4Types of Suture Material Absorbable - Suture material is absorbed over time by the body.Non-Absorbable - Suture material is permanent - not absorbed by the body.
5Basic Terms Associated With Sutures Absorption Profile - The number of weeks or days it takes the body to absorb suture.Tensile Strength - The amount of force necessary to break a suture. It is measured in days with absorbable sutures.Hydrolysis - Absorption process that uses the body’s water - Synthetic sutures are absorbed by hydrolysis.
6Basic Terms Associated With Sutures Enzymatic Process - Suture that is absorbed by the body’s enzymes - Gut suture products are absorbed in this mannerDegrade - A non-absorbable suture’s tendency to crumble and fall apart over time. The material is not absorbed, but it does not stay intact - Silk, NylonMechanical TraumaTrauma to the suture by mechanical instruments can result in suture failure.Compression of sutures between a needle holder with teeth can produce morphologic changes in sutures that can result in a marked reduction in suture breaking strength
7Basic Terms Associated With Sutures Braided - A suture strand that is woven or braided with numerous filaments.Monofilament - Suture strand is composed of a single strand or filament.D-Tach/ Pop-Off - Suture/needle combination that is designed so that the needle detaches from the suture strand when appropriate force is exerted.
8Basic Terms Associated With Sutures Running Closure - AKA “Continuous Closure” - Incision closed with repeated passes of one single suture.Interrupted Closure - Incision is closed with numerous sutures each tied separately.Double Armed - Needle on both ends of sutureTaper – Refers to a taper point needle generally used inside the bodyCutter - Refers to a cutting needle used generally to close skin
9Review of Primary Tissue Layers The primary layers which will determine the type of suture, needle and suturing technique used are:SkinSubcutaneous fatAnterior FasciaMusclePosterior FasciaPeritoneum
10Suture and Tissue Reactivity Although sutures are necessary to provide wound support so healing will occur, they may also cause a tissue reaction at the wound site.Tissue reactivity is the patients response to the physiological properties of the suture (what the suture is made from ). It can also be referred to as a foreign body response.
11Suture Function and Wound Healing Sutures function to hold wounds together until wound healing takes place.Fourteen to twenty-one days is often regarded as the critical wound healing period.It is during this time that the sutures provide strength to the closed wound, allowing the tissue to heal with minimal scarring.
13Suture Sizing - USP (United States Pharmacopoeia: - Diameters and strengths) Human hairChestSkinMicro / OphthalmicAbdominalclosureCABG*Suture Sizes range from a size 7 being the largest to a size 11-0 being the smallest(Note the typical application for each size by reviewing the chart on this slide)More 0’s = smaller size
15Suture Products Absorbable Sutures Braided Synthetic Absorbables (BSA)Polysorb - Syneture92.5% Polyglycolic 7.5% Polylactic AcidTensile Strength for 3 weeksAbsorbed in 56 to 70 daysVicryl - Ethicon90% Polyglycolic 10% Polylactic AcidTensile strength for 3 weeks
16Suture Products Absorbable Sutures Braided Synthetic Absorbable (BSA) Advantages:Tremendous strengthResistance to breakage due to multifilament constructionRelatively little memoryEasy to handle and tieTremendous variety of needle/suture combinations.
17Suture Products Absorbable Sutures BSA Disadvantages:Tends to be rougher on tissue as suture pulled through.Braids have potential to harbor infection due to numerous interstices.Can be a medium for stone formation in GYN and GU procedures involving the bladder and surrounding structures.
18Suture Products Absorbable Sutures BSA General Applications:General SurgeryMid line fascia closureSubcutaneous layer closureSubcuticular skin closureBowel anastomosisOther general tissue closures
22Suture Products Absorbable Sutures Long absorption profile Monofilament Synthetic AbsorbableMaxon - SyneturePDS - EthiconBoth sutures provide tensile strength for 6 weeks and are absorbed by the body in 180 days.Maxon maintains slightly higher tensile strength during the first two weeks in vivoSome surgeons might notice slight handling differences between the two sutures
23Suture Products Absorbable Sutures Long absorption MSA applications:Midline incision closuresLooped products are increasing in popularityBowel anastomosisAny application where extended approximation (three to six weeks) of tissue is needed.
24Suture Products Absorbable Sutures MSA Advantages:Smooth flow through tissueResistance to bacteria, infection and stone formation due to monofilament constructionLatest technology from suture manufacturersVariety of absorption ratesBest replacement for gut products
25Suture Products Absorbable Sutures MSA Disadvantages:Out of package memoryStiff and slightly more difficult to work withKnots require additional throws
27Suture Products Absorbable Sutures Gut Products - Ribbons of beef serosa (inner most layer of intestines) twisted to form suture strandsFast Absorbing GutProprietary to EthiconExtremely short absorption profilePlain GutMild Chromic GutProprietary to SynetureChromic GutCAPROSYN is an excellent alternative to using Gut suture.
28Suture Products Absorbable Sutures Gut ProductsGenerally fast, unpredictable absorption ratesDecreasing in popularityBanned in Europe and Japan
29Suture Products Absorbable Sutures Things to remember about Absorbable Suture Products - Means of absorptionSynthetic absorbable sutures are absorbed by hydrolysis (the body’s water) and are generally deemed to have predictable strength and absorption profilesOrganic absorbable sutures (gut products) are absorbed by the body’s enzymes and are generally thought to be more unpredictable in strength and absorption profile than synthetic absorbables.
30Suture Products Absorbable Sutures Any Questions?
32Suture Products Non Absorbable Sutures Braided Synthetic Non Absorbable Sutures:Braided PolyesterTicron - SynetureCoated with siliconeDyed BlueEthibond - EthiconPolyester suture coated with PBA (polybutylane adipate)Dyed Green
33Suture Products Non Absorbable Sutures Polyester Suture ApplicationsHeart valve replacementTendon RepairACL GraftDirect repair of herniaUterine suspension
34Suture Products Non Absorbable Sutures Braided Synthetic Non Absorbables (Cont)Braided NylonSurgilon - SynetureNurolon - Ethicon
35Suture Products Non Absorbable Sutures Braided Nylon Applications:Neuro surgery - Dura closureDirect repair of HerniaCannulation during heart bypass surgery
36Suture Products Non Absorbable Sutures Synthetic Monofilament Non AbsorbablesPolypropyleneSurgipro II – SynetureProlene - Ethicon
37Suture Products Non Absorbable Sutures Polypropylene applications:Blood vessel anastomosisHernia repairs using meshUterine and bladder suspensionPercutaneous skin closureAbdominal wall closure(where permanent suture is required)
40Suture Products Non Absorbable Sutures Monofilament non absorbable sutures that are proprietary to SYNETURENovafilMonofilament polybutester sutureUnique handling characteristics; Dramatically reduced memoryCan be used in all applications where polypropylene sutures are usedVascufilVascular version of NovafilCoated to minimize tissue drag and to improve knot run down
41Suture Products Non Absorbable Sutures Organic Non Absorbable Sutures:SilkConsidered the “gold standard” of suture handlingBraided and coated with wax or siliconeSteelSternal Wires - CVPacing Wires - CV
42Suture Products Non Absorbable Sutures Things to remember about non-absorbable sutures:Some non-absorbable sutures will degrade over time. They won’t absorb, but will degradeDegrading permanent suturesSilkNylonNon-degrading permanent suturesPolypropylenePolybutesterPolyester
43Topical AdhesivesCyanoacrylate based products used for the closure of topical skin incisions and trauma-induced lacerations in areas of low skin tension with easily approximated wound edges.Indermil (Syneture)n-Butyl 2-CyanoacrylateDermabond (Ethicon)2-Octyl Cyanoacrylate
47Needles must possess the following characteristics: The needle must be sharp enough to penetrate tissue with minimal resistance.The needle must carry the suture material through tissue with minimal trauma.The needle must be rigid enough to resist bending, yet flexible enough to bend before breaking.
48Every surgical needle has three basic parts The swage is the site of attachment of the suture to the needle. The body of the needle is the portion that is grasped by a needle holder. The point of the needle extends from the tip of the needle to the maximum cross section of the body.
50Needle PointsSpecific points are designed and produced to the required degree of sharpness to smoothly penetrate the types of tissue to be sutured.The point is from the extreme tip of the needle to the maximum cross section of the body.
51Surgical Needles Types of Surgical Needles: Taper Needles - Vast majority of needles are this typeGeneral Tissue ClosureMidline, Sub Q, PeritoneumVascular closures and anastomosisBowel closure and anastomosis
52Surgical Needles Types of Surgical Needles (Cont.) Cutting Needles - Needles with a triangular cutting configuration.Used for penetrating tough, fiberous tissue.Sub Cuticular skin closurePercutaneous skin closureSkin sutures for securing drainsVarious orthopedic tissue applicationsLigaments etc.
53Surgical Needles Types of Surgical Needles (Cont.) Taper cutting needles - Point of needle has a cutting tip. Body of needle quickly tapers.Used in places where taper needles are desired, but may not be quite sharp enough.Vascular procedures where vessels are heavily plaqued.
54Surgical Needles Types of Surgical Needles (Cont.) Spatula Needles - Used primarily in ophthalmic surgeryDeflects or pushes aside tissue as the needle passesCome in a variety of configurations.Blunt Needles -Needles have a blunt tipUsed primarily on delicate or friable tissue (Liver) or on patients with high risk blood diseases.
55Surgical Needles Types of Surgical Needles (cont’d) X-Cutting Dermax needles (proprietary to Syneture)Features a fourth cutting edge that allows four dimensional control: horizontal (left/ right), and vertical (up/ down)Unique double-point profile geometry for easier puncturing and needle embodying into the tissue.Used primarily in cosmetic procedures, & percutaneous skin closures.