PERIOPERATIVE NURSING SUTURE BY MURSIDI H.A

WHAT IS SUTURE “a thread, wire, or other materials used in the operation of stitching parts of the body together” “to suture is to unite by stitching (sewing) until healing take place” Purposes – ligating bleeding vessels, suturing internal structures, wound closure and retraction purposes

Characteristic of Suture Materials Physical characteristic Monofilament or Multifilament Capillarity Predetermined diameter (caliber) Good tensile strength Knot strength Maintained elasticity Memory capacity

Characteristic of Suture Materials Handling characteristic Pliability (easily bends) Co-efficient of frictions (slip easily) – to prevent tissue drag, knot slippage and to facilitate knot tying Tissue-reaction characteristic Non-allergenic Non-carcinogenic Minimal tissue reactions

TYPES OF SUTURE MATERIALS ABSORBABLE SUTURE “a sterile, flexible strand prepared from collagen derived from healthy mammals or synthetic polymers” Capable of being absorbed by living tissues through hydrolyzed or enzymatic process May be impregnated with coating, softening or anti-microbial agents Varies in treatments, colour, sizes, packaging and resistance to absorption according to purposes

Types of Absorbable sutures COLLAGEN DERIVED Surgical Gut SYNTHETIC DERIVED Coated Vicryl Monocryl PDS DERIVED FROM SILKWORM LARVA Silk suture

TYPES OF SUTURE MATERIALS NON-ABSORBABLE SUTURE “a strands of materials that effectively resist enzymatic digestion in living tissue” May be uncoated or coated with substance to reduce capillarity and friction Encapsulated by tissues around it during healing Required removal of suture after wound healing

Types of Non-Absorbable sutures SYNTHETIC DERIVED Ethilon (Nylon) Prolene Ethibond Monosof SURGICAL WIRE Stainless steel wire

INDIVIDUAL CHARACTERISTIC OF SUTURE (collagen derived absorbable sutures) TYPES RAW MATERIALS INTERACTION USAGE SURGICAL GUT PLAIN (yellow) COLLAGEN DERIVED FROM MAMMALS ABSORBABLE 7-10 DAYS Ligate superficial Vessels, SC tissue, oral mucosa, ophthalmology cases CHROMIC (brown) COLLAGEN DERIVED TREATED WITH CHROMIUM SALTS ABSORBABLE WITHIN TWO WEEKS Fascia or peritoneum Large vessels ties, muscle or mucosal layers (blue) [dye]

INDIVIDUAL CHARACTERISTIC OF SUTURE (synthetic absorbable sutures) TYPES/COLOR RAW MATERIALS INTERACTION USAGE Coated VICRYL MONOCRYL BRAIDED (violet) [undyed] MIXTURES OF LACTIC AND GLYCOLIC ACID POLYMERS AND CALCIUM STEARATE ABSORBED BY SLOW HYDROLYSIS IN TISSUES 2 – 3 WEEKS Ligate or suture tissues for approximation MONO-FILAMENT (Clear) PDS SYNTHETIC POLYMERS UP TO THREE MONTHS Fascial closure, elderly or oncologic patients

INDIVIDUAL CHARACTERISTIC OF SUTURE (synthetic non-absorbable sutures) TYPES/COLOR RAW MATERIALS INTERACTION USAGE ETHILON Nylon MONO- FILAMENT (Green) POLYAMIDE POLYMER NON- ABSORBABLE REMAINS ENCAPSULATED IN BODY TISSUES Skin Closure, retention, plastic surgery, ophthalmology and micro surgery PROLENE Poly- Propylene (Blue) POLYMER OF PROPYLENE Abdominal surgery, General plastic and Cardio-vascular surgery ETHIBOND Polyester Fibre BRAIDED (Green/ White) POLYSTER FIBRE WITH POLYBUTILATE

INDIVIDUAL CHARACTERISTIC OF SUTURE (SILK AND SURGICAL WIRE) TYPES/ COLOR RAW MATERIALS INTERACTION USAGE SILK BRAIDED (Black) PROTEIN FIBRE SPUN BY SILKWORM VERY SLOWLY ABSORBED AND DISSAPEAR AFTER FEW YEARS Most body tissues for ligating and suturing STEEL WIRE MONO OR MULTI- FILAMENT (Silver) AN ALLOY OF IRON (Stainless or Silver wire) NON- ABSORBABLE General and skin closure, tendon repaired, cranioplasty

MONOFILAMENT SUTURES PLAIN GUT PROLENE POLYPROPYLENE STEEL WIRE CHROMIC GUT SILK

BRAIDED/MULTIFILAMENTS SUTURES CHROMIC GUT SILK CHROMIC GUT SILK NYLON VICRYL

TENSILE STRENGTH AND DIAMETER Refer to knot pull strength of the suture rather than straight pull strength Suture diameter refer to the size of the strand (heavy size 7 to fine size of 11-0) SUTURE LENGTH Standardized length - 50 or 60 inches Precut length – 17,18 or 24 inches SUTURE PACKAGING Sealed in a primary inner packet with inside dry and outer, see-through peel-back packet – sterilized Sterility maintained until opened or date of expiry arrived

IDENTIFCATION OF SUTURE SIZE BATCH NUMBER SUTURE NAME SUTURE LENGTH NEEDLE SIZE & SHAPE PRODUCT NAME IDENTIFCATION OF SUTURE

SUTURES COLOUR CODING PACKAGES COLOUR CODE PLAIN GUT YELLOW CHROMIC GUT BROWN SILK LIGHT BLUE NYLON GREEN PROLENE ROYAL BLUE VICRYL PURPLE ETHIBOND ORANGE PDS GREY STAINLESS STEEL SILVER

COLOUR CODING AND PACKAGES OF SUTURES

ASEPTIC TRANSFER OF SUTURE METHOD 1 – Retrieval by scrub person Hold the packet flaps between extended thumbs Rolls hands outward to peel outer packet apart Exposed inner packet (suture) are then grasp by scrub person METHOD 2 – “Flipping” suture packet Standing a safe distance from sterile trolley, the circulator rolls the flaps of the outer package backwards Project (flips) the inner packet onto sterile trolley

ASEPTIC SUTURE TRANSFER TECHNIQUE SUTURE RETRIEVAL TECHNIQUE FLIPPING TECHNIQUE

SURGICAL NEEDLES Made of a steel alloy with high carbon content (stainless steel) Varies in shape, size, point design and wire diameter

ANATOMY OF NEEDLE

BASIC PARTS OF SURGICAL NEEDLES THE EYE ROLLED END ATRAUMATIC REGULAR EYE SPRING EYE SPRING DOUBLE

BASIC PARTS OF SURGICAL NEEDLES THE BODY SHAPE 1/2 Circle 3/8 circle 1/4 Circle 5/8 Circle J shape compound straight ½ curve

GENERAL USES OF NEEDLE ACCORDING TO IT’S SHAPE BODY SHAPE COMMON USAGE Straight Flat or shallow depth of skin wound Circle 3/8 Shallow depth of skin wound Circle ½ and ½ curve General purposes, interior of any wound Circle 5/8 Deepest, smallest maneuvering room wounds such as vaginal hysterectomy, hemorrhoidectomy Circle 1/4 Same as 1/2 circle J Curve Deep inaccessible wound or flat wound

BASIC PARTS OF SURGICAL NEEDLES THE POINT Taper cut Spatulated end Cutting edge Blunt Point

COMMON USAGE OF ATRUMATIC NEEDLES NEEDLE TYPES COMMON USE TAPER POINT Soft tissue closure below skin surfaces, dura, fascia, GI, muscle, nerve, pleura, vessels BLUNT POINT Friable tissues, spleen, liver, kidneys, cervix CUTTING EDGE Ligaments, tendons, calcified or fibrous tissue, thoracic, plastic, Ob & Gyn, scar tissue REVERSE CUTTING Skin closure, retention suture, S/C, ligaments or fibrous tissue, mucosa TAPER CUT Bronchus, calcified tissues, nasal & oral cavity, periosteum, trachea, uterus, vessels SPATULATED CURVED Ophthalmic surgery for muscle and retinal repair, eyelid suturing

WORKING WITH SUTURES AND NEEDLES MOUNTING THE NEEDLE THREADING THE NEEDLE

WORKING WITH SUTURES AND NEEDLES PASSING THE NEEDLE HOLDER WITH SUTURE NEEDLES’ COUNTS

TYPES OF WOUND SUTURING

OTHER METHODS OF WOUND CLOSURE SURGICAL STAPLER SKIN STRIPS & SKIN GLUE

TISSUE REACTION AFTER SUTURING Suture act as a foreign substance Begins when the suture inflicts injury to the tissue during insertion Increased factors include allergic, absorption period, cell reactions and types of suture

Comparison of tissue resorption according to sutures

REMOVAL OF WOUND CLOSURE (SUTURE AND STAPLE)

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