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Encyclopedia > Suture

Sutures are the stitches that doctors, and especially surgeons, use to hold skin, internal organs, blood vessels and all other tissues of the human body together, after they have been severed by injury or surgery. They must be strong (so they do not break), non-toxic and hypoallergenic (to avoid adverse reactions in the body), and flexible (so they can be tied and knotted easily). In addition, they must lack the so called "wick effect", which means that sutures must not allow fluids to penetrate the body through them from outside, which could easily cause infections. Sutures can be very painful. Image File history File links Broom_icon. ... A suture is a stitch used by doctors and surgeons to hold tissue together. ... “Surgeon” redirects here. ... Beyond overall skin structure, refer below to: See-also. ... In biology, an organ is a group of tissues which perform some function. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... “Surgeon” redirects here. ... Look up hypoallergenic in Wiktionary, the free dictionary. ...

Contents

Absorbable and nonabsorbable sutures

Sutures are divided into two kinds - those which are absorbable and will break down harmlessly in the body over time without intervention, and those which are non-absorbable and must be manually removed if they are not left indefinitely. The type of suture used varies on the operation, with a major criteria being the demands of the location and environment:

  • Sutures to be placed internally would require re-opening if they were to be removed. Sutures which lie on the exterior of the body can be removed within minutes, and without re-opening the wound. As a result, absorbable sutures are often used internally; non-absorbable externally.
  • Sutures to be placed in a stressful environment, for example the heart (constant pressure and movement) or the bladder (adverse chemical presence) may require specialized or stronger materials to perform their role; usually such sutures are either specially treated, or made of special materials, and are often non-absorbable to reduce the risk of degradation.

Absorbable sutures

Absorbable sutures are made of materials which are broken down in tissue after a given period of time, which depending on the material can be from ten days to eight weeks. They are used therefore in many of the internal tissues of the body. In most cases, three weeks is sufficient for the wound to close firmly. The suture is not needed any more, and the fact that it disappears is an advantage, as there is no foreign material left inside the body and no need for the patient to have the sutures removed.


Absorbable sutures were originally made of the intestines of sheep, the so called catgut. The manufacturing process was similar to that of natural musical strings for violins and guitars, and also of natural strings for tennis racquets. The inventor, a 10th century surgeon named al-Zahrawi reportedly discovered the dissolving nature of catgut when his lute's strings were eaten by a monkey. Today, gut sutures are made of specially prepared beef and sheep intestine, and may be untreated (plain gut), tanned with chromium salts to increase their persistence in the body (chromic gut), or heat-treated to give more rapid absorption (fast gut). However, the major part of the absorbable sutures used are now made of synthetic polymer fibers, which may be braided or monofilament; these offer numerous advantages over gut sutures, notably ease of handling, low cost, low tissue reaction, consistent performance and guaranteed non-toxicity. In Europe and Japan, gut sutures have been banned due to concerns over bovine spongiform encephalopathy(mad cow disease), although the herds from which gut is harvested are certified BSE-free. Each major suture manufacturer has its own proprietary formulations for its brands of synthetic absorbable sutures; various blends of polyglycolic acid (Vicryl for example), lactic acid or caprolactone are common. In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine (or colon). ... Catgut is the name applied to cord of great toughness and tenacity prepared from the intestines of sheep/goat, or occasionally from those of the hog, horse, mule, pig, and donkey. ... The violin is a bowed string instrument with four strings tuned in perfect fifths. ... For other uses, see Guitar (disambiguation). ... Abu al-Qasim (936 - 1013), (Arabic: أبو القاسم) also known as Abul Qasim Khalaf ibn al-Abbas al-Zahrawi known in the West as Abulcasis, is medieval Islams most prominent scholar of medicine. ... A medieval era lute. ... Classic image of a cow with BSE. A notable feature of such disease is the inability (of the infected animal) to stand. ... Vicryl™ (polyglactin 910) is an absorbable, synthetic, braided suture. ...


In rare cases, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.


Non-absorbable sutures

8 nonabsorbable sutures in a person's left thumb.
8 nonabsorbable sutures in a person's left thumb.

Nonabsorbable sutures are made of materials which are not metabolized by the body, and are used therefore either on skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in which absorbable sutures are not adequate. This is the case, for example, in the heart and in blood vessels, whose rhythmic movement requires a suture which stays longer than three weeks, to give the wound enough time to close. Other organs, like the bladder, contain fluids which make absorbable sutures disappear in only a few days, too early for the wound to heal. Inflammation caused by the foreign protein in some absorbable sutures can amplify scarring, so if other types of suture are less antigenic (ie, do not provoke as much of an immune response) it would represent a way to reduce scarring. Image File history File links Download high resolution version (2592x1221, 211 KB) Personal snapshot by User:Yelyos of own thumb. ... Image File history File links Download high resolution version (2592x1221, 211 KB) Personal snapshot by User:Yelyos of own thumb. ... For the server security software, see Microsoft Forefront. ... A request has been made on Wikipedia for this article to be deleted in accordance with the deletion policy. ...


There are several materials used for nonabsorbable sutures. The most common is a natural fiber, silk, which undergoes a special manufacturing process to make it adequate for its use in surgery. Other nonabsorbable sutures are made of artificial fibers, like polypropylene, polyester or nylon; these may or may not have coatings to enhance their performance characteristics. Finally, stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery. For other uses of this word, see Silk (disambiguation). ... Polypropylene lid of a Tic Tacs box, with a living hinge and the resin identification code under its flap Micrograph of polypropylene Polypropylene or polypropene (PP) is a thermoplastic polymer, made by the chemical industry and used in a wide variety of applications, including food packaging, ropes, textiles, plastic parts... SEM picture of a bend in a high surface area polyester fiber with a seven-lobed cross section Polyester is a category of polymers, or, more specifically condensation polymers, which contain the ester functional group in their main chain. ... For other uses of this word, see nylon (disambiguation). ... This fracture of the lower cervical vertebrae, known as a teardrop fracture is one of the conditions treated by orthopaedic surgeons. ... Cardiac surgery is surgery on the heart, typically to treat complications of ischemic heart disease (e. ...

Three sutures to a person's right arm, near the elbow.
Three sutures to a person's right arm, near the elbow.

Image File history File links Download high resolution version (600x800, 43 KB) Summary I received three stitches after I knelt down to spread bark and a kitchen knife that was in a pocket on my pants leg which I had been using to cut open bags of bark punctured my... Image File history File links Download high resolution version (600x800, 43 KB) Summary I received three stitches after I knelt down to spread bark and a kitchen knife that was in a pocket on my pants leg which I had been using to cut open bags of bark punctured my...

Surgical needles for use with sutures

Traumatic needles are needles with holes or eyes which are supplied to the hospital separate from their suture thread. The suture must be threaded on site, as is done when sewing at home. Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. There are several advantages to having the needle pre-mounted on the suture. The doctor or the nurse does not have to spend time threading the suture on the needle. More important, the suture end of a swaged needle is smaller than the needle body. In traumatic needles with eyes, the thread comes out of the needle's hole on both sides. When passing through the tissues, this type of suture rips the tissue to a certain extent, thus the name traumatic. Nearly all modern sutures feature swaged atraumatic needles. Swaging is a metal forming technique in which the metal is plastically deformed to its final shape using high pressures. ...


There are several shapes of surgical needles, including:

  • straight
  • half curved or ski
  • 1/4 circle
  • 3/8 circle
  • 1/2 circle
  • 5/8 circle
  • compound curve

Needles may also be classified by their point geometry; examples include:

  • taper (needle body is round and tapers smoothly to a point)
  • cutting (needle body is triangular and has a sharpened cutting edge on the inside)
  • reverse cutting (cutting edge on the outside)
  • trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point)
  • blunt points for sewing friable tissues
  • side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery

Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied.


Sizes of sutures

Suture sizes are defined by the United States Pharmacopeia (U.S.P.). Sutures were originally manufactured ranging in size from #1 to #6, with #1 being the smallest. A #4 suture would be roughly the diameter of a tennis racquet string. The manufacturing techniques, derived at the beginning from the production of musical strings, did not allow thinner diameters. As the procedures improved, #0 was added to the suture diameters, and later, thinner and thinner threads were manufactured, which were identified as #00 (#2-0 or #2/0) to #000000 (#6-0 or #6/0). Image File history File links Gnome-globe. ... The United States Pharmacopeia is a compendium of quality control tests for drugs and excipients to be introduced into a medicinal formulation. ...


Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.

A wound before and after being closed by simple interrupted sutures
A wound before and after being closed by simple interrupted sutures
U.S.P.
Designation
Collagen
metric diameter
(mm)
Synthetic absorbable
metric diameter
(mm)
Non-absorbable
metric diameter
(mm)
American wire gauge
11-0 0.01
10-0 0.02 0.02 0.02
9-0 0.03 0.03 0.03
8-0 0.05 0.04 0.04
7-0 0.07 0.05 0.05
6-0 0.1 0.07 0.07 38-40
5-0 0.15 0.1 0.1 35-38
4-0 0.2 0.15 0.15 32-34
3-0 0.3 0.2 0.2 29-32
2-0 0.35 0.3 0.3 28
0 0.4 0.35 0.35 26-27
1 0.5 0.4 0.4 25-26
2 0.6 0.5 0.5 23-24
3 0.7 0.6 0.6 22
4 0.8 0.6 0.6 21-22
5 0.7 0.7 20-21
6 0.8 19-20
7 18

Image File history File linksMetadata Download high resolution version (1136x1704, 1206 KB) Summary Photos of a wound before and after being closed with sutures. ... Image File history File linksMetadata Download high resolution version (1136x1704, 1206 KB) Summary Photos of a wound before and after being closed with sutures. ... American wire gauge (AWG), also known as the Brown and Sharpe wire gauge, is used in the United States and other countries as a standard method of denoting wire diameter, especially for nonferrous, electrically conducting wire. ...

Suture techniques

Common suture stitching techniques include:

  • Simple Interrupted Stitch ( or running)
  • Mattress
  • Horizontal mattress
  • Vertical mattress
  • Figure 8
  • Continuous locking
  • Subcuticular

A wound before and after being closed by simple interrupted sutures All bites are in the same vertical plane. ... Dashed lines are under the skin. ... all bites are in the vertical plane. ... Figure 8 might refer to: Figure 8, an expression describing a Lissajous curve that resembles the number 8 Figure 8, the basis for compulsory figures in figure skating Figure 8 (album), a 2000 album recorded by American singer-songwriter Elliott Smith Figure-of-eight knot, (also called a Flemish Knot...

Removal of sutures

Whilst some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short term device to allow healing of a trauma or wound. According to about.com's article on nursing:[1] Screenshot of About. ...

"Different parts of the body heal at different intervals. Common time to remove stitches will vary: facial wounds 3-5 days; scalp wound 7-10 days; limbs 10-14 days; joints 14 days; trunk of the body 7-10 days.
"Not all stitches must be removed. If a small area remains unhealed, notify the health care practitioner. Then if ordered, remove sutures from the healed area only."

(Further information on suture removal can be found here)


Suture materials

. Plain catgut Chromic catgut Polyglycolic
acid (P.G.A.)
Polydioxanone (PDS)
Description Absorbable biological suture material. Plain is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. The natural plain thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Plain is absorbed by enzymatic degradation. Absorbable biological suture material. Chromic is an absorbable suture made by twisting together strands of purified collagen taken from bovine intestines. Due to undergoing a ribbon stage chromicisation (treatment with chromic acid salts), the chromic offers roughly twice the stitch-holding time of plain catgut. The natural chromic thread is precision ground in order to achieve a monofilament character and treated with a glycerol containing solution. Chromic is absorbed by enzymatic degradation. It is a synthetic absorbable suture material. Braided synthetic absorbable multifilament made of polyglycolic acid and coated with N-laurin and L-lysine, which render the thread extremely smooth, soft and knot safe. It is a synthetic absorbable suture material. Monofilament synthetic absorbable suture, prepared from the polyester, poly (p-dioxanone).
Composition  ? Natural purified collagen Polyglycolic acid Polyester and poly (p-dioxanone)
Tensile strength Strength retention for at least 7 days.  ?  ?  ?
Structure Monofilament Monofilament Braided Monofilament
Origin Bovine serosa surface finish. Bovine serosa Synthetic Synthetic through the critical wound
Treatment  ? Treatment with a glycerol containing solution and chromic acid salts Coated with magnesium stearate Uncoated
Type of absorption Proteolytic enzymatic digestion complete by 90 days. Proleolytic enzymatic digestion complete in 70 days. Absorption by enzymatic digestion and starts losing tensile strength on implantation from 18–21 days of catgut chromic Absorption by hydrolysis complete between 60 and 90 days. Always predictable and reliable Wound support can remain up to 6 weeks, however tensile stength decreases to about 70% at 14 days and 25% at 42 days
Tissue reaction Moderate. Plain catgut enjoys lower tissue reaction as compared to chromicised. Moderate.  ?  ?
Thread color Straw Brown Violet Violet
Size available USP 6-0 (1 metric) to USP 3 (7 metric). USP 6-0 (1 metric) to USP 3 (7 metric). USP 6-0 (1 metric) to USP 2 (5 metric) USP 6-0 (1 metric) to USP 2 (5 metric)
Sterilization E.O. Gas. E.O. Gas E.O. gas. E.O. gas
Advantages Very high knot-pull tensile strength, good knot security due to special excellent handling features Very high knot-pull tensile strength, good knot security due to special surface finish, improved smoothness due to the dry presentation of the thread, excellent handling features High initial tensile strength, guaranteed holding power through the critical wound healing period. Smooth passage through tissue, easy handling, excellent knotting ability, secure knot tying Tensile strength retention, guaranteed holding power
Indications For all surgical procedures especially when tissues that regenerate faster are involved. General closure, ophthalmic, orthopedics, obstetrics/gynecology and gastro-intestinal tract surgery. For all surgical procedures, especially for tissues that regenerate faster. Subcutaneous, intracutaneous closures, abdominal and thoracic surgeries PDS is particularly useful where the combination of an absorbable suture and extended wound support is desirable, pediatric cardiovascular surgery, ophthalmic surgery
Contraindications Not recommended for incisions that require the sustaining of the tissues for a prolonged period of time. Not recommended for an incision that requires sustaining of the tissues for a prolonged period of time. This suture being absorbable should not be used where extended approximation of tissue is required. This type of suture being absorbable is not to be used where prolonged approximation of tissues under stress is required and/ or in conjunction with prosthetic devices
Precautions Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb the sutures at a higher rate. Cardiovascular surgery, due to the continued heart contractions. It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganisms. Avoid using where long term tissue approximation is needed. Absorption is faster in infected tissues It is absorbed much faster when used in the mouth and in the vagina, due to the presence of microorganism. Cardiovascular surgery, due to the continued heart contractions. Special precautions should be taken in patients with cancer, anemia and malnutrition conditions. They tend to absorb this suture at a higher rate. Special precautions should be taken in elderly patients and patients with history of anemia and malnutrition conditions. As with any suture material, adequate knot security requires the accepted surgical technique of flat and square ties. The PDS suture knots must be properly placed to be secure. Conjunctival and vaginal mucosal sutures remaining in placed for extended periods may be associated with localized irritation. Subcuticular sutures should be placed as deeply as possible in order to minimize the erythema and induration normally associated with absorption.

Tropocollagen triple helix. ... Tribes Bovini Boselaphini Strepsicerotini The biological subfamily Bovinae includes a diverse group of about 24 medium-sized to large ungulates, including domestic cattle, bison, the Water Buffalo, the Yak, and the four-horned and spiral-horned antelopes. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine (or colon). ... Polyglycolide or Polyglycolic acid (PGA) is a biodegradable, thermoplastic polymer and the simplest linear, aliphatic polyester. ... Lysine is one of the 20 amino acids normally found in proteins. ... Tensile strength isthe measures the force required to pull something such as rope, wire, or a structural beam to the point where it breaks. ... A filament is a fine, thinly spun thread, fiber, or wire. ... A braid Step by step creation of a basic braid using three strings To braid is to interweave or twine three or more separate strands of one or more materials in a diagonally overlapping pattern. ... A serosa is a serous membrane, Serous membranes line the pericardial, pleural, and peritoneal cavities, enclosing their contents. ... A serosa is a serous membrane, Serous membranes line the pericardial, pleural, and peritoneal cavities, enclosing their contents. ... “Glycerine” redirects here. ... General Name, symbol, number magnesium, Mg, 12 Chemical series alkaline earth metals Group, period, block 2, 3, s Appearance silvery white solid at room temp Standard atomic weight 24. ... Stearic acid also called octadecanoic acid is one of the many useful types of saturated fatty acids that comes from many animal and vegetable fats and oils. ... Proteolysis is the directed degradation (digestion) of proteins by cellular enzymes called proteases or by intramolecular digestion. ... Neuraminidase ribbon diagram An enzyme (in Greek en = in and zyme = blend) is a protein, or protein complex, that catalyzes a chemical reaction and also controls the 3D orientation of the catalyzed substrates. ... Hydrolysis is a chemical reaction or process in which a chemical compound reacts with water. ... Violet (named after the flower violet) is used in two senses: first, referring to the color of light at the short-wavelength end of the visible spectrum, approximately 380–420 nanometres (this is a spectral color). ... The chemical compound ethylene oxide is an important industrial chemical used as an intermediate in the production of ethylene glycol and other chemicals, and as a sterilant for foodstuffs and medical supplies. ... The subcutis is the layer of tissue directly underlying the cutis. ... Pediatrics (also spelled paediatrics or pædiatrics) is the branch of medicine that deals with the medical care of infants and children. ... Ophthalmology is the branch of medicine which deals with the diseases of the eye and their treatment. ... This article discusses the medical condition. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... In medicine, the field of (cardio)thoracic surgery or cardiovascular surgery is involved in the surgical treatment of diseases affecting the heart (cardiovascular disease) and lungs (lung disease). ... male human mouth The mouth, also known as the buccal cavity or the oral cavity, is the orifice through which an organism takes in food and water. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... A cluster of Escherichia coli bacteria magnified 10,000 times. ... This article discusses the medical condition. ... Percentage of population affected by malnutrition by country, according to United Nations statistics. ... The conjunctiva is a membrane that covers the sclera (white part of the eye) and lines the inside of the eyelids. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ... Erythema is an abnormal redness of the skin caused by capillary congestion. ... Induration (indoo rāshÉ™n, -dyoo-), a noun, means, in terms of pathology, (a) hardening of an area of the body as a reaction to inflammation, hyperemia, or neoplastic infiltration, or (b) an area or part of the body that has undergone such a reaction. ...

Other facts

Tissue adhesives

In recent years, topical cyanoacrylate adhesives ("liquid stitches") have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances/tissue, after which it cures (polymerizes) and forms a flexible film that bonds to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. A tube of Super glue Cyanoacrylate is the generic name for substances such as methyl-2-cyanoacrylate, which is typically sold under trademarks like Superglue and Krazy Glue, and 2-octyl cyanoacrylate or n-butyl-cyanoacrylate, which are used in medical glues such as Dermabond and Traumaseal. ...


Antimicrobial sutures

Another recent development in wound closure involves the use of sutures coated with antimicrobial substances to reduce the chances of wound infection. While long-term studies are not yet available, preliminary results indicate that these sutures are effective at keeping bacteria out of wounds.


See also

Barbed suture is a type of knotless surgical suture that has barbs on its surface. ... Structure of the chitin molecule, showing two of the N-Acetylglucosamine units that repeat to form long chains in beta-1,4 linkage. ... In medicine, a ligature is a device, similar to a tourniquet, usually of thread or string, tied around a limb, blood vessel or similar to restrict blood flow. ... KNOT is a commercial Classic Country music radio station in Prescott, Arizona, broadcasting to the Flagstaff-Prescott, Arizona area on 1450 AM. Query the FCCs AM station database for KNOT Radio Locator Information on KNOT AM radio stations in the Flagstaff-Prescott, Arizona market (Arbitron #151) By frequency: By... “Sewn” redirects here. ... Surgical staples holding a knee replacement surgery wound closed. ... This list of medical topics does not include terms from anatomy, dentistry, veterinary medicine, nor the names of medical practitioners, institutions and individual pathogens and diseases. ... Davis & Geck was a surgical/medical device company founded in 1909 by Charles T. Davis and Fred A. Geck originally located in Brooklyn, NY. It specialized in the development and manufacture of surgical sutures along with various other products in the wound closure, surgical technique, and aseptic technique catagories. ...

References

  1. ^ http://nursing.about.com/od/firstaid/ht/removestitches.htm

External links


  Results from FactBites:
 
Surgical needles,surgical sutures and suture needles - USN Medical Supplies Co.,Ltd. provides the best surgical ... (204 words)
USN Medical Supplies Co.,Ltd. is a high-tech and professional manufacturer to produce all kinds of medical suture and suture needles.
The workshops comply with gmp standards and the medical sutures comply with advanced standards of USP and technology of the UK.
The body of suture is smooth, causing no capillary and repelling reaction.
Sutures by DemeTECH - Surgical Suture Information (684 words)
Polydioxanone suture is an absorbable, sterile, surgical suture composed of the polyester poly (p-dioxanone).
Polyester suture is a non-absorbable, sterile, surgical suture composed of Poly (ethylene terephthalate).
Polypropylene suture is a non-absorbable, sterile surgical suture composed of a synthetic linear polyolefin.
  More results at FactBites »

 
 

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