SUTURES APPLICATION OF MEDICAL TEXTILE

Suture means, “to sew” or “seam”.

Sutures are the integral part of the surgical process used to close cuts and incision to ligate blood vessel and to draw tissue together and thereby preventing further infection

The suture is used to bring

The edges of wound in close approximation, to retain the medicated plug for dressing in deep wound or cavity,

To close any accidental opening To keep the lips of a deep extensive open wound

in contact temporarily To check recurrent hemorrhage

• Impact on the wound healing process

• Minimum reaction with tissue and maximum healing

• Good elasticity and good plasticity to accommodate wound swelling

• Physical and mechanical properties

• Handling properties

• Knotting properties &Easy to sterilize

• Non electrolytic

• Non allergic

• Cheap

Selection of the suture

Suture characteristics

Suture choice should be based on the patience, the wound, the tissue characteristic and the anatomic location

In different situations and with differences in tissue composition throughout the body, the requirement for adequate wound closure require different suture characteristic.

Suture possesses the characteristics that determine the utility

terms describe various characteristics related to suture material

Breaking strength

Capillarity

Elasticity

Fluid absorption

Knot-pull tensile strength

Knot strength

Memory

Plasticity

SUTURE MATERIAL

ABSORABLE

NATURALCollagen, Surgical

gut

SYNTHETICPolyglactinPolysorb

NON ABSORABL

E

NATURALSilk,

cottonsteel

SYNTHETIC

Nylon, polyester

CLASSIFICATION OF THE SUTURE

ABSORABLE SUTURE

• Calgut ,polydioxa one, polyglycolic acid• Used for deep tissue ,membranes & subcuticular

skin closure

may be used to hold wound edges in approximation temporarily, until they have healed sufficiently to withstand normal Stress

Natural absorbable sutures are digested by body enzymes which attack and break down the suture strand.

Synthetic absorbable sutures are hydrolyzed—a process by which water gradually penetrates the suture filaments, causing the breakdown of the suture's polymer chain

Some are absorbed rapidly, while others are treated or chemically structured to lengthen absorption time.

ABSORABLE - SUTURE

Absorbable - sutures inherent limitations

If a patient has a fever, infection, or protein deficiency, the suture absorption process may accelerate, causing too rapid a decline in tensile strength.

if the sutures become wet or moist during handling, prior to being implanted in tissue, the absorption process may begin prematurely.

Non-absorbable

Polyester ,nylon ,stainless steel Silk*(*not a truly permanent material; known to be broken down over a prolonged period of time—years)

Used for skin (removed) and some deep structure

(tendon,vessels nerve repair-not removed)

Non-absorbable

not digested by body enzymes or hydrolyzed in body tissue.

They are made from a variety of non biodegradable materials and only used when long term support is required

Exterior skin closure, to be removed after sufficient healing has occurred and tissue reaction is slow

Within the body cavity, where they will remain permanently encapsulated in tissue.

Patient history of reaction to absorbable sutures, keloidal tendency, or possible tissue hypertrophy.

Suture Classification

Mono filament Multi filament (braided)

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

Monofilament Suture

Multifilament Suture

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

1. Has capillary action2. Increased infection risk3. Less smooth passage4. Less tensile strength5. Better handling6. Better knot security

1. No capillary action2. Less infection risk3. Smooth tissue

passage4. Higher tensile

strength5. Has memory6. More throws

required

Braided v Monofilament

NaturalSilk, linen, catgut

Synthetic polymerPolypropylene, polyester, polyamide

Silk Catgut

Polypropylene Polyester

Suture Degradation

Suture Material Method of Degradation

Time to Degradation

“Catgut” Proteolytic enzymes Days

Vicryl, Monocryl Hydrolysis Weeks to months

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”.....”1”...”2”...”3”.....

Latest development in suture

Radioactive sutures and other fibrous surgical products

Smart sutures

Suture of polylactic acid