1. The Science of Sutures presented by: Chantal Souligny-Prud’homme Covidien

2. SUTURES

3. The definition of a suture
A surgical suture is any material used to approximate tissue during the critical wound healing period.
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

4. Suture Selection Training and experience of surgeon Type of operation
Site of operation
Healing and strength of tissues
Condition of the patient
Risk of infection
Post-operatives conditions
Strand properties
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

5. Suture Strand Reactivity
Natural Max Reactivity
Gut
Silk
Synthetic Braided
Polysorb*
Dexon*II/S …
Synthetic monofilaments
Caprosyn*
Biosyn*
Maxon*
Reactivity - Minimum
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

6. Strand Gauge/Diameter
11/0
10/0
9/0
8/0
7/0
6/0
5/0
4/0
3/0
2/0 1 2 3 4 5 7
Cardiovascular Surgery
Ophthalmology,
microsurgery
Retention
Plastics,
emergency
General Surgery
Gynecology,
orthopedics
Sternotomy
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

7. Monofilaments One strand Superior tissue passage Reduced knot security
Smooth surface
Stiffer material
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

8. Multifilaments Multiple strands, braids coatings
Surface interstices - capillarity
Difficult tissue passage
Superior knot security
Supple strand
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

9. Absorbable Sutures - Multifilaments
Gut
Short-term, natural-source multifilament
Absorption by enzymatic reaction leading to greater tissue reactivity, inflammatory response
Variable absorption period, variable tensile strength out-of-package
Excellent knot security
Alcohol packed – quick drying
Tendency to fray at surface
Plain Gut
~ 60 days absorption
~ 7 days strength retention
Chromic Gut
~ 90 days absorption
~ 14 days strength retention
Chromic salt bath
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

10. Absorbable Sutures - Multifilaments
VICRYL RapideTM
Short-term synthetic multifilament
Absorption by hydrolysis, low reactivity
Fixed absorption period ~ 42 days
Strength retention period ~ 7 days
Excellent knot security
Coated to reduce tissue drag
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

11. Absorbable Sutures - Multifilaments
DEXONTM ‘S’, POLYSORBTM, VICRYLTM
Medium-term synthetic multifilament
Absorption by hydrolysis, low reactivity
Fixed absorption period ~ days
Strength retention period ~ 28 days
Excellent knot security
Coated to reduce tissue drag
General surgery, orthopedics, gynecology ie: hysterectomy, ligation, skin closure
Opthalmic
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

12. Absorbable Sutures - Monofilaments
BIOSYNTM, MONOCRYLTM
Medium-term synthetic monofilament
Absorption by hydrolysis, low reactivity
Fixed absorption period ~ 100 days
Strength retention period ~ 21 days
Good knot security
Excellent tissue passage
Subcuticular closure (fascia, muscle, fat), general surgery (ie , plastic surgery,(ie Cosmetic work)
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

13. Absorbable Sutures - Monofilaments
MAXONTM, PDS IITM
Long-term synthetic monofilament
Absorption by hydrolysis, low reactivity
Fixed absorption period ~ 180 days
Strength retention period ~ 42 days
Good knot security
Excellent tissue passage
General surgery (ie Whipple procedure, bowel anastomosis, general closure, mass skin closure, pancreatoduodenectomy )Plastics subcuticular closure,( ie Breast Reduction)
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

14. Absorbable Sutures - Monofilaments
CAPROSYNTM
Short-term synthetic monofilament
Absorption by hydrolysis, low reactivity
Fixed absorption period ~ 56 days
Strength retention period ~ 10 days
Excellent knot security
Excellent tissue passage
Excellent replacement for gut products
gynecology, plastic surgery, subcuticular closure ei: prostatectomy, episiorraphy
in highly vascularised areas
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

15. Non Absorbable Sutures - Silk
SOFSILKTM, PERMAHAND™ Silk
Natural-source non-absorbable multifilament
Wax-coated/ Silicone coating
Fractures over long-term, high reactivity
Excellent knot security
Poor tissue passage
general surgery-ligatures, ophthalmology, plastic surgery
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

16. Non Absorbable Sutures - Nylon
DERMALON BlueTM, MONOSOFTM, ETHILONTM
Monofilament, Excellent tissue passage
Fractures over long-term, low reactivity
Good knot security
Also known as polyamide
Plastic surgery, general surgery, orthopedics, ophthalmics,
general closure
SURGILONTM, NUROLONTM
Braided, good tissue passage
Excellent knot security
Excellent replacement for silk
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

17. Non Absorbable Sutures - Polyester
TICRONTM, SURGIDAC™, MERSILENETM, ETHIBONDTM
Braided, good tissue passage
Permanent suture, low reactivity
Extremely strong
Excellent knot security
Excellent replacement for silk
Coated and Non-coated
Cardic surgery, sternal closure, plication ie: heart valve
repair – annuloplasty
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

18. Non Absorbable Sutures - Polypropylene
SURGIPROTM, SURGIPRO IITM, PROLENETM
Monofilament, excellent tissue passage
Permanent suture, low reactivity
Extremely strong
Nupack packaging
cardiovascular, cardiac, general surgery, orthopedics or general closure ie:
CABG (anastomosis), femoral popliteal bypass, microsurgery
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

19. Non Absorbable Sutures - Polybutester
NOVAFILTM
Monofilament, excellent tissue passage
Permanent suture, low reactivity
Extremely strong, minimal memory
Tactile ‘WARNING’ before elongation to breaking point
Excellent knot security
Elastic material conforms to post-operative edema to ensure proper approximation
A&E department, plastic surgery, hand surgery and any specialty requiring skin closure ie: blephroplasty, mamoplasty
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

20. NEEDLES

21. Needles ATRAUMATICTM vs. eyed (French eyed) Speed, reduced trauma
Curvature
Deep vs. superficial
Straight does not require needle driver
ATRUAMATIC
Eyed
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

22. Point Geometry Taper point Cutting Point Variations Spatula, lancet
Conventional Cutting
Reverse Cutting
Spatula Point
Taper point
Taper point
Cutting Point
Variations
Spatula, lancet
Trocar, Y, diamond, penetrating point.
Covidien | November 10, | Confidential
Formerly Tyco Healthcare

23. Wound Closure Techniques
« Principles of wound closure »
Gently manipulate tissues
Take small tissue bites
Just approximate tissue
Use smallest suture possible
Assure hemostasis
Avoid dead spaces
Covidien | November 10, | Confidential
Formerly Tyco Healthcare