SUTURES AND SUTURE MATERIAL

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SUTURES & SUTURE MATERIAL & LIGATURES:

SUTURES & SUTURE MATERIAL & LIGATURES Conducted by: Ms. Monika (clinical Instructor) Army college of nursing ,jalandhar cantt.

INTRODUCTION :

INTRODUCTION Sutures are the materials used in operation theatre for joining the two edges of the incised surgical or other wound. Suture need to be strong & non irritant to skin & body tissues. Sutures should be of such materials that can be easily sterilized.

Define :

Define a) Sutures : The process of joining two surfaces or edges together along a line by or as if by sewing. The material, such as thread, or wire, that is used in this procedure.. b) Ligature :In surgery, a filament or thread used to tie something, such a blood vessel to prevent it from bleeding .Ligatures may be of silk, wire, and other materials.

Types of sutures :

Types of sutures Sutures are of two types : Absorbable sutures such as plain ,chromic ,a traumatic catgut. Non absorbable or non absorbent sutures.

A) ABSORBABLE SUTURES:

A) ABSORBABLE SUTURES Absorbable sutures are also known as catgut. A tough thin cord made from the treated and stretched intestines of certain animals, especially sheep This type of suture are commonly used to suture the inner structure of the body such as: Walls of the organs Rectal sheath Muscles Subcutaneous tissue Peritoneum Intestinal anastomosis

1) Plain catgut :

1) Plain catgut These sutures are completely digested & absorbed by the tissue. Sizes of the absorbable catgut suture vary from 5/0 which is the finest to 2 which is the thickest. Catgut has an expensive. The raw product of the catgut is submucosal layer of the sheep intestine. When these are prepared each pieces is split longitudinally into 3 or 4 ribbons. All the fatty & muscle layer are scrapped off in an alkaline bath.

Cont……..d:

Cont……..d The strands are then dried. After that catgut is packed in sealed container & is sterilized by cobalt irradiation. This makes yellow colored plain catgut which is absorbed rapidly & is absorbed earlier than the chromic catgut.

2) Chromic catgut :

2) Chromic catgut an absorbable sterile strand derived from the intestinal submucosa of sheep and fixed in formalin, used as a surgical ligature and suture. surgical catgut that has been treated with chromium trioxide to strengthen it. It is an absorbable suture The chromic catgut is of brown color & is absorbed slowly. To chromised the catgut, it is soaked in a bath of chromic acid with frequent period of movement of 3 hours. The strands are then graded into size Then the catgut is packed & sterilized.

3) Atraumatic catgut :

3) Atraumatic catgut It is another type which is used for ligating small blood vessels. Dexon (Polyglycolic acid) is also an absorbable suture synthetically prepared. It is available in various sizes such as 3/0 to 2. This suture is used as ties for small blood vessels & also for suturing peritoneum ,rectal sheath etc.

b) Non absorbable sutures :

b) Non absorbable sutures These types of sutures are not absorbed. These sutures are used for closing or suturing outer surface of the body such as skin. These sutures are cheaper ,easy to handle ,easy to sterile ,have smooth surfaces & knot securely with the ends cut short.

Cont………d:

Cont………d But these kind of sutures are liable to cause stitch infection & stitch sinus. The infection cab be arrested by only removing the stitch . For this reason sutures on the superficial surface of the skin should always be interrupted suture & never be continuous suture. Because the disadvantage of the continuous suture is when infection occurs on one site it is difficult to remove the infected stitch from the site without removing the rest of the stitch. While stitching ,preferably all knots are to tied at the one side of the surgical wound.

Types of non absorbable sutures:

Types of non absorbable sutures a) Silk suture : these suture are non absorbent. Their sizes vary from 10/0 to 2 . These are used for skin closure after abdominal operation. b) Linen suture : these sutures are also non absorbent .their sizes vary form 3/0 to 2 . These are used for skin closure in hernia operation.

Cont…….d:

Cont…….d c) Monofilament Nylon suture ( Ethilon) : These are non absorbable suture. Their sizes vary from 10/0 to 2. these sutures are used as tension sutures in hernia repair. d) Stainless steel wire : these are non absorbent sutures used in areas of known infection. It is also used for secondary repair of disrupted wound. It is further used for surgery of ligament ,tendons. It is again used for repair of cleft lip .hair lip cleft palate ,hernia operations ,thoracic & orthopedic surgery .

Cont…..d:

Cont…..d e) Prolene –Ethifex merseline : These non absorbent sutures are used for cardiovascular & plastic surgery. f) Metal Clips : these non absorbent types of suture are of various types such as : Michael clips Trazies Van petz

Cont……d:

Cont……d The chemical composition of the suture determines the rate of occurrence of skin infection. Though catgut & silk sutures have been used for centuries throughout the world ,amongst the non absorbable suture. Silk suture causes increased infection rate .

New introduced sutures :

New introduced sutures VICRYL (polyelatine– 916) PROLENE (Polypropylene) POLYSTER (ethibond) POLYDIXONE SUTURE These material have reduced the rate of infection at the suture sites.

Methods of suturing :

Methods of suturing The wound edges are brought into close proximity. The stitches are then applied with sufficient tightness. On the other hand the stitches should not be too tight because extremely tight stitches may Cause ischemia of the tissues that may lead to delayed healing. Also for the interrupted & continuous stitches the distances between stitches should be equal & all the knots in the interrupted stitches are placed at the one side of the surgical wound.

Types of stitches :

Types of stitches interrupted stitches The simple interrupted stitch is a suturing technique used to close wounds. It is the most commonly used technique in the closure of skin. It is known as an interrupted stitch because the individual stitches aren't connected. Placing and tying each stitch individually is time-consuming, but this technique keeps the wound together even if one suture fails. The knot crosses the wound perpendicularly. The knots should not be left over the wound, but placed to one side in make the removal of the stitches easier.

2) Continuous stitches :

2) Continuous stitches one in which a continuous, uninterrupted length of material is used. Continuous suture means that the tissue is held together by a suture which runs over and over like a seam in a shirt. Uses less suture material

4) Skin stripping of the wounds:

4) Skin stripping of the wounds Steri-strips are branded thin adhesive strips which can be used to close small wounds, generically known as butterfly stitches They are applied across the laceration in a manner which pulls the skin on either side of the wound together. Steri-strips may be used instead of sutures (stitches) in some injuries, because they lessen scarring and are easier to care for. steri-strip is Micropore Surgical Tape. Reports exist of dramatic cases where Micropore Surgical tape alone was used to hold large abdominal incisions

5) Stapling of the surgical wounds :

5) Stapling of the surgical wounds Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds Stapling is much faster than suturing by hand, and also more accurate and consistent. The first commercial staplers were made of stainless steel with titanium Modern surgical staplers are either disposable, made of plastic, or reusable, made of stainless steel. Both types are generally loaded using disposable cartridges.

Removing of staples :

Removing of staples 1) Before removing skin staples, you must be sure the wound is sufficiently healed. If you remove staples from a wound that hasn't properly healed, it can lead to the unintended opening of the wound edges, called dehiscence. Wounds typically heal in approximately 10 to 14 days. Scalp and facial wounds tend to heal a bit faster because of rich blood supplies to those areas.

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