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Suturing Basics
TOPICS
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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
Granny knot
The
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