Suturing Techniques

Sutures are the surgical threads that are used to tie a blood vessel or to approximate two tissue.

Criteria Of Choosing A Suture Material

  1. Tensile strength
  2. Security of the knot
  3. Handling
  4. Tissue reaction
  5. Ability to resist bacterial infection

Types Of Sutures

According to absorbability

  1. Non absorbable sutures
    • Catgut
    • Vicryl
    • Steel
    • Nylon
    • Dexon
    • Maxon
  2. Absorbable suture
    • Silk
    • Nylon
    • Prolene
    • Dacron

According to number of filaments 

  1. Monofilament threads
    • Prolene
    • Catgut
    • Steel
  2. Braided polyfilament threads
    • PDS
    • Nylon
    • Vicryl
    • Dexon

According to origin

  1. Natural
    • Silk
    • Steel
    • Catgut
    • Cotton
  2. Synthetic
    • Vicryl
    • Prolene
    • Dexon
    • Decron

Important Facts

* Absorbable sutures are degraded by the inflammatory process of our body
* Absorbable sutures are used in GI, biliary and urinary
* Non absorbable sutures causes less scarring, but has to be removed
* Monofilament treads are used on skin as it will cause less bacterial infection
* Dyed sutures are not used on the skin
* Natural sutures causes inflammatory reactions / tissue reactions than synthetic materials

Half life and dissolution time is two term that is concerned with absorbable sutures

  • Half life is the time required for the tensile strength of a material to be reduced to half its original value
  • Dissolution time is the time that elapses before a thread is completely dissolved

Difference Between Monofilament And Braided Polyfilament Treads

Monofilament Treads

Braided Polyfilament Treads

1. Single strand of suture materials

1. Multiple strands of suture materials

2. Smooth tissue passage

2. More tissue friction

3. Minimal trauma to the tissues

3. More tissue damage

4. Harder to handle due to memory effect of the suture

4. Easier to handle

5. Less secure knot

5. More secure knot

6. More knots are required

6. Less knots are required


Sizes Of Suture

Types Of Needles

Types of needles in Surgery

Needles maybe straight or curved

According to the needle point geometry

  • Taper
  • Blunt
  • Conventional cutting
  • Reverse cutting
Reverse cutting needles are more advantageous than conventional cutting needles
  • More strength
  • Danger of tissue cutout is reduced
  • Needle leaves a wide wall of tissue against which the suture is to be tied

A traumatic sutures are defined as needle-suture combinations, where the needle is firmly attached to the suture in order to reduce tissue trauma.

General Rules Of Stiches

  • Not too close to the margin of the wound
  • Stitches should be placed in the same distance
  • Knots should be placed out of the wound line
  • No wrinkles or gaps
  • Avoid the overturn of the edges of the wound (exception purse-string ligature)

Anaesthesia

Local anaesthesia is given most commonly using lidocaine
Maximum dose is 5mg/kg or 300mg
300mg is 30ml of 1% lidocaine solution

Adrenaline should be avoided in case of penis, scrotum, fingers, toes, eyes, ears and nose

Suturing Techniques

  Simple interrupted sutureFig : Simple interrupted suture

Vertical mattress suture   Fig : Vertical mattress suture

Horizontal mattress suture   Fig : Horizontal mattress suture

  Simple running sutureFig : Simple running suture

  Simple running lock sutureFig : Simple running lock suture

   Subcuticular running sutureFig : Subcuticular running suture

 

Watch the video to learn the proper technique of suturing which is demonstrated by Dr. Michael R. Zenn, M.D. in his Suture skill course.

By courtesy of Dr. Zenn

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