“SUTURE IN SURGERY”

Oleh : Andrie Febriansyah, S.Ked

Tri Rahayu Marbaniati, S.KedDesti Omega Rohyadi, S.Ked

Pembimbingdr. ASWEDI PUTRA, Sp.OT, FICS

Introduction

• Suture means to “sew” or ‘seam’. In surgery suture is the act of sewing or bringing tissue together and holding them in apposition until healing has taken place, usually suture material is an artificial fibre

• A suture is a strand of material used to ligate blood vessels and to approximate tissues together.

ligate blood vessels to arrest or control bleeding

approximate tissues together

Ligature

Goals of suturing:1- Provide an adequate tension of wound closure

without dead space but loose enough to obviate tissue ischemia and necrosis.

2- Maintain hemostasis.3- Permit primary intention healing4- Reduce postoperative pain5- Provide support for tissue margins until they have

healed and the support no longer needed6- Prevent bone exposure resulting in delayed

healing and unnecessary resorption7- Permit proper flap position

suture

• Ideal suture material· All-purpose, composed of material which could be

used in any surgical procedure (the only variables being size and tensile strength)

· Sterile · Nonelectrolytic, noncapillary, nonallergenic, and

noncarcinogenic· Nonferromagnetic, as is the case with stainless steel

sutures· Easy to handle

suture

• Ideal suture material· Minimally reactive in tissue and not

predisposed to bacterial growth· Capable of holding securely when knotted

without fraying or cutting · Resistant to shrinking in tissues · Absorbed with minimal tissue reaction after

serving its purpose· Doesn’t exist!

Classification of suture materials• According to source :1. Natural-biological origin-cause intense inflammatory

reactionex : - catgut (purified collagen

fibers from intestine of healthy sheep or cows)

- Chromic – coated “catgut”

- Silk

2. Synthetic Suture:- Synthetic polymers- Do not cause intense

inflammatory reaction Examples:– Vicryl– Monocryl– PDS– Prolene– Nylon

• According to the structure :

•Grossly appears as single strand of suture material; all fibers run parallel• Minimal tissue trauma• Resists harboring microorganisms• Ties smoothly• Requires more knots than multifilament suture• Possesses memory• Examples:– Monocryl, PDS, Prolene, Nylon

•Fibers are twisted or braided together

• Greater resistance in tissue• Provides good handling and ease of tying• Fewer knots required• Examples:– Vicryl (braided)– Chromic (twisted)– Silk (braided)

• According to fate :

1. Absorbable• Degraded and eventually eliminated in one of two ways: – Via inflammatory reaction utilizing tissue enzymes – Via hydrolysis Examples: – “Catgut” – Chromic – Vicryl – Monocryl – PDS• Internal• Intradermal/ subcuticular• Rarely on skin

2. Non-absorbable• Not degraded, permanent• Only used when long term support is required• Remove when used for skin• Tissue reaction generally low (except silk)• True non absorbable sutures include polyester,

polythylene, polypropylene and steel (*not a truly permanent material; known to be

broken down over a prolonged period of time—years)

Non-Absorbable SuturesMonofilament Polypropylene:Polyester Fiber: Mersilene®,

Dacron®, Ethibond®, Ti.cron®Monofilament Nylon: Ethilon®,

Dermalon®Braided Nylon: Nurolon®, Surgilon®SilkSurgical Stainless Steel Wire

Suture Size:

• Sized according to diameter with “0” as reference size

• Numbers alone indicate progressively larger sutures (“1”, “2”, etc)

• Numbers followed by a “0” indicate progressively smaller sutures (“2-0”, “4-0”, etc)

Smaller -------------------------------------Larger .....”3-0”...”2-0”...”1-0”...”0”...”1”...”2”...”3”.....

Suture material summary

THANK YOU