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Suturing technique |absorbable, non absorbable suturing|

 Suturing technique 

 Content:

  • Introduction
  • Features
  • Equipment
  • Types
  • Classification
  • Absorbable & non absorbable

Introduction

  • Method for closing cutaneous wounds
  • Closing dead space
  • Supporting and strengthening wounds - healing increases their tensile strength
  • Approximating skin edges for an aesthetically
  • Minimizing the risks of bleeding and infection

Features:

  • Adequate tensile strength
  • Good knot holding 
  • Least reactive
  • Easy handling
  • Less memory
  • Easily available
  • Cost effective

Equipment:

Suituring equipment

Types:

Suituring technique

Classification:


Absorbable Suituring materials:

1.Plain catgut- yellowish white

  •  Submucosa of sheep gut (jejunum)
  • Last for 7 to 10 days
  • Used for subcutaneous layer, muscle, circumcision
  • Absorption-Inflammatory reaction and phagocytosis

Plain catgut

2.chromic catgut:

Chromic catgut

  • Brown color
  • Plain catgut + chromic salt = chromic catgut
  • Absorption- 15 to 25 days
  • Used- intestinal anastomosis, urinary bladder, Common Bile Duct (CBD), gastrojejunostomy
  • 2.0,3.0,4.0- refers to the thickness
  • Absorption- Enzymatic hydrolysishydrolysis

Vicryl ( polyglactin or polyglactic acid) :

Vicryl

  • Synthetic & absorbable- Violet color (braided & multifilament)
  • Reaction  is less
  • Copolymer - Glycolide and lactide
  • Absorption- 90 days
  • Used- bowel anastomosis, suturing muscles, closure of peritoneum, replaced catgut –CBD (strength & reliability) 
  • Vicryl –used in infection

Dexon (polyglycolic acid) :

Dexon

  • Synthetic absorbable material
  • Creamy yellow or biege (braided)
  • Used like Vicryl

Poly dioxone suture (PDS) :

Pds(poly dioxone suture)

  • Synthetic & absorbable suture
  • Creamy color
  • Properities- vicryl 
  • Very expensive
  • Better than vicryl

Uses of absorbable suture :

  • Bowel anastomosis- gastrojejunostomy, resection and anastomosis (Vicryl used)
  • Cholecystojejunostomy, choledochojejunostomy, pancreaticojejunostomy (Vicryl)
  • Suturing muscle,fascia, peritoneum, Sub.cut.tissue,mucosa
  • Ligating pedicle ex.ligation of pedicle in hysterectomy
  • Circumcision (plain catgut or chromic catgut)

Non absorbable:

Prolene (polypropylene):

Polypropylene
  • Blue & Clear
  • Synthetic (Monofilament) Non-absorbable
  • No micro organism harboring- chance of infection is less
  • High memory(recoiling tendency- removal from packet)
  • Used in-abdominal closure, repair of hernias, repair of incisional hernias.

Silk or black silk:

Silk or mersilk
  • Natural - multifilament & braided
  • Derived from cocoon of silkworm larva
  • Black colour
  • Coated wax- reduces capillary reaction
  • Cholecystostomy- ligate cystic duct & cystic artery.
  • Ligate mesenteric vessels-small & large gut resection
  • Ligate pedicles- nephrectomy & splenectomy

Mersilk:

  • Black-braided
  • Used for ligating bleeding points or anastomosis, nerve suture

Polyamide|Ethilon |Nylon

Polyamide

  • Braided, uncoated, monofilament 
  • Black
  • Uses – similar to prolene
Others:
  • Cotton
  • Linen
  • Polyester
  • Steel or metal wire- orthopaedic surgery(bone fixation) & sternotomy (Cardiac surgery)
Suituring needle:



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