SUTURES APPLICATION OF MEDICAL TEXTILE

Suture means, to sew or seam.

Sutures are the integral part of the surgical process used to close cuts and incision to ligate blood vessel and to draw tissue together and thereby preventing further infection

The suture is used to bring

The edges of wound in close approximation, to retain the medicated plug for dressing in deep wound or cavity, To close any accidental opening To keep the lips of a deep extensive open wound in contact temporarily To check recurrent hemorrhage

Selection of the suture

Impact on the wound healing process Minimum reaction with tissue and maximum healing Good elasticity and good plasticity to accommodate wound swelling Physical and mechanical properties Handling properties Knotting properties &Easy to sterilize

Non electrolytic
Non allergic Cheap

Suture characteristics
Suture choice should be based on the patience, the wound, the tissue characteristic and the anatomic location In different situations and with differences in tissue composition throughout the body, the requirement for adequate wound closure require different suture characteristic. Suture possesses the characteristics that determine the utility

terms describe various characteristics related to suture material

Breaking strength Capillarity Elasticity Fluid absorption Knot-pull tensile strength Knot strength Memory Plasticity

CLASSIFICATION OF THE SUTURE

SUTURE MATERIAL

ABSORABLE

NON ABSORABLE

NATURAL Collagen, Surgical gut

SYNTHETIC Polyglactin Polysorb

NATURAL Silk, cotton steel

SYNTHETIC

Nylon, polyester

ABSORABLE SUTURE
Calgut ,polydioxa one, polyglycolic acid Used for deep tissue ,membranes & subcuticular skin closure

ABSORABLE - SUTURE
may be used to hold wound edges in approximation temporarily, until they have healed sufficiently to withstand normal Stress Natural absorbable sutures are digested by body enzymes which attack and break down the suture strand. Synthetic absorbable sutures are hydrolyzeda process by which water gradually penetrates the suture filaments, causing the breakdown of the suture's polymer chain Some are absorbed rapidly, while others are treated or chemically structured to lengthen absorption time.

Absorbable - sutures inherent limitations

If a patient has a fever, infection, or protein deficiency, the suture absorption process may accelerate, causing too rapid a decline in tensile strength. if the sutures become wet or moist during handling, prior to being implanted in tissue, the absorption process may begin prematurely.

Non-absorbable
Polyester ,nylon ,stainless steel Silk*
(*not a truly permanent material; known to be broken down over a prolonged period of timeyears)

Used for skin (removed) and some (tendon,vessels nerve repair-not removed)

deep

structure

Non-absorbable
not digested by body enzymes or hydrolyzed in body tissue. They are made from a variety of non biodegradable materials and only used when long term support is required

Exterior skin closure, to be removed after sufficient healing has occurred and tissue reaction is slow
Within the body cavity, where they will remain permanently encapsulated in tissue. Patient history of reaction to absorbable sutures, keloidal tendency, or possible tissue hypertrophy.

Suture Classification
Mono filament Multi filament (braided)

Monofilament Suture
Grossly appears as single strand of suture material; all fibers run parallel

Minimal tissue trauma

Resists harboring microorganisms Ties smoothly Requires more knots than multifilament suture Possesses memory Examples: Monocryl, PDS, Prolene, Nylon

Multifilament Suture
Fibers are twisted or braided together Greater resistance in tissue Provides good handling and ease of tying Fewer knots required Examples: Vicryl (braided) Chromic (twisted) Silk (braided

Braided

v Monofilament

1. 2. 3. 4.

5.
6.

Has capillary action Increased infection risk Less smooth passage Less tensile strength Better handling Better knot security

1. No capillary action 2. Less infection risk 3. Smooth tissue passage 4. Higher tensile strength 5. Has memory 6. More throws required

Silk
Natural
Silk, linen, catgut

Catgut

Synthetic polymer
Polypropylene, polyester, polyamide

Polypropylene

Polyester

Suture Degradation
Method of Degradation Time to Degradation

Suture Material

Catgut

Proteolytic enzymes

Days

Vicryl, Monocryl

Hydrolysis

Weeks to months

Suture Size Sized according to diameter with 0 as reference size

Numbers alone indicate progressively larger sutures (1, 2, etc)

Numbers followed by a 0 indicate progressively smaller sutures (2-0, 4-0, etc)

Smaller --------------------------- Larger .....3-0...2-0...1-0.....1...2...3.....

Latest development in suture

Radioactive sutures and other fibrous surgical products Smart sutures Suture of polylactic acid