SUTURE MATERIALS

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a. ABSORBABLE: Those that are absorbed or digested by the body cells and tissue fluids in which they are embedded during and after the healing processes.

SURGICAL GUT: The most commonly used absorbable suture material. Derived from the small intestine of healthy sheep. It is uniformly fine-grained and possesses great tensile strength and elasticity.

DEXON (POLYGLYCOLIC ACID): Widespread absorbable suture material of a synthetic, braided polymer. Dexon has low rate of reactivity and infection rate, and has excellent knot security and tensile strength. A drawback of Dexon is its high friction that binds and snags when wet.

CHROMIC SUTURE MATERIAL: Chromic suture materials have undergone various intensities of tanning with the salt of chromic acid to delay the tissue absorption time. Typical examples of chromic suture and absorption times are:

Type A: Plain, 10 days
Type B: Mild chromic, 20 days
Type C: Medium chromic, 30 days
Type D: Extra chromic, 40 days

b. NON-ABSORBABLE: Those suture materials that can not be absorbed by the body cells or fluids.

NYLON (ETHILON): Of all the non-absorbable suture materials, monofilament nylon is the most commonly used in surface closures. It has minimal tissue reactivity and resists inflections greater when compared to braided suture materials. It has a high tensile strength that ensures wound security. The disadvantage of nylon is the difficulty in achieving good knot security. Because of this at least 4-5 “throws” (knots) are required to achieve a secure knot.

PROLENE: Polymer polypropylene (Prolene) appears to be stronger then nylon and has better overall wound security. However, it has a greater memory (returns to its packaging shape) and is more difficult to work with.

BRAIDED: These include cotton, silk, braided nylon and multifilament Dacron. Until the advent of synthetic fibers, silk was the mainstay of wound closure. It is the most workable and has excellent knot security. Disadvantages: high reactivity and infection due to the absorption of body fluids by the braided fibers.

SUTURE SIZES
1-0 and 2-0: Used for high stress areas requiring strong retention, i.e. – deep

fascia repair

3-0: Used in areas requiring good retention, i.e. – scalp, torso, and hands

4-0: Used in areas requiring minimal retention, i.e. – extremities. Is the most common size utilized for superficial wound closure.

5-0: Used for areas involving the face, nose, ears, eyebrows, and eyelids.

6-0: Used on areas requiring little or no retention. Primarily used for cosmetic effects.

c. SURGICAL NEEDLES: There are a variety of needles for wound closure. Curved needles have two basic configurations; tapered and cutting. For wound and laceration care, the reverse cutting needle is used almost exclusively. It is made in such a way that the outer edge is sharp so as to allow for smooth and atraumatic penetration of tough skin and fascia. Tapered needles are used on soft tissue, such as bowel and subcutaneous tissue, or when the smallest diameter hole is desired.

d. SURGICAL INSTRUMENTS: It is not necessary to have large numbers of instruments for emergency wound care. Wounds and lacerations can be managed with the following instruments:

NEEDLE HOLDERS: Needle holders come in various sizes and shapes, but for most lacerations a standard size 4″ will complete the task. For larger, deeper wound closures a larger needle and needle holder may be required.

FORCEPS: Grasping and controlling tissue with forceps is essential to proper suture placement. However, whenever force is applied to skin or other tissues, inadvertent damage to cells can occur if an improper instrument or technique is used. Be gentle when grasping tissue, and never fully close the jaws on the skin.

SCISSORS: There are three types of scissors that are useful in minor wound care.
IRIS SCISSORS: Iris scissors are predominantly used to assist in wound debridement and revision. These scissors are very sharp and are appropriate in situations that require very fine control. They are very delicate and are not recommended for cutting sutures. However, when very small sutures require removal they can be use.
DISSECTION SCISSORS: Used for heavier tissue revision as necessary for wound undermining.
SUTURE REMOVAL SCISSORS: Standard 6-inch, single blunt-tip, suture scissors are most useful for cutting sutures, adhesive tape, and other dressing materials. Because of their size and bulk, these scissors are very durable and practical.

HEMOSTATS: Hemostats have three functions in minor wound care: clamping small blood vessels for hemorrhage control, grasping and securing facia during debridment, and are an excellent tool for exposing, exploring and visualizing deeper areas of the wound.

KNIFE HANDLES AND BLADES: The knife handle holds the blade and is used in the debridment and excisions during wound revision. Common blades are the #10 blade (used for large excisions), #15 blade (small, versatile and well suited for precise debridement and wound revision), and the #11 blade (ideal for incision and drainage of superficial abscesses and the removal of very small sutures).

e. ANESTHETIC AGENTS: Prior to suturing of wounds a thorough understanding of the properties of anesthetic solutions and injection techniques is required. The choice of anesthetics and techniques are individualized for every patient in relationship to severity of wounds, location of wounds, and allergic reactions; which could lead to anaphylactic shock.

        

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