1. ST230 Concorde Career College
Suture, Needles, Staplers, Wound Closure Techniques, & Wound Closure Devices
ST230
Concorde Career College

2. Objectives Define the term suture as a noun and as a verb.
List the specifications for suture material and describe the importance of each.
Describe the suture selection process.

3. Objectives
List and describe the ideal characteristics for suture material and surgical needles.
Identify the types and sizes of suture material, provide examples of each, and describe the type of tissue usage appropriate for each type.

4. Objectives
Identify the types and sizes of surgical needles, provide examples of each, and describe the type of tissue usage appropriate for each type.
Describe suture packaging, list the information found on the suture package, and explain its importance.

5. Objectives
Identify types of stapling and ligating devices and provide examples of when each may be utilized.

6. Objectives
Identify types of alternative wound closure materials, tissue adhesives, and tissue repair and replacement materials and provide examples of when each may be utilized.

7. Definition
Suture
Noun

8. Definition
Suture
Verb
(It’s what you do…)

9. Brief Suture History
3000 BCE - Linen strips and animal sinew (tendon) were used to close wounds with needles made of bone
600 BCE - Cotton, leather, horsehair, and bark fiber from trees was used to close wounds

10. Brief Suture History
Lister (late 1800s) was the first to use a bacteriocide (carbolic acid) on suture
Suture manufacture and sterilization started in the early 20th Century
First synthetic absorbable suture was produced in the 1960s

11. Brief Suture History
Sinew
(wolverine)

12. Brief Suture History
Suture Needle
(buffalo bone)

13. Specifications for Suture Material
Must be sterile and sterile technique must be used when handling
Uniform tensile strength
Uniform size
Appropriate diameter for tissue type
Provide knot security
Cause minimal foreign body tissue reaction

14. Suture Selection Characteristics of the suture material Age Weight
Allergy status
General tissue condition
Surgical site disease
Comorbid condition(s)
Surgeon preference
Suture availability
Cost
Mentor influence

15. Ideal Suture Characteristics
Pliable
Easy to tie secure knots
Tensile strength (will not fray or break)
Glide through tissue effortlessly
Inert
Nonallergenic
Inexpensive

16. Tensile Strength
Tensile strength of absorbable and non-absorbable sutures is critical both during and after surgical procedures. Breaking strength and elongation can be measured using either a "straight pull" test or a "knot pull" test.

17. Types of Suture Material
Natural
Absorbable
Monofilament
Synthetic
Nonabsorbable
Multifilament

18. Types of Suture Material
Natural
Raw Silk
Magnified 1300 X

19. Types of Suture Material
Synthetic
Nylon

20. Types of Suture Material
Absorbable
Plain

21. Types of Suture Material
Nonabsorbable
Silk

22. Types of Suture Material
Monofilament

23. Types of Suture Material
Multifilament
Twisted

24. Types of Suture Material
Multifilament
Braided

25. Suture Packaging

26. Suture Sizes

27. Ideal Needle Characteristics
Stainless steel (corrosion resistant)
Slim without compromising strength
Stable in the needle holder
Carries suture through tissue with minimal tissue trauma
Sharp
Sterile
Inexpensive

28. Needle Eye Types
Open
Closed
Swaged
Swaged (CV)

29. Needle Sizes & Types

30. Needle Sizes & Types

31. Microsurgical suture with needle
Needle Sizes & Types
Microsurgical suture with needle

32. Anatomy of a Needle
Eye
Point
Body
Shape
Chord Length

33. Needle Points Taper – most internal tissues
Cutting – Skin and other tough tissues
Reverse Cutting – Tendon sheath, bone, cornea, other tough tissues
Blunt – Liver and other friable tissues

34. Commonly Used Needle Codes (Ethicon)CP CT
CTX CV FS
FSL
FSLX KS MO SH TF OS UR PS RB S

35. Suture Handling
Needle holder is clamped onto the needle approximately 1/3 the distance from the swage to the point

36. Suture is removed from the package placing tension on the swage
Suture Handling
Suture is removed from the package placing tension on the swage

37. Needle holder correctly armed
Suture Handling
Needle holder correctly armed

38. Passing the armed needle holder
Suture Handling
Passing the armed needle holder

39. Rapid (control) Release
Suture Handling
Rapid (control) Release
Step 1

40. Rapid (control) Release
Suture Handling
Rapid (control) Release
Step 2

41. Simple Suture
Interrupted
Running (continuous)

42. Mattress Suture
Vertical
Horizontal

43. Suturing Techniques
Retention Suture

44. Suturing Techniques
Figure of Eight Suture

45. (Connell’s Technique)
Suturing Techniques
Tendon Suture
(Connell’s Technique)

46. Tie Terms Free-tie Stick-tie Tie on a pass Ligate
Place a suture (no needle) into the surgeons hands
Stick-tie
Suture on a needle (use a needle holder)
Tie on a pass
Place the suture (no needle) on an instrument (tonsil/right angle)
Ligate
To tie

47. Stapling Devices

48. Skin Stapler
Surgical Skin Stapler

49. Skin Staples - Shape

50. Skin Stapler
Skin staples in place

51. Skin Stapler
Skin Staple Remover

52. Surgical Staplers
Linear Stapler

53. Surgical Staplers
Linear Cutter
Assorted Size Staples

54. Meckel’s Diverticulectomy
Surgical Staplers
Linear Cutter
Meckel’s Diverticulectomy

55. Surgical Staplers
Linear Cutter
Duodenal Division

56. Side-to-Side Anastomosis
Surgical Staplers
Linear Cutter
Side-to-Side Anastomosis

57. Ligating Clip Applier

58. Ligating Clips
Ligating Clips

59. Clip Applier
Automated Ligating Clip Applier

60. Surgical Staplers
Intraluminal Stapler

61. Surgical Staplers
Intraluminal Stapler
Schematic

62. Surgical Staplers
Intraluminal Stapler
Anvil in Position

63. Surgical Staplers
Intraluminal Stapler
Placement

64. Preparation for attachment of stapler segments
Surgical Staplers
Intraluminal Stapler
Preparation for attachment of stapler segments

65. Meshes/Fabrics

66. Meshes/Fabrics
Stainless Steel Mesh
Fine Weave

67. Meshes/Fabrics
Stainless Steel Mesh
Loose Weave

68. Meshes/Fabrics
2” x 3” Mesh
$305.00

69. Polypropylene Mesh Configurations
Meshes/Fabrics
Polypropylene Mesh Configurations
(Knitted)

70. Ventral Herniorrhaphy with Polypropylene Mesh Implant

71. Tissue Adhesives

72. Tissue Adhesives
Tissue Adhesive
(Skin)

73. Tissue Adhesives
Liquid Bandage