2 Suture Materials 2024.pdf

Suture Materials John D. Bennett DPM. FACFAS College of Podiatric Medicine and Surgery Des Moines University Objectives: } The Material presented in this lecture is considered basic surgical principles } Recognize and recall the different characteristics associated with suture material. Recognize th...

Suture Materials John D. Bennett DPM. FACFAS College of Podiatric Medicine and Surgery Des Moines University Objectives: } The Material presented in this lecture is considered basic surgical principles } Recognize and recall the different characteristics associated with suture material. Recognize the different suture materials (absorbable and non-absorbable) and their mechanical properties Recognize the basic design of suture needles including the eye, body, and types of points. Recognize the indications for specific suture material based on tissue type and surgical procedure. Recognize suturing techniques including the simple interrupted, subcutaneous technique, horizontal and vertical mattress suture technique, and running subcuticular suture techniques. } } } } Purposes } } } Approximate tissue until healing takes place Ligate vessels Tag fragile or important structures Selection is based on: } } Biological and mechanical properties of material used. Structure to be sutured (tendon, fascia, skin, vessels, and bone) } Bacterial presence within the tissue. Suture characteristics: 1. 2. Strength and thread dimensions -varies with material composition and dimension Suture volume -use of smaller sutures decrease foreign body volume with the sacrifice of knot pull strength Suture characteristics 3. Elongation -elasticity: ability to return to original length after applied strain ( stainless steel, braided polyester, catgut, silk) -plasticity: elongation persist with the cessation of strain (polypropylene) -intermediate: possesses properties of both (nylon, polyglactin 910) Suture characteristics 4. Flexibility -based on material and diameter of suture a. small diam. is more flexible than large b. silk, dexon –flexible c. nylon, catgut--stiff Suture characteristics 5. Configurations: Monofilament vs. braided 1. Monofilament has a low coefficient of friction and is better suited for contaminated wounds. 2. Braided has a high coefficient of friction, greater strength, and capillarity Suture characteristics Capillarity 1. Fluid and bacteria may penetrate into interstices of braided suture 2. PMN’s, macrophages are too large to reach interstices Suture characteristics Coating 1. Helps decrease capillarity 2. Improves handling 3. Reduces drag Handling Characteristics Pliability -flexibility of the suture } Tissue drag -the abilitity to pass through tissue } Knot tying -ease of knot tying } Knot slippage -the hold ability of a knot } Tissue reaction characteristics } } } } Inflammatory/ fibrous cell reaction Absorption Potentiation of infection Allergic reaction (reactivity) Classification of non-absorbable surgical suture } } } Class I: suture composed of silk or synthetic fibers, monofilament or braided. Class II: suture composed of natural or synthetic fibers but consisting of a coating. Class III: suture composed of monofilament or multifilament metal wire. Synthetic nonabsorbable surgical sutures } } } } Nylon: (dermalon, ethilon, nurolon, surgilon) Polypropylene: (surgilene, prolene) Polybutester: (novafil) Polyester: (mersilene, dacron, polydeck, tevdek, ethibond, ticron) } } } Resorption of polyester&polypropylene: solid line Resorption of Nylon: dotted line Resorption of Silk: dashed line Tensile strength } resorption Resorption and tensile strength of polyglycolic acid (Dexon) and polyglactin910 (Vicryl) Suture types Absorbable 1. Generally lose tensile strength within 60 days 2. Natural ( degraded by lysosomes) intestine vs. tendon a. catgut b. collagen 3. Synthetic -degraded by hydrolysis a. polyglycolic acid (dexon) -braided -good tensile strength & knot pull -very inert -maybe coated -skin & subcutaneous b. Polyglactin 910 (vicryl) -braided -65% tensile strength at 14 days -very inert -completely hydrolyzed 80 days -may be coated w/ polyglactin 370 & ca+stearate c. Polydiaxonone (PDS) -monofilament -high flexibility & tensile strength - completely hydrolyzed 90 days -very inert -70 % tensile strength @ 14 days d. Polyglyconate (Maxon) -monofilament -resist kinking and curling -becomes softer w/ exposure to tissue fluid -loses 30% tensile strength in 2 weeks (or 70% tensile strength in 2 weeks) -completely hydrolyzed at 180 days e. Poliglecaprone (Monocryl) -monofilament -very pliable and inert -completely hydrolyzed in 90-120 days -20-30% tensile strength lost at 14 days (70-80% tensile strength after 14 days) Non-absorbable 1. 2. Generally maintain tensile strength longer than 60 days Natural a. silk -known for superior handling properties -impregnated & coated w/ waxes -low tensile strength (slowly absorbable) -highly tissue reactive b. Cotton, linen -similar to silk -increased tissue reaction -very low tensile strength, weakest suture 3. Synthetic a. nylon (ethilon, surgilon) -possesses memory -elastic in nature -high tensile strength and low tissue reactivity -monofilament and braided -may be used in contaminated wounds b. Polyester (ethibond, dacron) -braided -high tissue strength -low tissue reactivity -may be coated w/ silicone -used when strong apposition of tissue is needed c. Polypropylene (prolene, surgilene) -very inert - monofilament -pliability & handling -excellent tensile strength -minimal tissue drag -often used in contaminated wounds & plastics d. Stainless steel (flexon = braided) -monofilament and braided -may corrode especially at stress points -mild to moderate tissue reactivity -may fracture, fatigue, or kink -used for bone fixation, tendon repair, and retention sutures } Fiber wire } FiberWire® suture is constructed of a multi-strand, long chain ultra-high molecular weight polyethylene (UHMWPE) core with a braided jacket of polyester and UHMWPE that gives FiberWire® superior strength, soft feel and abrasion resistance that is unequaled in orthopaedic surgery. FiberWire® is the first suture on the market to offer a collagen coated option. Suture breakage during knot tying is virtually eliminated, which is especially critical during arthroscopic procedures. FiberWire’s strength and reliability represents a major advancement in orthopaedic surgery. Wright medical Suture needles } } } } Made of high quality steel Slim as possible w/o compromising strength Sharp enough to penetrate tissue w/ minimum resistance Rigid enough not to bend or break Suture attachments } } } Closed (eyed) French (split or spring) Swaged (eyeless) -most common -suture attachment directly into needle -decrease tissue damage body -straight, ½ curved, ¼ circle, ½ circle(most common), 3/8 circle, 5/8 circle -geometric shape (round, flat, oval, triangular) -length (4mm-60mm) Point a. blunt -used for friable tissue b. tapered -useful for tissue w/ slight resistance -paratenon,tendon sheath, sub-Q c. cutting -conventional 1. Cutting edge on concave curvature 2. Cuts through dense tissue 3. Care must be taken not to cut through tissue -reverse 1. Cutting edge on convex curvature 2. Prevents cutting through tissue 3. Greater strength } } } 4. spatula 5. lancet 6. diamond point Needle Points Cutting edge is on the concave edge Cutting edge is on the convex surface Key to Suture information on packet Typical suture size range for Podiatric surgeons Simple interrupted suture technique Running locked stitch Interrupted horizontal mattress stitch Cruciate mattress suture Interrupted vertical mattress stitch Running subcuticular stitch staples