Surgical Suture also known as stitches a piece of thread like material use to secure wound edges or body partstogether after an injury or surgery. A variety of suture exists in size strength and durability.Stitches placeddeep inside the wound always requires the use of dissolvable (absorbable) sutures, whereas stitches visible on the skin (placed superficially) may use dissolvable or non-dissolving (non-absorbable) sutures.
Surgical Suture Classification
Surgical sutures as defined by the U.S.P. (United States Pharmacopoeia) are divided into two major classifications based on their reactions with body tissues
- Absorbable sutures
- Description: capable of being absorbed by living mammalian tissue, yet may be treated to modify resistance to absorption source is both natural and synthetic.
- Tissue interaction: absorbable sutures are digested by body enzymes by first losing their strength then gradually disappearing form the tissue.
- Non Absorbable sutures
- Description: material not affected by enzyme activity or absorption in living tissues and are natural and synthetic sources.
- Tissue interaction: non absorbable sutures become encapsulated in fibrous tissue during the healingprocess and remains embedded in body tissues unless they are surgically removed.
- Class 1-silk or synthetic fibers of monofilament, twisted of branded construction.
- Class 2 -cotton or linen fibers or coated natural or synthetic fibers. The coating forms a thickness, yet does not contribute to its strength.
- Monofilament suture is a single strand that is non capillary (Resistant to fluids soaking into the suture) it is designed by the U.S.P.
- Multifilament suture on the other hand is multiple strands of suture held together by a process of twisting,braiding of spinning the material. All multifilament sutures have certain capacity to absorb body fluid(capillarity),which elicits a higher degree of tissue reaction and are classified by the U.S.P. as Type A.
Commonly Use Suture Materials
|Suture||Type||Color||Raw Material||Interaction||Frequent Uses|
|Surgical Gut||Plain||Yellowish tan,Blue (Dyed)||Collagen derived from healthy mammals||Absorbed relatively quickyl by body tissues||Ligate superficial vessels suture subcutaneous and other tissues that heal rapidly may be used in presence of infection.
|Chromic||BrownBlue (Dyed)||Collagen derived form healthy mammals treated to resit digestion by body tissues||Absorbed more slowly by body tissues due to chemical treatment||Fascia and peritoneum for support,most versatile of all materials for use in practically all tissues ,may be used in presence of infection.
|Coated VICRYL(Polyglactin 910)||Braided||Violet (Undyed)||Copolymer of lactide and glycolide coated with polyglactin 370
and calcium stearate
|Absorbed by slow hydrolysis in tissues||Ligate or suture tissues where an absorbable suture is desirable except where approximation under stress is required.|
|Natural protein fiber spun by silkworm||Very slowly absorbed; remains encapsulated in body tissues||Most body tissues for ligating and suturing.Ophtalmology and plastic surgery|
|Surgical Cotton||Twisted||White,blue,pink||Natural cotton fibers||Nonabsorbable;remais encapsulated in body tissues||Most body tissues for ligating and suturing|
|Surgical Steel||Monofilament ormultifilament||Silver colored||An alloy of iron||Nonabsorbable;remais encapsulated in body tissues||General and skin closure;retention;tendon repair;orthopedic and neurosurgery.|
|ETHILON Nylon||Monofilament||Green||Polyamide polymer||Non absorbable;remains encapsulated in body tissues||Skin closure;retention,plastic surgery;ophthalmology,microsurgery|
|NUROLON Nylon||Braided||Black||Polyamide polymer||Non absorbable;remains encapsulated in body tissues||Most body tissues for ligating and suturing;general closure;neurosurgery.|
|MERSILENE Polyester Fiber||Braided||Green,white||Synthetic material made from chemicals||Non absorbable;remains encapsulated in body tissues||Cardiovascular and plastic surgery.|
|ETHIBOND Polyester Fiber||Braided||Green,white||Polyester fiber material treated with polybutilate||Non absorbable;remains encapsulated in body tissues||Abdominal closure;cardiovascular and plastic surgery|
|PROLENE Polypropylene||Monofilament||Clear,blue||Polymer of propylene||Non absorbable;remains encapsulated in body tissues||General plastic and cardiovascular surgery|
The size of suture material is measured by its width or diameter and is vital to proper wound closure. As a guide the following are specific areas of their usage:
- 1-0 and 2-0: Used for high stress areas requiring strong retention, i.e. – deep
- fascia repair
- 3-0: Used in areas requiring good retention, i.e. – scalp, torso, and hands
- 4-0: Used in areas requiring minimal retention, i.e. – extremities. Is the most common size utilized for superficial wound closure.
- 5-0: Used for areas involving the face, nose, ears, eyebrows, and eyelids.
- 6-0: Used on areas requiring little or no retention. Primarily used for cosmetic effects.
- When suturing the edges of a wound together, it is important to evert the skin edges that is, to get the underlying dermis from both sides of the wound to touch. For the wound to heal, the dermal elements must meet and heal together. If the edges are inverted (the epidermis turns in and touches the epidermis of the other side), the wound will not heal as quickly or as well as you would like. The suture technique that you choose is important to achieve optimal wound healing.