SUTURE MATERIAL Critical Wound Healing Period Tissue Skin

SUTURE MATERIAL

Critical Wound Healing Period Tissue Skin 5 -7 days Mucosa 5 -7 days Subcutaneous 7 -14 days Peritoneum 7 -14 days Fascia 14 -28 days 0 5 7 14 21 Tissue Healing Time/Days 28

Surgical Wound Classification �Clean: (1 -5% risk of infection) Operative incisional without penetrating infectious organs �Clean-contaminated: (3 -11% risk) operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and without unusual contamination. the biliary tract, appendix, vagina, and oropharynx

Surgical Wound Classification �Contaminated: (10 -17% risk) open, fresh, accidental wounds, operations with gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent �Dirty or infected: (>27% risk) old traumatic wounds , necrotic tissue, perforated viscera postoperative infection predicted

Types of Sutures �Absorbable or non-absorbable (natural or synthetic) �Monofilament or multifilament (braided) �Sizes 3 to 12 -0

Non-absorbable Not biodegradable and permanent Absorbable Degraded via inflammatory response Nylon Vicryl Prolene Monocryl Stainless steel PDS Silk (natural, can Chromic break down over years) Cat gut (natural)

Natural Suture Synthetic Biological Cause inflammatory reaction Catgut (connective from cow or sheep) Silk (from silkworm fibers) Chromic catgut Synthetic polymers Do not cause inflammatory response Nylon Vicryl Monocryl PDS Prolene

Monofilament Multifilament (braided) Single strand of suture material Minimal tissue trauma Smooth tying but more knots needed Harder to handle due to memory Examples: nylon, monocryl, prolene, PDS Fibers are braided or twisted together More tissue resistance Easier to handle Fewer knots needed Examples: vicryl, silk, chromic

Suture Selection �Use monofilament on the skin as multifilament harbor BACTERIA �Non-absorbable cause less scarring but must be removed �Absorbable for GI, urinary or biliary �Non-absorbable or extended for up to 6 mos for skin, tendons, fascia �Cosmetics = monofilament or subcuticular

Suture Sizes

Surgical Needles � 2 basic configurations for curved needles �Cutting: cutting edge can cut through tissue, such as skin �Tapered: no cutting edge. For softer tissue inside the body

Surgical Needles

Contraindications to Suturing �Redness �Edema of the wound margins �Infection �Fever �Puncture wounds �Animal bites �Tendon, verve, or vessel involvement �Wound more than 12 hours old (body) and 24 hrs (face)

Continuous Locking and Nonlocking Sutures

Subcuticular suture

Vertical Mattress Good for everting wound edges (neck, forehead creases, concave surfaces)

Suture Removal �Average time frame is 7 – 10 days �FACE: 3 – 5 d �NECK: 5 – 7 d �SCALP: 7 – 12 days �UPPER EXTREMITY, TRUNK: 10 – 14 days �LOWER EXTREMITY: 14 – 28 days �SOLES, PALMS, BACK OR OVER JOINTS: 10 days �Any suture with pus or signs of infections should be removed immediately.

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