Suturing Basics

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Suturing Basics
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TOPICS

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

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Suture Material

• 3 ways of classifying suture material
• Natural or Synthetic
• Absorbable or Non-Absorbable
• Monofilament or Braided/Twisted

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Silk Catgut

• Natural
• Silk, linen, catgut
• Synthetic polymer
• Polypropylene, polyester, polyamide

Polypropylene Polyester
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• 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)

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• Monofilament
• Polypropylene
• Polydioxanone
• Nylon
• Multifilament
• Catgut (twisted)
• Polyester
• Silk (braided)

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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 ???

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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.

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Surgical Needle

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

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

• Remember!!! Thumb ring finger into needle
  holders rings (NOT your middle finger!)

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X
NOT YOUR MIDDLE FINGER!!!
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Index finger stabilizes the instrument by resting
on the shaft.
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Surgical Scissors
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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!!
  

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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!!

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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.

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SIMPLE INTERRUPTED suture
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VERTICAL MATTRESSsuture
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VERTICAL MATTRESSsuture

• 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

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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).
  

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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.

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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!

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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

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Now you are ready to practice!
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Practice! Practice! Practice!
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KNOTS
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KNOT TYING Is it really all that important?

• A patients life may depend on the security of
  one ligature. Slippage of a tie may result in a
  life-threatening haemorrhage.

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Tying Knots

• Square (reef) knot
• Surgeons knot

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Square knot
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Surgeons knot
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Whats the difference between these 2 knots?

• Square knot
• Surgeons knot

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The END
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Granny knot