SUTURES

1. SUTURES • Sutures, or stitches, are materials used to close a wound.

2. FEATURES • The body of suture is smooth. • The body of the suture does not cause any capillary and repelling reaction.

3. FEATURES…. • Due to the softness of the suture, it will not tear at tissue. • It is easy to knot and the knot tied is firm.

4. Features….. • The breaking strength of suture and knot are strong. • The sewing is made firm, which is best for the healing of the patient without ductility.

7. TYPES OF SUTURES • Absorbable suture:The absorbable ones get dissolved in the body on their own and do not require removal. • Non absorbable suture:The non absorbable ones have to be removed after specified time. The type of suture is decided again by the location of the wound.

8. TYPES • MONOFILAMENT • MULTIFILAMENT • BRAIDED • TWISTED

11. Non Absorbable Sutures • SILK • LINEN • SURGICAL STEEL • NYLON • POLYESTER • POLYBUTESTER • POLYPROPYLENE

12. Absorbable Sutures • CATGUT • POLYGLACTIN • POLYGLYCONATE • POLYGLYCOLIC ACID • POLYDIOXANONE (PDS) • POLYGLYCAPRONE

13. NON ABSORBABLE

14. SILK • Raw Material: Silk from silk worm • Tensile Strenght: loses 20% when wet 80%-100% lost in 6 months • Absorption rate: slowly over 1-2 years • TISSUE REACTION: Moderate – High • Capillarity encourages infection causing suture sinuses and abscesses

15. SILK… • UNSUITABLE • Contraindications: NOT suitable for vascular prosthesis NOT suitable for routine skin closure • USE: when long term support necessary

16. LINEN • Raw Material: long staple flax fibres • TENSILE STRENGHT: stronger when wet; loses 50% at 6 months; 30% remaining at 2 years • NON-ABSORBABLE, remains encapsulated in body tissues • TISSUE REACTION: Moderate

17. LINEN • NOT advised for use with vascular prosthesis • USE: ligation and suture in GI surgery • NO LONGER USED in most centers

18. SURGICAL STEEL • An alloy of Iron, Nickel and chromium • Infinite Tensile Strenght ( > 1 year) • Non Absorbable; remains encapsulated in body tissue • Tissue Reaction: MINIMAL • Should not be used in combination with prosthesis of different metal

19. SURGICAL STEEL… • USE: • Closure of STERNOTOMY wounds • Previously found favour for tendons and hernia repairs

20. NYLON • Polyamide polymer • Tensile strenght: lose 15%- 20% per year • Absorption Rate: degrades at 15-20% per year • Tissue Reaction: LOW • NO CONTRAINDICATIONS

21. NYLON…. • USES: General surgical Uses • Skin closure • Abdominal wall mass closure • Hernia repair • Plastic surgery • Neuro surgery • Microsurgery • Opthalmic surgery

22. POLYESTER • TENSILE STRENGHT: INFINITE • Non Absorbable; remains encapsulated in body tissue • TISSUE REACTION: LOW • NO Contraindications • USES: Cardiovascular, ophthalmic, plastic and general surgery

23. POLYBUTESTER • Same properties as of polyester • Exhibits a degree of elasticity • USE: Plastic Surgery

24. POLYPROPYLENE • Properties same as polyester • USES: • Cardiovascular surgery • Plastic surgery • Ophthalmic surgery • General surgey • Subcuticular skin closure

25. ABSORBABLE SUTURES

26. CATGUT (Plain type) • Source: Collagen derived from healthy sheep and cattle • TENSILE STRENGTH/ Retention in vivo: lost within 7- 10 days. • UNRECOMMENDED • ABSOPRTION: phagocytosis and enzymatic degradation within 7-10 days

27. CATGUT (Plain type)… • TISSUE REACTION: HIGH • Not for use in tissues which heal slowly and require prolonged support; synthetic absorbables are superior • USES: • Ligate Superficial vessel, sutures, subcutaneous tissues, Stomas and other tissues which heal rapidly

28. CATGUT(Chronic) • Tanned with chromium salts Improves handling Resists degradation • Lost within 21.28 days • Marked patient variability • NOT RECOMMENDED

29. CATGUT(Chronic) • Phagocytized and ezymatically degraded within 90 days • TISSUE REACTION: MODERATE • CONTRAINDICATIONS same as plain • Synthetic absorbables are superior • Uses same as for Plain Catgut

30. POLYGLACTIN • Copolymer of lactide and glycolidein ratio 90:10, coated with polyglactin and calcium sterate • TENSILE STRENGTH: 60% remains at 2 weeks; 30% remains at 3 weeks • NOT ADVISED in tissues which require prolonged approximation under stress.

31. POLYGLACTIN • USES: • general surgery • Gut anastomoses • Vascular ligatures • Undyed subcuticular wound cloure Opthalmic surgery

32. POLYGLYCONATE • Copolymer of glycolic acid and trimethylene carbonate • TENSILE STRENGHT: 70% remains after 2 weeks; 55% remains after 3 weeks • ABSORPTION RATE: Hydrloysis minimal until 8-9 weeks. Complete absorption by 180 days

33. POLYGLYCONATE… • TISSUE REACTION: MILD • NOT ADVISED for use in tissues where prolonged approximation under stress is required • USES: • Alternative to vicryl and PDS

34. POLYGLYCOLIC ACID • 87% excreted in urine in 3 days • TENSILE STRENGHT: 40% remains at 1 week 20% remains at 3 weeks • ABSORTION RATE: Hydrolysis minimum at 2 weeks, significant at 4 weeks Compelete absorption at 180 days

35. POLYGLYCOLIC ACID…. • NOT ADVISED for use in tissues where prolonged approximation under stress is required • USES: as for other absorbable sutures • where slightly longer wound support needed

36. POLYDIOXANONE(PDS) • Polyester polymer • TENSILE STRENGTH: 70% remains at 2 weeks 50% remains at 4 weeks 14% remains at 8 weeks • Hydrolysis • minimum at 90 days • Complete at 180 days

37. POLYDIOXANONE(PDS) • TISSUE REACTION:MILD • CONTRAINDICATIONS: • not for use in association with heart valves or synthetic grafts • Prolonged tissue approximation under stress

38. POLYDIOXANONE(PDS) • USES: as for other absorbable sutures • where slightly longer wound support needed

39. POLYGLYCAPRONE • TENSILE STRENGTH: 21 Days Max • ABSORPTION RATE: 90-120 days • Contraindications: NO use for extended support or RENAL or CARDIOVASCULAR

40. POLYGLYCAPRONE • USES: • Subcuticular in skin ligation • GI surgery • Muscle surgery