1. Suture material what to choose how to handle
Dr Jameel miro

2. Suture Characteristics
Tensile Strength
Related to suture size (see below)
Related to weight required to break a suture
Knot strength
Force required for a knot to slip
Configuration
Monofilament (less risk of infection)
Braided multifilament (easier to handle and tie)
Elasticity
Degree suture stretches and return to original length
Memory or suture stiffness
High memory: Suture stiff, difficult handling, unties
Tissue reactivity (inflammatory response to suture)
Reaction peaks in first 2 to 7 days

3. Ideal suture material The ideal suture material should
Have good handling characteristics
Not induce a significant tissue reaction
Allow secure knots
Have adequate tensile strength
Not cut through tissue
Be sterile
Be non-electrolytic
Be non-allergenic
Cheap and sterile

4. Choice of a suture Choice of suture depends on:
Properties of suture material
Absorption rate
Handling characteristics and knotting properties
Size of suture
Type of needle

5. Classification of Sutures
Monofilament
Multifilament
Synthetic
Biological
Absorbable
Non - Absorbable
Contains the key characteristics of a suture
Six specific attributes that can be separated into three pairs:-
Monofilament / Multifilament
Synthetic / Biological
Absorbable / Non – Absorbable

6. Absorbable Advantages Broken down by body No foreign body left
Disadvantages
Consideration of wound support time
These materials are broken down by the body after implementation.
Advantages
Main advantage is that no foreign body is is left permanently in the patient which could precipitate long term problems.
Disadvantages
A suture must provide support to a tissue for as long as it’s necessary. If the suture absorbs too quickly, it could lead to wound failure.

7. Non - Absorbable Advantages Permanent wound Support Disadvantages
Foreign body left
Suture removal can be costly and inconvenient
Sinus & Extrusion if left in place
Advantages
Permanent wound Support
These are materials which are not broken down by the body, remaining in place permanently.
However, it should be noted that some materials are included in this category which can eventually be broken down.
For example, silk is broken down by the body over a period of years but it is still considered to be non – absorbable.
Advantages
They can be used to suture tissues which need long term support, they provide permanent wound support. For example, prosthetic heart valve implants must obviously be held in place by a suture that will never lose its strength.
Disadvantages
The disadvantage of a non – absorbable suture is that a foreign body is left in the patient.
If used for skin suturing there is a strong economic case for considering the use of absorbables to avoid the hidden costs and inconvenience of suture removal. Patients can become anxious about suture removal or require transport and a carer to attend. Occasionally patients may leave sutures in too long and present at another location for wound care.
This presence of a foreign body can cause a wound sinus to form. A sinus is a track communicating with an abscess and the skin.
In extreme cases, a sinus forms and the body physically expels the suture. Thus is known as suture extrusion.

8. ETHICON Absorbable Sutures
Wound Support
Mass Absorption
Typical Uses
Skin
Perineum
Orals
VICRYL* rapide
10 days
By 42 days
Ligature
Mucosa
Obstetrics
Bowel
Skin
20 days
MONOCRYL*
days
Ligature
General
Bowel
Ophthalmic
Coated VICRYL*
30 days
days
Coated VICRYL* Plus Antibacterial Suture
Summary
Reiterate
ETHICON has a portfolio of absorbable sutures that cover a range of uses with various specifications.
From the short term properties of Coated VICRYL* rapide Suture, to the long term strength and reliability of PDS* II Suture.
We are continuing to push the boundaries of wound closure using absorbable sutures which is has been proved through the development and launch of Coated VICRYL* Plus Suture.
Ligature
General
Bowel
Orthopaedics
30 days
days
Traumatology
Ligaments
Fascia
Vessel anastomosis
60 days
days
PDS* II

9. Anatomy of a Surgical Needle
The Anatomy of a Surgical Needle will now be considered. We shall examine the aspects illustrated.
Needle Point : Penetration of a needle is dependant on the point. Each specific point is designed and produced to the required degree of sharpness to penetrate smoothly the types of tissues to be sutured.
Chord Length : The straight line distance from the point of a curved needle to the swage. This can vary from 2mm to more than 2 inches. Length is a determining factor in the width of bite taken by the needle.
Swage : This is the area in which the suture is attached to the needle. The swage area is of specific importance to the relationship of needle and suture thicknesses. It is also the weakest point of the needle.
The objective of the swage area is to achieve the closest one-to-one suture needle ratio as possible. A one-to-one needle ratio reduces additional trauma which may be caused by the needle or the suture and in addition prevents leakage in anastomotic procedures.
Needle Diameter : The gauge or thickness of the needle wire. Needle Diameter various from 30 microns to over 1mm The diameter equals the size of the needle track - except with spatulated or cutting designs.
Needle Radius : If the curvature of the needle were to continue to make a full circle, the radius of the curvature is the distance from the centre of the circle to the body of the needle. Think of the needle as part of a circle.

10. Needle passing through skin
Use of Needle Holders
Loading Needle
Needle Body : Is the portion between point and swage and is used as the grasping area.
Needle Arming : The needle should be grasped in the middle to 1/3 of the distance from the swage area to the point. The needle should be placed securely in the tip of the needle holder jaws.
After the needle has penetrated the tissue, the needle holder can be used as shown to pull the needle and suture through.
Good suturing technique dictates that the needle should only penetrate one side of the wound at a time, it should not bridge both sides of the wound.
Needle passing through skin

11. Needle Shapes Nasal cavity Nerve Skin Eye Microsurgery Tendon Dura Eye
Fascia
Nerve
Eye (Anterior
segment)
Muscle
Eye
Skin
Peritoneum
Laparoscopy
Needles are available in various shapes to accommodate the desired depth of bite and the desired "turnout" in specific tissue. The available shapes are shown on the slide.
Selection of the needle shape is dependent on the size and depth of the area to be sutured. Use of the 1/4 circle needle is often limited to ophthalmic and microsurgical procedures.
A commonly used curved needle is the 3/8 Circle. These needles can be easily manipulated in relatively large and superficial wounds such as closure of the dermis.
Because a large arc of manipulation is required, 3/8 Circle needles can be awkward or impossible to use in deep cavities such as the pelvis or in other small difficult to access locations.
A 1/2 Circle needle is relatively easy to use in these confined locations, although it requires more rotation of the wrist than a 3/8 circle.
The tip of a 1/2 circle needle can become obscured by tissue deep in the pelvic cavity for example. When this occurs the surgeon may have difficulty locating the point to reposition the needle holder and pull the needle through tissue. A 5/8 Circle needle may be useful in this situation, as may a 'J' needle.
Straight needles are generally used for skin and compound curved needles for Ophthalmics.
Cardiovascular
Oral
Pelvis
Urogenital tract

12. Round Bodied Needles TAPERPOINT
Round bodied needles are designed to separate tissue fibres rather than cut them. They are used in situations where easy splitting of tissue fibres is possible. They do not have cutting edges.
TAPERPOINT NEEDLES are often preferred where the smallest possible hole in tissue and minimal tissue trauma is desired.
Taper point needles are used primarily on soft tissues, such as peritoneum, abdominal fascia, blood vessels, ureters and subcutaneous tissue.

13. Cutting Needles Conventional Cutting Reverse Cutting PRIME P Needle
Cutting needles are required whenever dense or tough tissue is encountered.
CONVENTIONAL CUTTING needles have the third cutting edge on the inside curvature of the needle.
REVERSE CUTTING needles have a cutting edge on the outer convex curvature of the needle.
Common applications for these needles are : Closure of skin and various plastic surgery applications and for orthopaedic procedures.
Reverse cutting needles are stronger than conventional cutting needles because of their different triangular shape.
PRIME NEEDLES are specialised skin needles which utilise a slimmer wire for use in finer applications.
The unique hollow form point design improves penetration over needles of this type which were supplied for Plastic and cosmetic surgery.
PRIME needles are available in both Conventional and Reverse cutting versions.
P Needles are made of ethalloy – a stronger material which resists bending.

14. Packaging… Imperial Gauge Product (re-order) Code Metric Gauge
Needle size
& curvature
Needle type
Needle point
This slide outlines the key markings that are on the suture box.
Each diagram / image is an important piece of information regarding the suture / needle.
Needle profile
Batch Number
Do Not Re-use
Sterilised
Ethylene Oxide
Expiry date
See Instructions for use

15. Don’t forget to
Practice
Thank you