1. Presented by Chesapeake Bay Consortium
Suture
Presented by
Chesapeake Bay Consortium
Property of Chesapeake Bay Perioperative
Reviewed May 2017
Created 4/2015

2. Today’s Objectives Critical Wound Healing Period (CWHP)
Suture Characteristics
Types of Sutures
Anatomy Surgical Needles
Topical Skin Adhesive

3. Surgical Technologist Role
Considered the role Model
Most knowledgeable
Familiar with suturing techniques

4. Wound Healing

5. Wound Healing Types of Wound Healing Influence on Wound Healing
Wound Support

6. Critical Wound Healing Period
Skin 5-7 days
Mucosa 5-7 days
Subcutaneous 7-14 days
Peritoneum 7-14 days
Fascia days
Layer Closure Inside out
-Peritoneum
Lines the abdominal cavity
Fast healing may not require suturing
-Facia
Connective tissue covering the muscle
Slow healing
Primary supportive tissue
-Muscle
Do not tolerate surters well
Try not to cut, most often separated or retracted out of the way
-Subcutaneous
Does not tolerate sutures well
Closed to prevent dead space
-Subcuticular
Tough connective tissue below the skin
Used to minimize scarring. Uses skin tapes or adhesives
-Skin
Fast healing times
Scars easily
Tissue Healing Times

7. The Critical Wound Healing Period Can Depend on Various Factors
Age
Weight
Nutrition
Dehydration
Blood Supply
Immune response
Chronic Diseases
Localized infection
Diabetes
History of Radiation Therapy

8. Short-term Wound Support
Situation in Short-term Wound Support
Skin & mucosa
Typically areas with increased blood flow
Need Benefit
Fast-absorbing suture Good clinical outcomes
Rapid loss of strength/mass
Good knot formation/snug down
Procedure Example: Episiotomy

9. Short-Medium-term Wound Support
Situation in Short-Medium-term Wound Support
Skin, mucosa, subcuticular
Typically cosmetic surgery cases
Typically areas with increased blood flow
Need Benefit
High initial strength Good Clinical Outcomes
Good cosmetic
Good handling & passage through tissue
Good knot formation/snug down
Low reactivity
Procedure Example: Plastic surgery

10. Medium-term Wound Support
Situation in Medium-term Wound Support
All tissue layers that align with the critical wound healing period of days
All tissue types
Typically areas with increased blood flow
Need Benefit
Consistent strength around the
Around the CWHP Good Clinical outcomes
Good handling & passage through tissue
Good knot formation/snug down
Low reactivity
Procedure Example: General Closure

11. Longer-term Wound Support
Situation in Longer-term Wound Support
Tissue that requires extended support
Friable tissue
Slow healing tissue/compromised patients
Typically fascia tissue
Need Benefit
Strength beyond the CWHP of 21 days Good Clinical outcomes
Good handling & passage through tissue
Good knot formation/snug down
Low reactivity
Procedure Example: Body Contouring

12. Suture Characteristics
Absorbable VS Non-absorbable
Monofilament VS Multifilament (Braided)
Natural VS Synthetic
Size

13. Absorbable vs Non-absorbable
Undergo degradation and absorption
Naturally digested by the body enzymes
Used to hold wound edges or tissue together temporarily
Non-absorbable
Resistant to absorption
Encapsulated or walled off by the body
Retains tensile strength

14. Mono-filament VS Multi-filament
Mono-filament sutures are made of a single strand of material.
Less resistance when passing through tissue
Resist harboring organisms which may cause infection
Easy tie down
Multi-filament suture consist of several strands twisted or braided together.
Greater tensile strength
Greater flexibility
Holds knots securely

15. Natural vs Synthetic Natural Synthetic
From naturally occurring substances:
Cellulose
Animal products
Animal tissue
Synthetic
Man made
Petroleum based products

16. Suture Size Correlate With tissues to be sewn
In an effort to minimize trauma to the tissue, the goal is to use the smallest diameter suture that will adequately hold tissue together
Variety of sizes ranging from 7 (largest) to 11-0 (smallest)
1 to 4-0 are most commonly used
1 and 0 are typical orthopedic sutures
6-0 to 7-0 for vascular anastamosis
8-0 to 11-0 for eye procedures
4-0 and 3-0 for skin closure (called subcuticular closure)

17. The Perfect Suture
Pliable and flexible with good handling characteristics.
Easy to tie, and would hold knots securely.
Not fray as it was tied.
Slide through tissues effortlessly.
The smallest diameter would never break.
No tissue reaction.
Tensile strength of the absorbable suture would be maintained only for as long as the wound required support.

18. Perfect Suture (Continued)
Absorbable suture would disappear completely the second the wound could support itself.
Absorption would be predictable in every patient.
It could be used in infected wounds.
It could be used in every surgical situation.
It would be inert, non-allergenic, and economical to use.

19. Products Packaging
Suture can have a needle incorporated into the suture stand called swaged
Suture can be without a needle also just called a tie or ligature
These ties can be loaded onto individually packaged “free needles” and these suture ligatures are called “stick ties”
Ties can be on reels similar to a spool of thread
Clearly distinguishes the types of
Suture and needle information
Code
Suture size
Product name
Suture length
Needle size
Type of needle
Quantity

20. Suture Types
Absorbable

21. Yellow Packages
Ethicon
Plain Gut
Coviden/Syneture
Plain Gut

22. Ethicon Plain Gut Coviden/Syneture Plain Gut
Monofilament
Natural
Submucosa of sheep intestine or beef intestine serosa
5-10 day wound support
Absorbs in days
Patient characteristics can affect rate of support and absorption
Used for superficial homeostasis and tissue that heals quickly

23. Brown Package
Ethicon
Chromic Gut
Coviden/Syneture
Chromic Gut

24. Ethicon Chromic Gut Coviden/Syneture Chromic Gut
Monofilament
Natural
Beef Serosa Sheep Submucosa
Wound support 21-28days
Absorption 90 days
Patient factors can affect rate of support and absorption
Most commonly used in OB, GYN, plastic and oral surgery

25. Pink Packages
Ethicon
Monocryl
Coviden/Syneture
Biosyn

26. Ethicon Monocryl Coviden/Syneture Biosyn
Monofilament
Synthetic
7 – 14 days Wound support
Absorption days
One of the most common used for skin closure, cosmetic surgery and soft tissue closure

27. Purple Package
Ethicon
Vicryl
Coviden/Syneture
Polysorb

28. Ethicon Vicryl Coviden/Syneture Polysorb
Braided and/or coated
Synthetic
14-28 days wound Support
Absorption days
One of the most common used to approximate soft tissue

29. Silver Package
Ethicon
PDS II
Coviden/Syneture
Maxon

30. Ethicon PDS II Coviden/Syneture Maxon
Monofilament
Synthetic
14-42days wound support
Absorption days
A longer lasting suture used to approximate fascia in abdominal cases

31. Suture Types
Non-Absorbable

32. Light Blue Package
Ethicon
Silk
Coviden/Syneture
Sofsilk

33. Ethicon
Silk
Coviden/Syneture
Sofsilk
Braided
Natural
Used to tie surgical drains, repair bowel and ligate large blood vessels

34. Orange Package
Ethicon
Ethibond
Coviden/Syneture
Ti-Cron

35. Ethicon Ethibond Coviden/Syneture Ti-Cron
Braided
Synthetic
Used in orthopedic surgery on high tension tissue such as muscle and tendons.

36. Green package
Ethicon
Ethilon
Coviden/Syneture
Monosof

37. Ethicon Ethilon Coviden/Syneture Monosof
Monofilament
Synthetic
20% loss of wound support each year
Most commonly used on nerves and blood vessels. Can also be used to secure surgical drains

38. Dark Blue Package
Ethicon
Prolene
Coviden/Syneture
Surgipro II

39. Ethicon Prolene Coviden/Syneture Surgipro II
Monofilament
Synthetic
Most commonly used to create anastamosis for vascular grafts and repair vessels.

40. Antibacterial Suture:
Kill bacteria and inhibit colonization of the suture
Create a zone of inhibition around the suture against
Staphylococcus aureus
Staphylococcus epidermidis
Methicillin-resistant Staph a (MRSA)
Methicillin- resistant Staph e (MRSE)
Monocryl Plus and PDS Plus also kill:
E. Coli
Klebsiella pneumoniae

41. Anatomy of the Surgical Needle

42. The Best Surgical Needle
Made of high quality stainless steel
As slim as possible without compromising strength
Stable in the grasp of a needle holder
Able to carry suture material through tissue with minimal trauma
Sharp enough to penetrate tissue with minimal resistance
Rigid enough to resist bending, yet ductile enough to resist breaking during surgery
Sterile and corrosion-resistant to prevent introduction of micro- organisms or foreign materials into the wound

43. Needle Curvature
Also describe by shape (curved (1/4, 3/8, ½ circle, 5/8 circle, or straight)

44. Anatomy of a Needle
Swaged End
Point
Body

45. Arming The Needle
Swaged End
Point
Body

46. Needle Types* Taper Point needles Blunt point needles
Conventional cutting needles
Reverse cutting needles
Spatula needles
Endoscopic needles
Micropoint needles
Premium cosmetic needles
Premium spatula needles
Heavy body needles
Straight needles
Tapercut needles
*Trademark
Covidien and Ethicon, Inc.

47. Needle Types

48. Non Cutting Needles TAPERPOINT Round shaft with out a cutting edge
Round bodies needles that pierce and spread tissue without cutting it.
For soft, easily penetrated tissues.
Vessels, gastrointestinal and delicate tissue
BLUNTPOINT
Round shaft with a blunt tip
Blunt needles are for blunt dissection and suturing friable tissue.
Can be used when suturing kidney, liver or deep spaces prone to space and visibility limitations.

49. Cutting Needles CONVENTIONAL CUTTING
There are two opposing cutting edges with a third on the inside curve.
REVERSE CUTTING
Cutting edge on outer curve.
Used for tough, difficult to penetrate tissues.
More strength than conventional cutting.
Danger of cutout greatly reduced.

50. Cutting Needles continued
TROCAR POINT
Three sharp edges ending in a sharp point
Your trocars used for endoscopic delivery as well as surgical wound drain insertion
SPATULA- SIDECUTTING
These edges are on the side for accurate depth placement. Used in ophthalmic surgery.

51. Adhesive Skin Closures Indermil and Dermabond*
Significantly Faster Closure
Sets in just 30 seconds
Easy-to-use for precision application
Enhanced Patient Comfort and Convenience
Cost effective
INDERMIL® Tissue Adhesive sloughs from wound in 7 to 10 days when no longer needed.
*Trademark
Covidien and Ethicon,Inc

52. Adhesive Skin Closures Indermil and Dermabond*
Quick Facts
Microbial Barrier
Provides the strength of healed tissues at 7 days in less than 3 minutes
Equivalent to a 4-0 suture
Effectively closes long incisions
Successfully used across a range of procedures by surgeon from 6 different specialties
No dressing needed
Patient may shower immediately
*Trademark
Covidien and Ethicon,Inc

53. Types of Staplers
Skin
Ligating Clips

54. Skin Stapler Used to approximate skin edges for closure
Must be removed postoperatively

55. Skin Stapler

56. Ligating Clips Used for hemostasis on a vessel Occlude a duct
Can be automated disposable devices or manually loaded with re-usable applicators

57. Ligating Clips

58. Suture Resources Ethicon wound closure manual

59. QUESTIONS