1. Wound Healing Suture & Needles John P. Hunt LSU New Orleans Department of Surgery

2. Objectives Understand basic science of wound healing Relate this to clinical wound care Learn different types of suture & there applications Understand the different types of needles available and there uses

3. The cells that are central to wound healing are: A) Fibroblasts B) Macrophages C) Polymorphic Neutrophils D) T-cells E) B-cells American Board of Surgery In-training Exam - 2012

4. Ans – B PMN’s arrive at the site of injury in 24-48 hours, but are gone with another 24 to 48 hours. There primary function involves phagocytosis and release of superoxides. Macrophages peak in the wound at approximately three days post-injury. They have numerous tasks which include phagocytosis, oxidative species production, wound debridement, elaboration of growth factors to stimulate fibroblast production of extracellular matrix materials and production of enzymes to destroy injured cellular matrix components (collagenase and elastase), and elaboration of growth factors to stimulate angiogenesis. Fibroblasts occur in the lag phase of wound healing and typically arrive 3-5 days post-injury and are responsible for collagen formation. T-cells peak at the 5 th day and do receive antigen from macrophages. B-cells have little to do with wound healing and may even exhibit an inhibitory effect.

6. Phases of Wound Healing

11. The most common collagen found in skin and bone is: A) Type I B) Type II C) Type III D) Type IV E) Type VI

12. Ans – A The most common collagen found in adults is type I comprising 80% of all collagen found in skin and bone. The majority of the remaining 20% is type III. There are higher concentrations of type III collagen in children and early wound healing. Type II collagen is found predominantly in articular surfaces. Type IV collagen is found in basal lamina.

13. Phases of Wound Healing Wound strength is directly proportional to Type I collagen content Maximum strength is 80% of original and does not occur for 1-2 years

14. Layers of Bowel Mucosa- epithelial cells lamina propria muscularis mucosa Submucosa- Collagen Muscularis propria- smooth muscle Serosa- mesothelium connective tissue

15. Intestinal Anastomoses Strength-Submucosa Collagenase Versus Collagen Deposition Weakest at 3-7 days

16. Wound Healing Times Days

17. Wound Healing Impediments Tension Blood supply Infection Hypovolemia/Shock Immunodeficiency Blood Transfusion Malnutrition Medication

18. Suture & Needles

19. Identifying suture/needles

20. Suture Types Absorbable versus Non-absorbable Monofilament versus Braided Synthetic versus Natural

21. Suture Strength #5 = 5 #4 = 4 #3 = 3 #2 = 2 #1 = 1 0 = 0 2-0 = 00 3-0 = 000 4-0 = 0000 5-0 = 00000 6-0 = 000000 Etc.

22. Suture Strength 6-05-04-03-02-00#1#2

23. Suture Strength

24. Vicryl –75% of strength at 2 weeks –50% of strength at 3 weeks

25. Suture Strength

26. Anatomy of a Needle

27. The Point Tapered needles Cutting needles Blunt needles Combination

28. Needle Types

29. Reading the Packaging

30. Non-Absorbable Suture NaturalSynthetic MonofilamentBraidedMonofilamentBraided SteelSilk Nylon Prolene Ethibond Mersilene Sternal closure Ortho Abdomen Ubiquitous Not skin/SubQ Vascular Skin Adbomen Hernia Abdomen

31. Absorbable Suture NaturalSynthetic MonofilamentBraidedMonofilamentBraided Chromic Gut X PDS Monocryl Vicryl Dexon Liver GU SubQ X Hepato-biliary GU Skin GI Skin/SubQ GU Abdomen