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