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Wednesday 1 February 2012

Sutures, Ligatures and Staples


sutures, ligatures and staples[i]

sutures

·         the purpose of post operative  sutures
o    to allow primary intention wound healing by approximating wound
·         the ideal suture should have those characteristics…
o    easy to handle
o    secure knotting
o    predictable tensile strength and performance
o    sterile
o    does not shrink in tissues
o    pulls thru tissues easily
o    non-electrolytic
o    non-capillary
o    non-allregenic
o    non-carcinogenic
o    does not promote tissue reaction / infection
o    Cheap!
·         Different procedures require different suture material - for e.g.
o    Vascular anastomoses require smooth, non-absorbable material
o    Gastric anastomoses require absorbable material
o    Skin incisions may require support for several days
o    Muscular aponeuroses may require support for several weeks.
·         Therefore, in closing any wound, surgeon must define…
o    the requirements for closure
o    select the suture material
o    Method of suturing

classifications of suture

Sutures may be classified into several groups according to their physical and biochemical characteristics.
·         Classification of sutures
·         Absorbability
o    Absorbable
o    Non-absorbable
·         Construction
o    Monofilament
o    multifilament
·         composition
o    natural fibre
o    synthetic
o    metallic

·         Characteristics of suture material
·         Physical
o    Monofilament
§  Smooth and slide well in sutures
§  Requires careful knotting
§  Requires proper use of forceps and needle holders
·         May result in formation of microfractures in the monofilament
·         Predisposes to fracture of suture
o    Multifilament sutures
§  Several thousand times the surface area of monofilament
·         Easier to handle
·         Good knotting qualities
·         Tend to drag thru tissues
o    Some are lubricated with beeswax, Teflon, silicon etc
§  Can result in capillary action
·         Nidus of infection
·         Tensile behavior
o    Some sutures can have tendencies to return to their former shape, or assume new shape. This is referred to “memory” and can be correlated to elasticity.
§  No Memory
·         Willing to assume and hold new shape
·         Good in knotting
·         May coil (not favourable)
·         May kink (steel)
§  Good memory
·         Bad trait -
o    Harder to handle
o    Tend to knot poorly
·         May need to be pulled sharply (but gently) to remove its curls.
·         Strength and size
o    Generally, the thicker the suture, the stronger it is.
o    Suture is strongest when dry.
o    Weakened by
§  Wetting
§  Knotting
§  Natural absorption
§  Placement in aggressive environment
§  Abuse by grasp by instruments
o    The smallest diameter suture that will adequately hold the healing tissue should be used
§  To minimize trauma as it pass thru tissue
Minimal mass of foreign tissue in body


[i] Kitikbhai A Patel, W E G Thomas; Sutures, Ligatures and Staples.; Surgery 2007 26:2 pg 48-53

1 comment:

  1. Informative post! The data about sutures and classification of suture are really useful and would help somebody for sure.

    ReplyDelete

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