Presentation on theme: "Sutures Tim Brandys MD FRCSC. Objectives At the end of this teaching session the student will recognize the following: 1. The importance of suture needle."— Presentation transcript:
Objectives At the end of this teaching session the student will recognize the following: 1. The importance of suture needle design for performance of different tasks. 2. The importance of differences in suture material for different tasks. The student will demonstrate the ability to make appropriate needle and suture material selections for different tasks.
Purpose of Suturing Close the wound and provide Close the wound and provide exogenous support of wound during healing. exogenous support of wound during healing.
Wound Healing How long does it take ? How long does it take ? Healing: Healing: week 1 week 1 wound tensile strength 15-20% wound tensile strength 15-20% week 12 week 12 - 80% - 80%
Everything you wanted to know about sutures but were afraid to ask!
History Earliest reports of Suture date back the Ancient Egyptians in 3000 BC Oldest Known Suture was found in a Mummy from 1100 BC First detailed Description of wound sutures is from the Indian sage Sushruta in 500 BC Early Suture materials included :fibers from plants (Flax,Hemp,Cotton) or Animal products (hair,tendon,gut)
Lister –routine sterilization of sutures in the late 1800’s 1930’S and 1950’s synthetic sutures (polyesters,polyglycolic acid) Silk and gut sutures are the only remnants of ancient sutures still in use today
Needle Anatomy Point Point Body Body Swage Swage
Needle types Taper Taper atraumatic passes through tissue by stretching it. atraumatic passes through tissue by stretching it. Vascular,bowel,liver,etc Cutting Cutting –Conventional cutting –Reverse Cutting –Traumatic –Dense tissues skin,fascia Conventional Cutting Reverse Cutting Spatula Point Taper point
Needle Curvature 3/8 Circle 3/8 Circle ½ circle ½ circle Straight needle Straight needle
Suture Material What,When,Why and Where do use different suture material ?
Suture Characteristics Size: Diameter size indicated by number of zeros Diameter size indicated by number of zeros Example :7/0 small, number 2 large Example :7/0 small, number 2 large
Suture Characteristics Tensile Strength: Tensile Strength: Weight required to break divided by cross sectional area (not same as absorption time) Weight required to break divided by cross sectional area (not same as absorption time) Strength Matters
Suture Characteristics Memory Memory Ability suture to regain original form after tying a knot Ability suture to regain original form after tying a knotElasticity Ability to regain original form after stretch. Ability to regain original form after stretch.
Suture Selection Suture & Needle selection depends on tissue type,tension exerted on wound and wound location. Suture & Needle selection depends on tissue type,tension exerted on wound and wound location.
Suture Selection Site of operation Site of operation Healing ability of tissues Healing ability of tissues Condition of the patient Condition of the patient Risk of infection Risk of infection Post-operatives conditions Post-operatives conditions
What sutures would you choose and why? Closure of abdominal wall fascia Closure of abdominal wall fascia Liagation of a blood vessel Liagation of a blood vessel Closure of oral mucosa Closure of oral mucosa Subcuticular skin closure Subcuticular skin closure
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