SUTURE MATERIALS AND

TECHNIQUES
 Criteria of Ideal Suture Material

1. Easy to handle.

2. Good knot security.

3. Minimal tissue reaction.

What’s It (Suture) Used for?

1. To bring tissue edges together (tissue

apposition).

2. Orthopedic surgery to help stabilize joints

or repair ligaments.

3. Ligate vessels.
Types of Needles

• Eyed needles
(Disadvantages?)
1. More Traumatic.
2. Tends to unthread
itself easily.
3. More infection.
Types of Needles
• Swaged-on needles
(Advantages)?
1. Much less traumatic.
2. Sterile.
(Disadvantages)?
1. Much more expensive.
 Points of Needles

• Rounded
– Atraumatic.
– For Internal organs.
Points of Needles

• Cutting
• For Skin.
• Traumatic.
Types of Suture Material

• Absorbable Vs. Non-absorbable.

• Mono-filament Vs. Multi-filament.

• Natural Vs Synthetic.
Absorbable Sutures

• Internal organs
• Internal layers of
abdominal wall
Non-absorbable Suture
• Primarily Skin
– Needs to be removed later.
Monofilament Vs. Multifilament

• Has a memory Easy to handle

difficult to handle
• Doesn’t wick Wicks / bacterial
inf.
• Poor knot security Good knot security
• - ve tissue reaction + ve tissue reaction
 Natural Vs. Synthetic

Natural Synthetic
(Examples): (Examples):
1. Cat Gut. 1. Vicryl.

2. Chromic Cat Gut. 2. PDS.

3. Silk. 3. NYLON.
4. Collagen.
4. Polypropylene.

5. Stainless Steel.
Natural
Cat Gut & Chromic Gut
• Made of sub-mucosa
of small intestines of
sheep.
• Natural sutures.
• absorbable
• Multi-filament.

• Breaks down by
phagocytosis:
inflammatory reaction
common
 Chromic Cat Gut
• Chromic: tanned, lasts
longer, less reactive
• Easy handling
• Natural sutures.
• absorbable
• Multi-filament.

• Absorption:
1. Plain: after 3-5 days
2. Chromic: after 10-15 days
Collagen
• Natural sutures.

• Multi-filament

• Absorbable.

• Used in Ophthalmic
surgery only.
Synthetic
Vicryl

• Multi-filament, synthetic, absorbable.

• Stronger than Cat gut
• Broken down by enzymes, not
phagocytosis.
PDS
• Monofilament (Worse knot security – lots
of “memory”)
• Synthetic, delayed absorbable.
• Very good tensile strength (better than
gut, Vicryl, dexon) which lasts months
• Absorbed completely by 182 days.
Polypropylene
• Prolene.
• NON-ABSORBABLE.
• Mono-filament, Synthetic.
• Won’t lose tensile strength over time.
• Bad knot security.
• Very little tissue reaction.
Stainless Steel
• Mono-filament.
• Synthetic.
• NON-ABSORBABLE.
• Strongest!
• Great knot security.
• Difficult handling.
• Very little tissue reaction, won’t harbor
bacteria
Suture Sizes
• Sized 3 , 2 , 1 , Zero , 1-0 , 2-0 , 3-0
BIGGER >>>>>>>>>>>>>>>> SMALLER
 Skin Staples (Adv. & Disadv.??)

• Very easy
• Very secure
• Very little tissue reaction
• Expensive
• Removal:
– Special tool required
(Staples remover)
Staples removing using staples
remover
 Reading the Suture Label
Order Code
Size

Also:
Name
LENGTH
NEEDLE
SYMBOL

Needle COLOR
Absorbable
or Non

• Company
Needle Holder (Uses??)
sterilization by AUTOVLAVE
 Toothed forceps

Toothed forceps are used for

handling (Tough structures)
skin, subcutaneous tissue,
muscles & sheath. NOT TO BE
used when handling bowel or
blood vessels.
Plan (non-toothed) forceps
Used to hold (delicate structures) like
peritoneum, nerves & vessels.
Instrument sterilization
All metal instruments are sterilized by autoclave.
Autoclave is used to sterilize equipment by
subjecting them to high-pressure saturated steam
at 121 °C for around 15–20 minutes depending on
the size of the load and the contents.