1. SUTURE MATERIAL

2. Critical Wound Healing Period
Tissue
Skin
Mucosa
Subcutaneous
Peritoneum
Fascia
5-7 days
5-7 days
7-14 days
7-14 days
14-28 days
Tissue Healing Time/Days

3. Surgical Wound Classification
Clean: (1-5% risk of infection)  Operative incisional without penetrating infectious organs
Clean-contaminated: (3-11% risk)  operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and without unusual contamination.  the biliary tract, appendix, vagina, and oropharynx

4. Surgical Wound Classification
Contaminated: (10-17% risk) open, fresh, accidental wounds, operations with gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent
Dirty or infected: (>27% risk) old traumatic wounds , necrotic tissue, perforated viscera  postoperative infection predicted
This classification scheme has been shown in numerous studies to predict the relative probability that a wound will become infected. Clean wounds have a 1%-5% risk of infection; clean-contaminated, 3%-11%; contaminated, 10%-17%; and dirty, over 27% (2,3,7). These infection rates were affected by many appropriate prevention measures taken during the studies, such as use of prophylactic antimicrobials, and would have been higher if no prevention measures had been taken.

5. Types of Sutures Absorbable or non-absorbable (natural or synthetic)
Monofilament or multifilament (braided)
Sizes 3 to 12-0

6. Absorbable Non-absorbable Nylon Prolene Stainless steel
Not biodegradable and permanent
Nylon
Prolene
Stainless steel
Silk (natural, can break down over years)
Degraded via inflammatory response
Vicryl
Monocryl
PDS
Chromic
Cat gut (natural)
Nylon (Ethilon®): of all the non-absorbable suture materials, monofilament nylon is the most commonly used in surface closures.
 Polypropylene (Prolene®): appears to be stronger then nylon and has better overall wound security.
BRAIDED: includes cotton, silk, braided nylon and multifilament dacron. Before the advent of synthetic fibers, silk was the mainstay of wound closure. It is the most workable and has excellent knot security. Disadvantages: high reactivity and infection due to the absorption of body fluids by the braided fibers.

7. Natural Suture Synthetic Synthetic polymers Biological
Do not cause inflammatory response
Nylon
Vicryl
Monocryl
PDS
Prolene
Biological
Cause inflammatory reaction
Catgut (connective from cow or sheep)
Silk (from silkworm fibers)
Chromic catgut

8. Multifilament (braided)
Monofilament
Multifilament (braided)
Single strand of suture material
Minimal tissue trauma
Smooth tying but more knots needed
Harder to handle due to memory
Examples: nylon, monocryl, prolene, PDS
Fibers are braided or twisted together
More tissue resistance
Easier to handle
Fewer knots needed
Examples: vicryl, silk, chromic

9. Suture Selection
Use monofilament on the skin as multifilament harbor BACTERIA
Non-absorbable cause less scarring but must be removed
Absorbable for GI, urinary or biliary
Non-absorbable or extended for up to 6 mos for skin, tendons, fascia
Cosmetics = monofilament or subcuticular

10. Suture Sizes

11. Surgical Needles 2 basic configurations for curved needles
Cutting: cutting edge can cut through tough tissue, such as skin
Tapered: no cutting edge. For softer tissue inside the body

12. Surgical Needles

13. Contraindications to Suturing
Redness
Edema of the wound margins
Infection
Fever
Puncture wounds
Animal bites
Tendon, verve, or vessel involvement
Wound more than 12 hours old (body) and 24 hrs (face)

15. Continuous Locking and Nonlocking Sutures

16. Subcuticular suture

17. Vertical Mattress Good for everting wound edges
(neck, forehead creases, concave surfaces)

19. Suture Removal
Average time frame is 7 – 10 days
FACE: 3 – 5 d
NECK: 5 – 7 d
SCALP: 7 – 12 days
UPPER EXTREMITY, TRUNK: 10 – 14 days
LOWER EXTREMITY: 14 – 28 days
SOLES, PALMS, BACK OR OVER JOINTS: 10 days
Any suture with pus or signs of infections should be removed immediately.

20. THANK YOU