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TIM ILMU BEDAH UMUM

FKH UB
2018
 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
 Physical characteristic
 Physical configuration : mono or multifilament
 Capillarity : ability to soak up fluid along the
strand
 Fluid absorption ability
 Diameter : in milimeters, expressed in USP sizes
with zeroes (0)
 Tensile strenght : amount of weight (Breaking
load) necessary to break a suture (Breaking
strenght)
 Handling characteristics
 Pliability : the material ability to bend
 Coefficient of friction : the material ability to slip
through tissues & ties
 Knot Strenght : force necessary to cause a given
type of knot to slip, partially or completely
Tissue reaction characteristics :
 Inflammatory and fibrous tissue reaction
 Absorption
 Potention of infection
 Allergic reaction
 To bring tissue edges together and speed
wound healing (=tissue apposition)

 Orthopedic surgery to help stabilize joints


– Repair ligaments

 Ligate vessels or tissues


Natural

Origin

Synthetic

Absorbable

SUTURES Absorption

Nonabsorbable

Multifilament
Fiber
construction
Monofilament
 Absorbable Vs. Nonabsorbable

 Monofilament Vs. Multifilament

 Natural or Synthetic
 Internal organs
 Intradermal/ subcuticular
 Rarely on skin
 Primarily Skin
– Needs to be removed later

 Stainless steel = exception


– Can be used internally
▪ Ligature
▪ Orthopedics
– Can be left in place for long periods
 How long you need it
to work

 Do you want to see the


animal again for suture
removal
 Memory  easy to handle
 less tissue drag  more tissue drag
 doesn’t wick  wicks/ bacteria
 poor knot security  good knot security
 - tissue reaction  +tissue reaction
 Natural:
– Gut
– Chromic Gut
– Silk
– Collagen
 All are absorbable
 Sutures which are broken down & eventually
absorbed by either hydrolysis (Synthetic) or
digested by lysosomal enzyme elicited by
WBC’s (natural)

 Mechanism
 Natural Lysosomal enzyme attack & break down strands
 Synthetic water gradually penetrate
Hydrolyzed

suture filaments & break down suture polymer


chain
ADVANTAGES DISVANTAGES

 Broken down by body  Consideration of wound


support time
 No foreign body left
 Derived from submucosal layer of sheep or
the sorosa of cattle intestines, which is
harvested, purified and sterilized
 Its classified by its degree of chromatization
or tanning (treated with chromic acid to
lengthen and standarize absorbtion time
and to reduce the intensity of soft tissue
reaction to the gut)
1. Type A – plain or untreated (absorbed within
3 – 7 days)
2. Type B – Mild chromic treatment (absorbed
within 14 days)
3. Type C – Medium chromic treatment
(absorbed within 20 days)
4. Type D – Extra chromic treatment (absorbed
within 40 days)
 Surgical gut is available in USP size 3 (the haviest),
to 7-0 (the thinnest)
 Not to submerged for long period, because of
hydroscopic
 Three or more throws should be used in tying.
 Capillary and support infection
 Used for general ligation and for surgery of the
gastrointestinal, urogenital and parenchymatous
organs
 Contra indicated for skin suture and implantation
against nervous tissue
 Made of submucosa of
small intestines

 Multifilament

 Breaks down by
phagocytosis:
inflammatory reaction
common
 Chromic: tanned, lasts
longer, less reactive

 Easy handling

 Plain: 3-5 days


 Chromic: 10-15 days

 Bacteria love this stuff!


 Are prepared from bovine tendon as homogenous
extrusion of collagen fibers
 Uniform size
 Ties well
 Handles as well as catgut
 Cause less inflamatory than gut
 Prematurely absorbed and may loose strength in
vivo
 Natural sutures

 VERY reactive,
absorbable

 Ophthalmic surgery
only
 Synthetic absorbable suture that is
copolymer of lactide and gycolide
 Similar use and attributes to PGA exept that
may be braided or monofilament
 Maintain tensile strength for about 3 weeks
and is absorbed within 90 days by hydrolisis
 Braided, synthetic, absorbable
 Stronger than gut: retains strength 3 weeks
 Broken down by enzymes, not phagocytosis
 Break-down products inhibit bacterial growth
– Can use in contaminated wounds, unlike other
multifilaments
 Woven from fine filementous threads extracted
from hydroacetic acid
 Suture size is determine by the number of
woven strands
 Handle well, but the knot tend to slip
 High coefficient of friction and tens to cut friable
tissue
 Uniformly absorbed in 40-60 days
 Less reactive than surgical gut with similar
indication
 Don’t use in tissue that heal slowly or in
mucosa of urinary bladder or urethra
(prematurely absorbed in urine)
 Polymer of glycolic acids
 Braided, synthetic, absorbable
 Broken down by enzymes
 Both PGA and dexon have increased tissue
drag, good knot security
 Both are stronger than gut
 Synthetic monofilament absorbable suture
 Less drag in tissue and may be used more
effestively in friable tissues
 Safe in use in urologic surgery

Other absorbable suture materials


 Kangaroo tendon (tail ), fascia lata and dura
 Synthetic, absorbable
 Monofilament (less drag,
worse knot security – lots
of “memory”)
 Very good tensile strength
 better than gut, vicryl,
dexon, which lasts
months
 Absorbed completely by
182 days
 Monofilament- memory
 Synthetic Absorbable
 Very little tissue drag
 Poor knot security
 Very strong
 Natural or Synthetic
 Monofilament or multifilament
ADVANTAGES DISVANTAGES

 Permanent wound support  Foreign body left


 They can be used to suture  Suture removal can be
tissues which need long costly and unconvenient
term support  Sinus & extrusion if left in
place
 Synthetic
 Mono or Multifilament
 Memory
 Very little tissue reaction
 Poor knot security
 Vetafil, Braunamid, Supramid
 Multifilament suture with protein coating
 Synthetic
 Good knot security, easy handling
 Not very reactive
 Don’t use in contaminated wound
 Usually comes on a reel
 Prolene, Surgilene
 Monofilament, Synthetic
 Won’t lose tensile strength over time
 Good knot security
 Very little tissue reaction
 Monofilament
 Strongest !
 Great knot security
 Difficult handling
 Can cut through tissues
 Very little tissue reaction, won’t harbor
bacteria
 Sized #5-4-3-2-1-0-00-000-0000…30-0
– BIGGER >>>>>>>>>>>>>>>>SMALLER
 00 = 2-0, “two ought”

 SA : 0 through 3-0 (Optho 5-0 >>7-0)

 LA : 0 through 3
 Stainless Steel
– In gauges (like needles)
▪ Smaller gauge = bigger, stronger
▪ Larger gauge= smaller, finer

– 26 gauge = “ought”
– 28 gauge = 2-0
 Generally 4 “throws” for >90% knot security
(nylon may need 5)
– Less “throws” = more likely to untie itself

 Stainless steel = exception again


– 2 “throws” = 99% knot security
Physical characteristic
 Durability
- fascia (2-0 or 0), large animal (0 to 2)
- ligation of large vessels (0 to 2-0)
- dense connective tissue (0 to 3-0) small animal,
0 to 2 in large animals
- skin and subcutaneous tissue (0 to 4-0)
- thin skin, skin grafts, small vessels (3-0 to 4-0)
- gastrointestinal and urogenital surgery (3-0 to 4-0)
- vascular sutures (3-0 to 6-0)
- nerve sheats (5-0 to 6-0)
 Very common in human medicine
 Expensive
 Very easy
 Very secure
 Very little tissue reaction
 Removal =
– Special tool required
 Nexaband, Vetbond,
and others

 Little strength

 Should not be placed


between skin layers or
inside body
 Eyed needles
– More Traumatic
– Only thread
through once
– Suture on a reel
– Tends to unthread
itself easily
 Swaged-on
needles
– Much less traumatic
– More expensive
suture material
– Sterile
 Taper
– Atraumatic
– Internal organs
 Cutting
 Cutting edge on
inside of circle
 Skin
 Traumatic
 Reverse Cutting
 Cutting edge on
outside of circle
 Skin
 Less traumatic than
cutting
 Curved- deep tissue
 Straight/half curved – superficial tissue
 Needle points generally classified as:
 taper (cutting)
 blunt (noncutting)(suturing liver or kidney)
 Cutting point:
 triangular cutting
 reverse cutting
 side cutting
 flat spatula
 modified spatula
 Body or shaft of suture needles varies in wide
range of: gauge, length, shape
 And may be: round, oval, flat, angular, ribbed
 Needle shape size