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SUTURE MATERIALS (Ideal Suture Material (Good handling technique, Low…
SUTURE MATERIALS
Ideal Suture Material
Good handling technique
Low tissue reactivity
Non-cappilary
Does not support bacterial growth
Knot securely
Absorb predictably once tissue has healed
Affordable
Easy to sterilise
Examples of Absorbables
Catgut
Poliglecaprone 25
Polyglactin 910
Vicryl Rapide
Polydiocanone
Classification of sutures
Absorbable vs. non-absorbable
Absorbables
gradually looses tensile strength and disappears
rate
depends on suture material and environment
strength loss should be proportional to rate of strength gain of wound
removed by phagocytosis or hydrolysis
Loss of strength more rapid than lost of bulk
Monofilament vs. multifilament
Multifilament
Greater
Friction
Tissue drag
reduced by coating
Pseudomonofilaments
Ensheathed multifilament materials
Supramid
Potential of wicking
ease of handling
less memory
Knot security
Internal space
synthetic vs. natural
Synthetic
Absorbed
emzyme degradation and pahgocytosis
hydrolysis
predictable and consistent absorption
Antigenicity
tissue reaction
Coated vs, non-coated
Coating
#
Modify suture characteristics
Reduce tissue drag
Fill internal space
Reduced friction
Less knot security
Antibacterial suture coating
Suture Materials
Absorbable Suture Materials
Strength lost more rapidly than bulk
Rate of strength lost should be proportional to rate of strength gain in wound
Removal by phagocytosis or hydrolysis
gradually lose tensile strength and disappear - rate depends on material and environment
Multifilament Suture Materials
Increased friction and tissue drag causing more tissue tear - reduced by coating
Internal space for potential bacteria growth
Ease of handling - low memory
Knot security
Potential of wicking
Synthetic Suture Materials
Predictable absoprtion rate
Hydrolysis
Suture Coatings
Modify surface characteristics
Reduce tissue drag
FIll internal space
Reduced friction means knots should be considered less secure
Antibacterial suture coatings
Knots
Square Knot
Even knot
Surgeons Knot
Uneven knot
Potential damage to monofilament materials
Rule of thumb
Interrupted patterns
4 throws
Continuous patterns
5 throws to start
6 throws to end
Surgical Needles
Curved needles
Closed eye needles
Require threading
Pulling double strand through tissue
Can be blunt
cause more irritation
Swaged needles
Produce less tissue trauma
Fewer suture strands
Always sharp
Single use
Preferable
Straight needles
suture skin
Example of Non-absorbables
Nylon
Polypropylene
Selection of sutures
match strength, size and rate of absorption to tissue
infected wounds
avoid permanent and multifilament materials
Suture Sizing