. It is important to ensure that the needle used for a surgical task is chosen to minimize tissue trauma, maximize wound healing and apposition or placement, and limit the need for multiple passes.
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