Sutures, Needles , and Instruments

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Sutures, Needles , and Instruments

• Dr. Aidah Abu Elsoud Alkaissi
• An-Najah National University
• Faculty of Nursing

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History and evolution of surgical sutures (2000
BC to present)

• Suture is a generic term for all materials used
  to bring served body tissue together and to hold
  these tissues in their normal position until
  healing takes place
• A ligature is a strand of suture material used to
  tie off (seal)blood vessels to prevent hemorrhage
  and simple bleeding or to isolate a mass of
  tissue to be excised (cut out)

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History and evolution of surgical sutures (2000
BC to present)

• Gut of sheep intestines was first mentioned as
  suture material AD 200
• Surgical gut, or cat gut AD 900 Al Rhazi
• Technique for ligating to replace cautery in
  treatment of traumatic war injuries 1500
• Confronted with fact that severe pain and
  subsequent infection markedly curtailed the
  advancement made possible by surgical repair and
  correction
• Gold, silver, metalic, wire, silkworm, gut, silk,
  cotton, linen, tendon, and intestinal tissue

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Suture materials

• A variety of suture materials are available for
  ligating, suturing and closing the wound
• The appropriate suture is selected according to a
  number of characteristics whether it is
  absorbable or nonabsorbable
• Its breaking strength, whether it is monofilament
  or multifilament
• Its knot tying facility, its tissue reactivity

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Characteristics of suture materials

• Ways to evaluate the properties of suture
  material
• Physical xs
• Handling xs
• Tissue reaction
• Please read page 115 table 7.1

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Physical xs

• Please read page 116
• plasticity definition

(mechanics) The property of a solid body whereby
it undergoes a permanent change in shape or size
when subjected to a stress exceeding a particular
value, called the yield value.
Memory The average time lag between a request
for information stored on a particular component
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Handling Xs

• Relaed both to pliability (The quality or state
  of being pliable flexibility as, pliability of
  disposition. Pliability of movement) or how
  easily the material bands
• A suture with a high friction coefficient tends
  to drag through tissue
• It is more difficult to tie because knots do nor
  set easily
• Some suture materials are coated to reduce their
  coefficient of friction
• This coating not only improves the way they pull
  through tissue on insertion, but also affects the
  force needed to remove the suture after the wound
  is healed

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Tissue reaction Xs

• Because it is a foreign substance, all suture
  material causes some tissue reaction
• Tissue reaction begins when the suture inflicts
  (To force (another) to accept a burden) injury to
  the tissue during insertionin addition tissue
  reaction to the suture material itself occurs
• The reaction begins with infiltration of WBC,
  macrophages and fibroblasts then appearby about
  the seventh day, fibrous tissue with chronic
  inflammation is present
• The reaction persists until the suture is
  encapsulated (nonabsorbable material) or absorbed
  (absorbed material)

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• Please read Table 7-2, 7-3

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Types of suture material

• Absorbable suture material
• Surgical gut
• Collagen sutures
• Synthetic absorbable sutureNonabsorbable sutures

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Types of nonabsorbable sutures materials

• Silk
• Cotton
• Surgical Nylon
• Surgical polyster fiber
• Polypropylene
• Surgical stainless steel

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Packaging and storing methods

• Suture material is sealed in a primary inner
  packet which may or may not contain fluids,
  inside a dry, outer, peel-back packet (To strip
  or cut away the skin)
• This method permits easy dispensing onto the
  sterile field
• Various form of foil, plastic and special paper
  are used for poth inner and outer pachets
• Pachages are stored in moistureproof and
  dustproof container
• Studies indicte that wounds heal more quickly and
  with less tissue reaction when sutures of a finer
  gauge are used

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Skin staples