1. Dr. Muath Mustafa Dept of Surgery, BMC HOD. Dr. Ashraf Balbaa
Sutures and Suturing
Dr. Muath Mustafa
Dept of Surgery, BMC
HOD. Dr. Ashraf Balbaa

2. Definition:
Suture is a generic term for all materials used to bring served body tissue together and to hold these tissues in their normal position until healing takes place
A ligature is a strand of suture material used to tie off (seal)blood vessels to prevent hemorrhage and simple bleeding or to isolate a mass of tissue to be excised (cut out)

3. History: 50,000 BC Eyed needles are invented
1600 BC One of the earliest known references to suture material. Sutures are made from flax, hemp, bark fiber, hair, etc
Joseph Lister proves that the body absorbs catgut sutures. However he is most famous for demonstrating the need for antiseptic techniques for sterilization of implanted sutures.
George Merson begins the sale of eyeless needled sutures where one strand of suture material is attached to the butt of the needle. This type of swaged needle is still in use and is the standard today.
1947 Introduction of Nylon.
1972 First synthetic absorbable suture introduced.
2000 Distribution of gut material ends in many parts of Europe and Japan due to Bovine Spongiform Encephalopathy (“Mad Cow Disease”)

4. Why do we need sutures? 1- Provide an adequate tension of wound closure without dead space but loose enough to obviate tissue ischemia and necrosis. 2- Maintain hemostasis. 3- Permit primary intention healing 4- Reduce postoperative pain

5. 5- Provide support for tissue margins until they have healed and the support no longer needed 6- Prevent bone exposure resulting in delayed healing and unnecessary resorption 7- Permit proper flap position

6. Ideal sutures:
Can be used in any tissue
Easy to handle
Good knot security
Minimal tissue reaction
Unfriendly to bacteria
Strong yet small
Won’t tear through tissues
Cheap

7. Types of sutures: ABSORBABLE SUTURE TYPES Synthetic Natural
Synthetic Absorbable
Natural
Short-Medium
Short
Fast Absorbing Gut
Plain Gut
Medium
Chromic Gut
Virtual Monofilament
Natural Absorbable
Synthetic
Monofilament
Braided
Short / Medium
Long
Short
Medium
PDS (polydioxanone) Suture
VICRYL (polyglactin ) Suture
MONOCRYL (poliglecaprone ) Suture
Coated VICRYL (polyglactin ) Suture

8. Natural Synthetic NON-ABSORBABLE SUTURE TYPES Surgical Stainless Steel
Braided
Monofilament
Surgical Stainless Steel
Silk Suture
Synthetic
ETHIBOND EXCEL Polyester Suture
MERSILENE Polyester Fiber Suture
NUROLON Nylon Suture
PRONOVA Poly (Hexafluoropropylene - VDF) Suture
PROLENE Polypropylene Suture
ETHILON Nylon Suture

9. Mechanisms of degradation of Sutures: Natural Sutures
Sutures made of material that can be found in nature
Absorption method (if absorbable): Enzymatic reaction (proteolysis)
Synthetic Sutures
Sutures made of materials created by man
Absorption Method (if absorbable): Hydrolysis – breakdown in the presence of water or moisture

10. Types of surgical wounds:
Class I
Clean
Uninfected wound in which no inflammation is encountered and respiratory, alimentary, genital, or uninfected urinary tract is not entered.
Class II
Clean-contaminated
Operative wound in which respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
Class III
Contaminated
Open, fresh, accidental wounds.
Class IV
Dirty-infected
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera.

11. Types of needles:
Eyed needles
More Traumatic
Only thread through once
Suture on a reel
Tends to unthread itself easily

12. Swaged-on needles Much less traumatic More expensive suture material
Sterile

13. Points of Needles
Taper
Atraumatic
Internal organs

14. Cutting
Cutting edge on inside of circle
Skin
Traumatic

15. Reverse Cutting Skin Less traumatic than cutting
Cutting edge on outside of circle
Skin
Less traumatic than cutting

16. Cutting vs Reverse Cutting

17. Shapes of Needles
3/8 circle
1/2 circle
Straight
Specialty

18. Problems Associated with Surgical Sutures
Time-consuming nature of secure knot tying
Need for knot security under all conditions with all sutures
Risk of suture breakage during surgery
Loss of control due to needle slippage or rotation within the needle holder
Postsurgical slippage of the knotted suture
Early or pathologically induced degradation of absorbable suture

19. THANK YOU