Needles & SuturesHow to Select and Understand

Shady Nafie - Urology LAT

James Cook University Hospital

February 2015

Historical Landmarks

• Oldest known medical record describing trauma and sutures

• Ancient Egyptian, dated 3500 B.C.

• Edwin Smith Surgical Papyrus, discovered 1862

• Sutures were fashioned from hair, cotton or silk.

Historical Landmarks

• Joseph Lister, British surgeon and pioneer of antiseptic surgery.

• Tried to sterilise silk suture in carbolic acid, unsuccessful.

• Sterilised catgut, marked reduction in incidence of infection, 1869.

Historical Landmarks

• Robert Wood Johnson and brothers established Johnson & Johnson, 1885.

• Mass production of sterile catgut, 1886.

• Independent division of suture production - Ethicon, 1956.

Needles

Anatomy of NeedlesMade of Stainless steel

The Point

• Needle body is round and tapers smoothly to a point. For soft tissue e.g. bowels, blood vessels.

• Needle body is round and has a blunt end. Reduces risk of needle sticks. For less dense internal tissue e.g. muscle and fascia.

The Point

• Needle body is triangular and has a sharpened cutting edge on the inside curve. For tough tissue e.g. skin, tendons

• Cutting edge on the outside . Decrease the likelihood of sutures pulling through tissue.

The Body (Shaft)

The Eye (End)

Closed Swaged

• Non traumatic.

• Minimise handling & preparation.

• Don't unthread prematurely.

• More traumatic.

• Unthreads prematurely.

• More intaoperative handling.

Sutures

Suture Materials

Absorbable Non-Absorbale

Natural Syntheic

Monofilament Multifilament

Suture MaterialsAbsorbable

(<60 days)Non-Absorbable

(>60 days)

Advantages -Broken down by body-No foreign body left

-Permanent wound support

Disadvantages-Limited time of wound support

-Suture sinus-Foreign body left

Suture MaterialsSynthetic Natural

Advantages

-Absorption by hydrolysis

-Predictable absorption-Strength

-Handling & knotting-Economic

Disadvantages -Monofilament handling -Tissue reaction

Suture MaterialsMonofilament Braided

Advantages

-Smooth-Less tissue trauma-Less infection-No capillarity

-Strength-Soft & Pliable-Good handling-Good Knotting

Disadvantages-Slippery handling-Less Pliable-More Knotting

-Capillary action-Tissue trauma-Harbours bacteria

Suture MaterialsAbsorbable

(<60 days)Non-Absorbable

(>60 days)

Monofilament- Gut

- Monocryl (2/52)- PDS (3/52)

- Steel- Nylon

- Prolene

Braided - Vicryl (2/52)

- Silk- Cotton

- Ethibond- Dacron

Suture Sizes

USP size Diameter in mm

10-0 0.02

8-0 0.04

5-0 0.10

4-0 0.15

3-0 0.20

2-0 0.30

0 0.35

1 0.40

2 0.50

3 0.60

United States Pharmacopeia (USP)

Suture Packing

Suture size

Material

Length

Product code

Needle shape

Needle length

Suture colour

Point type

Needle circle

Needle code

Ideal Suture• Gentle passage through tissues

• Comfortable handling

• Knot security

• Maximum tensile strength

• Consistent performance

• Minimal tissue reaction

• Predictable absorption

Selecting a Suture

• Anatomic site

• Surgeon's preference

• Required suture characteristics

Thank You