TYPES OF SUTURES 1) Surgical Sutures 2) Suture Types a.
Absor ba ble
Sutures o Polyglycolic Acid Sutures o Polyglactin 910 Sutures o Catgut Sutures o Poliglecaprone Sutures o Polydioxanone Sutures b. Non-a bsor ba ble Sutures o Polypropylene Sutures o Polyamide / Nylon Sutures o Polyester Sutures Silk Sutures o o Polyvinylidene fluoride / PVDF Sutures Stainless Steel Sutures o
Absorbable and non absorbable sutures
Sutures can be divided into two types ± those which are a bsor ba ble and will break down harmlessly in the body over time without intervention, and those which are non-a bsor ba ble and must be manually removed if they are not left indefinitely. The type of suture used varies on the operation, with the major criteria being the demands of the location and environment and depends on the discretion and professional experience of the Surgeons. y
y
Sutures to be placed internally would require re-opening if they were to be removed. Sutures which lie on the exterior of the body can be removed within minutes, and without re-opening the wound. As a result, a bsor ba ble sutures are often used internally; non-a bsor ba ble externally. Sutures to be placed in a stressful environment, for example the heart (constant pressure and movement) or the bladder (adverse chemical presence) may require specialized or stronger materials to perform their role; usually such sutures are either specially treated, or made of special materials, and are often non-a bsor ba ble to reduce the risk of o f degradation.
Absorbable sutures include :- Polyglycolic Acid sutures, Polyglactin 910 , Catgut, Poliglecaprone 25 and Polydioxanone sutures. on-Absorbable N on-Absorbable
sutures include :- Polypropylene sutures, PVDF, silk and stainless steel sutures.
ylon N
(poylamide), Polyester,
Monofilament and Multifilament Sutures
Sutures can also be divided into two types on the basis of material structure i.e. monofilament sutures and multifilament or braided sutures. Braided sutures provide better knot security whereas monofilament sutures provide better passage through tissues. In general, Monofilament sutures elicit lower tissue reaction compared to braided sutures. M onofilament
sutures include :- Polypropylene sutures, Catgut, Poliglecaprone and Polydioxanone sutures. M ultifilament
ylon, N
PVDF, Stainless steel,
or braided sutures include :- PGA sutures, Polyglactin 910, silk and polyester
sutures.
Synthetic and Natural Sutures
Surgical sutures can also be divided into two types on the basis of raw material origin i.e. natural and synthetic sutures. N atural
sutures include silk and catgut sutures whereas all other sutures are synthetic in
nature.
Suture Techniques
Running, Continuous Stitch
The "Running" stitch is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema during or the wound healing process. However, there is a greater potential for malapproximation of wound edges than with the interrupted stitch. Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch.
Interrupted Stitch
dou ble stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge. Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue. A
Mattress Suture
continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as a hernia or an appendiceal stump. A
Purse String
dou ble loop technique alternating near and far stitches. for approximating fascial edges. A
Commonly
used
SmeadJones/Far-andNear
A
Continuous Locking, or Blanket Stitch
self-locking running stitch used primarily for approximating skin edges.
