1. PERIOPERATIVE NURSING
SUTURE
BY MURSIDI H.A

2. WHAT IS SUTURE
“a thread, wire, or other materials used in the operation of stitching parts of the body together”
“to suture is to unite by stitching (sewing) until healing take place”
Purposes – ligating bleeding vessels, suturing internal structures, wound closure and retraction purposes

3. Characteristic of Suture Materials
Physical characteristic
Monofilament or Multifilament
Capillarity
Predetermined diameter (caliber)
Good tensile strength
Knot strength
Maintained elasticity
Memory capacity

4. Characteristic of Suture Materials
Handling characteristic
Pliability (easily bends)
Co-efficient of frictions (slip easily) – to prevent tissue drag, knot slippage and to facilitate knot tying
Tissue-reaction characteristic
Non-allergenic
Non-carcinogenic
Minimal tissue reactions

5. TYPES OF SUTURE MATERIALS
ABSORBABLE SUTURE
“a sterile, flexible strand prepared from collagen derived from healthy mammals or synthetic polymers”
Capable of being absorbed by living tissues through hydrolyzed or enzymatic process
May be impregnated with coating, softening or anti-microbial agents
Varies in treatments, colour, sizes, packaging and resistance to absorption according to purposes

6. Types of Absorbable sutures
COLLAGEN DERIVED
Surgical Gut
SYNTHETIC DERIVED
Coated Vicryl
Monocryl
PDS
DERIVED FROM SILKWORM LARVA
Silk suture

7. TYPES OF SUTURE MATERIALS
NON-ABSORBABLE SUTURE
“a strands of materials that effectively resist enzymatic digestion in living tissue”
May be uncoated or coated with substance to reduce capillarity and friction
Encapsulated by tissues around it during healing
Required removal of suture after wound healing

8. Types of Non-Absorbable sutures
SYNTHETIC DERIVED
Ethilon (Nylon)
Prolene
Ethibond
Monosof
SURGICAL WIRE
Stainless steel wire

9. INDIVIDUAL CHARACTERISTIC OF SUTURE (collagen derived absorbable sutures)
TYPES
RAW MATERIALS
INTERACTION
USAGE
SURGICAL GUT
PLAIN
(yellow)
COLLAGEN DERIVED FROM MAMMALS
ABSORBABLE 7-10 DAYS
Ligate superficial Vessels, SC tissue, oral mucosa,
ophthalmology cases
CHROMIC
(brown)
COLLAGEN DERIVED TREATED WITH CHROMIUM SALTS
ABSORBABLE
WITHIN TWO WEEKS
Fascia or peritoneum
Large vessels ties, muscle or mucosal layers
(blue)
[dye]

10. INDIVIDUAL CHARACTERISTIC OF SUTURE (synthetic absorbable sutures)
TYPES/COLOR
RAW MATERIALS
INTERACTION
USAGE
Coated
VICRYL
MONOCRYL
BRAIDED
(violet)
[undyed]
MIXTURES OF LACTIC AND GLYCOLIC ACID POLYMERS AND CALCIUM STEARATE
ABSORBED BY SLOW HYDROLYSIS IN TISSUES
2 – 3 WEEKS
Ligate or suture tissues for approximation
MONO-FILAMENT
(Clear)
PDS
SYNTHETIC POLYMERS
UP TO THREE MONTHS
Fascial closure, elderly or oncologic patients

11. INDIVIDUAL CHARACTERISTIC OF SUTURE (synthetic non-absorbable sutures)
TYPES/COLOR
RAW MATERIALS
INTERACTION
USAGE
ETHILON
Nylon
MONO-
FILAMENT
(Green)
POLYAMIDE POLYMER
NON-
ABSORBABLE
REMAINS ENCAPSULATED IN BODY
TISSUES
Skin Closure, retention, plastic surgery, ophthalmology and micro surgery
PROLENE
Poly-
Propylene
(Blue)
POLYMER
OF PROPYLENE
Abdominal surgery,
General plastic and Cardio-vascular
surgery
ETHIBOND
Polyester
Fibre
BRAIDED
(Green/
White)
POLYSTER
FIBRE WITH
POLYBUTILATE

12. INDIVIDUAL CHARACTERISTIC OF SUTURE (SILK AND SURGICAL WIRE)
TYPES/
COLOR
RAW MATERIALS
INTERACTION
USAGE
SILK
BRAIDED
(Black)
PROTEIN FIBRE SPUN BY SILKWORM
VERY SLOWLY ABSORBED AND DISSAPEAR AFTER FEW YEARS
Most body tissues for ligating and suturing
STEEL
WIRE
MONO OR MULTI- FILAMENT
(Silver)
AN ALLOY OF IRON
(Stainless or
Silver wire)
NON-
ABSORBABLE
General and skin closure, tendon repaired, cranioplasty

13. MONOFILAMENT SUTURES PLAIN GUT PROLENE POLYPROPYLENE STEEL WIRE
CHROMIC GUT
SILK

14. BRAIDED/MULTIFILAMENTS SUTURES
CHROMIC GUT
SILK
CHROMIC GUT
SILK
NYLON
VICRYL

15. TENSILE STRENGTH AND DIAMETER
Refer to knot pull strength of the suture rather than straight pull strength
Suture diameter refer to the size of the strand (heavy size 7 to fine size of 11-0)
SUTURE LENGTH
Standardized length - 50 or 60 inches
Precut length – 17,18 or 24 inches
SUTURE PACKAGING
Sealed in a primary inner packet with inside dry and outer, see-through peel-back packet – sterilized
Sterility maintained until opened or date of expiry arrived

16. IDENTIFCATION OF SUTURE
SIZE
BATCH
NUMBER
SUTURE
NAME
SUTURE
LENGTH
NEEDLE
SIZE &
SHAPE
PRODUCT NAME
IDENTIFCATION OF SUTURE

17. SUTURES COLOUR CODING PACKAGES
COLOUR CODE
PLAIN GUT
YELLOW
CHROMIC GUT
BROWN
SILK
LIGHT BLUE
NYLON
GREEN
PROLENE
ROYAL BLUE
VICRYL
PURPLE
ETHIBOND
ORANGE
PDS
GREY
STAINLESS STEEL
SILVER

18. COLOUR CODING AND PACKAGES OF SUTURES

19. ASEPTIC TRANSFER OF SUTURE
METHOD 1 – Retrieval by scrub person
Hold the packet flaps between extended thumbs
Rolls hands outward to peel outer packet apart
Exposed inner packet (suture) are then grasp by scrub person
METHOD 2 – “Flipping” suture packet
Standing a safe distance from sterile trolley, the circulator rolls the flaps of the outer package backwards
Project (flips) the inner packet onto sterile trolley

20. ASEPTIC SUTURE TRANSFER TECHNIQUE
SUTURE RETRIEVAL
TECHNIQUE
FLIPPING TECHNIQUE

21. SURGICAL NEEDLES Made of a steel alloy with high carbon
content (stainless steel)
Varies in shape, size, point design and wire
diameter

22. ANATOMY OF NEEDLE

23. BASIC PARTS OF SURGICAL NEEDLES
THE EYE
ROLLED END
ATRAUMATIC
REGULAR EYE
SPRING EYE
SPRING DOUBLE

24. BASIC PARTS OF SURGICAL NEEDLES
THE BODY SHAPE
1/2 Circle
3/8 circle
1/4 Circle
5/8 Circle
J shape
compound
straight
½ curve

25. GENERAL USES OF NEEDLE ACCORDING TO IT’S SHAPE
BODY SHAPE
COMMON USAGE
Straight
Flat or shallow depth of skin wound
Circle 3/8
Shallow depth of skin wound
Circle ½ and
½ curve
General purposes, interior of any wound
Circle 5/8
Deepest, smallest maneuvering room wounds such as vaginal hysterectomy, hemorrhoidectomy
Circle 1/4
Same as 1/2 circle
J Curve
Deep inaccessible wound or flat wound

27. BASIC PARTS OF SURGICAL NEEDLES
THE POINT
Taper cut
Spatulated end
Cutting edge
Blunt Point

28. COMMON USAGE OF ATRUMATIC NEEDLES
NEEDLE TYPES
COMMON USE
TAPER POINT
Soft tissue closure below skin surfaces, dura, fascia, GI, muscle, nerve, pleura, vessels
BLUNT POINT
Friable tissues, spleen, liver, kidneys, cervix
CUTTING EDGE
Ligaments, tendons, calcified or fibrous tissue, thoracic, plastic, Ob & Gyn, scar tissue
REVERSE CUTTING
Skin closure, retention suture, S/C, ligaments or fibrous tissue, mucosa
TAPER CUT
Bronchus, calcified tissues, nasal & oral cavity, periosteum, trachea, uterus, vessels
SPATULATED CURVED
Ophthalmic surgery for muscle and retinal repair, eyelid suturing

29. WORKING WITH SUTURES AND NEEDLES
MOUNTING THE NEEDLE
THREADING THE NEEDLE

30. WORKING WITH SUTURES AND NEEDLES
PASSING THE NEEDLE HOLDER WITH SUTURE
NEEDLES’ COUNTS

31. TYPES OF WOUND SUTURING

32. OTHER METHODS OF WOUND CLOSURE
SURGICAL STAPLER
SKIN STRIPS
&
SKIN GLUE

33. TISSUE REACTION AFTER SUTURING
Suture act as a foreign substance
Begins when the suture inflicts injury to the tissue during insertion
Increased factors include allergic, absorption period, cell reactions and types of suture

34. Comparison of tissue resorption according to sutures

35. REMOVAL OF WOUND CLOSURE (SUTURE AND STAPLE)

36. THANK YOU