Danica Maezzie Dee BSN3 Types of Suture

The "Running" stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema Running, or during the wound healing process. However, there is a greater potential for Continuous Stitch malapproximation of wound edges than with the interrupted stitch. Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch. Interrupted Stitch A double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge. Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue. A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as a hernia or an appendiceal stump.

Mattress Suture

Purse String A double loop technique alternating near and far stitches. Commonly used for approximating fascial edges. Smead-Jones/Farand-Near A self-locking running stitch used primarily for approximating skin edges.

Continuous Locking, or Blanket Stitch

2) Suture Types Absorbable Sutures o Polyglycolic Acid Sutures o Polyglactin 910 Sutures o Catgut Sutures o Poliglecaprone Sutures o Polydioxanone Sutures b. Non-absorbable Sutures o Polypropylene Sutures o Polyamide / Nylon Sutures o Polyester Sutures o Silk Sutures o Polyvinylidene fluoride / PVDF Sutures o Stainless Steel Sutures
In general, sutures can be divided into absorbable and non-absorbable: Non-absorbable sutures: Generally used to close skin, and must be removed after wound healing is complete. These sutures are fine/thin, hassle-free, unlikely to leave marks, unlikely to get infected, and may be removed by the patient (on the 7th or 8th day.). The non-absorbable sutures are "non- reactive" to the body's immune response, so they need to be removed when placed through the skin. Types of non-absorbable sutures include: synthetic (nylon and polypropylene, which are inert), silk (animal protein) and cotton. Non-dissolving stitches are usually coloured blue or black to make them more visible against the blood red of a wound. They have a smooth surface that usually allows them to be removed easily. Absorbable (self-dissolving) sutures: These are degraded by the body's enzymatic pathways through a reaction against "foreign" material. Phagocytes carried by the blood- stream attack and destroy the stitch material. They are not intended to be used on the surface of the skin. Absorbable sutures can also be used to close skin but only in a subcuticular or completely buried pattern. Absorbable sutures should not be exteriorized. They work better when used on internal surgery (buried inside) where the body can break them down easier, and if scar tissue should develop, it is not visible. In circumcisions, the problem with self-dissolving stitches is skin tunnels, which are like piercings, that never go away. When used for a circumcision, the stitch passes through the dry outer layer of skin where the blood-stream cannot reach the stitch, so a hole remains. If the dissolving process is relatively slow, the natural healing process forms a tunnel around the stitch. A stitch scar (or tunnel) internally is no problem, but at the site of a circumcision it is unsightly. The

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probability of scarring or tunnels if the stitches are left in longer than needed leads to the advice to remove them at about 7 days after circumcision, by which time the two cut surfaces of skin will have joined together sufficiently. It is quite possible to manage without any stitches for a circumcision, so there is plenty of safety margin in the 7-day recommendation. Removal of the stitches eliminates a source of irritation and increases comfort noticeably. Some urologists may prefer self-dissolving stitches simply because then they don't have to go necessarily through the procedure of removing them afterwards. Types of self-dissolving sutures: * Catgut (old technology): Natural fibre made from the submucosa of the bovine intestine. Excites considerable inflammatory reaction and tends to potenciate infections. It loses strength rapidly and it's of little use in modern surgery. Plain catgut dissolves more quickly than the type treated with chromium salts. * Vicryl / Dexon (Polyglactin): Dissolves slower than catgut, but causes less of a reaction on implantation. Used below the surface of the skin. Also used in areas where suture removal might jeopardize the repair such as with small children who might not easily cooperate with suture removal. * Vicryl Rapide: Similar substance to Vicryl, but absorbed in a shorter period (5 days). Recent development, worth asking your surgeon about. * Monocryl: The least reactive substance of this group, and should leave least scarring. Unfortunately this is not a very soft material and may be slightly irritating while the stitches are in place. Sutures also come either as monofilament or braided: * Monofilament sutures cause less reaction than do braided sutures but require more ties to assure an adequate maintenance of the knot compared to braided suture. Monofilament sutures are usually non- absorbable. * Braided suture usually incites a greater inflammatory response but requires fewer ties to maintain the knot integrity. These include silk, cotton and Mersilene. The strength of the sutures varies according to their size, which can be determined by a uniformly applied number. For example, a 6-0 suture is more delicate and has less strength than a 4-0 suture. The surgeon uses as many stitches as necessary to approximate the wound edges. Every stitch becomes a foreign body and becomes the source of an additional wound, so one must use what is required and no more.