SUTURING seminar

							Suturing Basics

TOPICS
• • • • • • • • • • Sutures Knots Wounds (classification & healing) Wound Closure Postoperative Wound Care Local Anaesthetics Surgical Instruments Scrubbing Obtaining Haemostasis Skin Flaps

Suture Material
• 3 ways of classifying suture material:
– Natural or Synthetic

– Absorbable or Non-Absorbable
– Monofilament or Braided/Twisted

Silk

Catgut

• Natural
– Silk, linen, catgut

• Synthetic polymer
– Polypropylene, polyester, polyamide

Polypropylene

Polyester

• Absorbable
– catgut, polydioxanone, polyglycolic acid

– Used for deep tissues, membranes, & subcuticular skin closure

• Non-Absorbable
– polyester, nylon, stainless steel

– Used for skin (removed) & some deep structures (tendons, vessels, nerve repairs – not removed)

• Monofilament – Polypropylene – Polydioxanone – Nylon

• Multifilament – Catgut (twisted) – Polyester – Silk (braided)

HOW DOES THE SUTURE MATERIAL AFFECT THE SECURITY OF THE SUTURE-KNOT?
• The security of any tied suture is improved by the use of certain patterns & the friction between threads. • Friction factor is affected by size of contact area between threads, tightness of tying, & suture material used. • How many knots ???

So what type should I use?
• The most commonly used suture materials for interrupted & exposed skin sutures are nylon & polyprolene.

• Sutures that are buried, or run in the skin (eg. subcuticular suture), may use either nonabsorbable, or absorbable materials.

Surgical Needle
• Curvature * Most common, general use in all tissues
–¼ – 3/8 * –½* – 5/8 – J-shaped

Using needle holder, grasp needle about 2/3rds of the way back from point.

Needle Holder
• Remember!!! Thumb & ring finger into needle holder’s rings (NOT your middle finger!)

X

NOT YOUR MIDDLE FINGER!!!

Index finger stabilizes the instrument by resting on the shaft.

Surgical Scissors

Cutting Skin Sutures
• With skin sutures, leave 3-4mm tail.
– Tail = amount of suture left above knot – Tail is left because it helps prevent loosening or undoing of sutures.

• REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!!

Cutting Deep Sutures
• Buried sutures are left within the body. • Cut the suture on the knot, leaving no tail behind.

• REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!!

FORCEPS

• Grasp forceps between thumb & middle finger, while index finger is used for stabilization. • If possible, use forceps to grasp dermis, rather than epidermis or skin surface itself. This helps prevent marking & injuring of skin at wound edge.

SIMPLE INTERRUPTED suture

VERTICAL MATTRESS suture

VERTICAL MATTRESS suture
• This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin).

• The 2nd ‘mini-suture’
– in the same line as the main suture – Needle is inserted to pick up just the skin (epidermis & dermis) of both wound edges. – ensures eversion of the skin edges

Simple Interrupted vs. Vertical Mattress

• This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin).

How many knots?
• With a braided material, such as silk, a 3rd throw (replicating the first) would be placed to secure the knot. • If a slippery monofilament material, such as nylon were being used, one would place 5 or 6 throws of alternating construction in order to minimize knot slippage.

Important points to think about:
• Tightly tied sutures can cause ischaemia & wound edge necrosis. Gentle but firm knots & minimal wound tension will minimize these factors. • Remember, keep skin edges everted, NOT inverted!

When can I remove the sutures?
• Face: 3-4 days

• Scalp: 5 days
• Trunk: 7 days • Arm or leg: 7-10 days

• Foot: 10-14 days

Now you are ready to practice!

Practice! Practice! Practice!

KNOTS

KNOT TYING Is it really all that important?
• A patient’s life may depend on the security of one ligature. Slippage of a tie may result in a life-threatening haemorrhage.

Tying Knots
• Square (reef) knot

• Surgeon’s knot

Square knot

Surgeon’s knot

What’s the difference between these 2 knots?
• Square knot

• Surgeon’s knot

The END

Granny knot