SUTURE MATERIAL

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

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 This classification scheme has been shown in numerous studies to predict the relative probability that a wound will become infected. Clean wounds have a 1%-5% risk of infection; clean-contaminated, 3%-11%; contaminated, 10%-17%; and dirty, over 27% (2,3,7). These infection rates were affected by many appropriate prevention measures taken during the studies, such as use of prophylactic antimicrobials, and would have been higher if no prevention measures had been taken.

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

Absorbable Non-absorbable Nylon Prolene Stainless steel Not biodegradable and permanent Nylon Prolene Stainless steel Silk (natural, can break down over years) Degraded via inflammatory response Vicryl Monocryl PDS Chromic Cat gut (natural) Nylon (Ethilon®): of all the non-absorbable suture materials, monofilament nylon is the most commonly used in surface closures.  Polypropylene (Prolene®): appears to be stronger then nylon and has better overall wound security. BRAIDED: includes cotton, silk, braided nylon and multifilament dacron. Before the advent of synthetic fibers, silk was the mainstay of wound closure. It is the most workable and has excellent knot security. Disadvantages: high reactivity and infection due to the absorption of body fluids by the braided fibers.

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

Multifilament (braided) 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 tough 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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