Surgical Technology: Suture Properties

Suture Properties

US Pharmacopeia Sizes

General Size Use

≥ 2-0: High Tension (Fascia)
3-0: Requiring Good Retention (Scalp, Torso, Hands)
4-0: Requiring Minimal Retention
- Most Common Size for Superficial Wounds
≤ 5-0: Delicate Areas Needing Little/No Retention (Cosmetic)
- Also Used in Vascular Cases

Braiding

Monofilament (Single Strand)
- Less Reactive
- Less Tensile Strength
- Require More Ties (5-6) to Assure Knot Integrity
- Lower Risk of Infection
Braided (Multiple Strands)
- Incites a Greater Inflammatory Response
- Increased Tensile Strength & Pliability
- Require Fewer Ties (3-4) to Assure Knot Integrity
- More Likely to Harbor Infection

Monofilament (Above) & Braided (Below)

Absorption

Absorbable
- More Reactive – More Scarring
- Absorption Time Depends on Material
Non-Absorbable
- Less Reactive – Less Scarring
- Time to Removal Depends on Location/Function

Barbed Suture

Suture with Barbs Along the Length
- Barbs Made by Cutting into the Shaft of Smooth Suture
- Barbs Prevent Suture from Retracting Backwards
- Fixed at the End with Either a Loop or Anchor
Brands:
- Quill
- V-Loc
- Stratafix Spiral
Effects of Barbed Suture:
- No Knots Required
- Some Studies Show that Barbed Suture Better Maintains Tissue Tension & Integrity Over the Entire Closure (Debated)
  - Distributes Force Over a Larger Contact Area & Reduces Tension on Tissue
  - Despite a Reduced Tensile Strength (Due to Cutting into the Suture)
- Improved Efficiency – Reduced Closure Times & Easier Closure in a Laparoscopic Setting
- Effects on Inflammation & Wound Healing Not Yet Proven
Negative Effects of Surgical Knots:
- Reduced Tensile Strength (Stretching & Thinning)
- Higher Volume & Density of Foreign Body Material – Increasing Inflammatory Reaction

Barbed Suture

Absorbable – Monofilament

Chromic Catgut
- Material: Natural – Sheep/Cattle Mucosa (Not Cats)
- Absorption: 90 Days
  - Strength Maintains for 1-2 Weeks
Monocryl
- Material: Synthetic – Poliglecaprone
- Absorption: 90-120 Days
  - 50% at 1 Week, 25% at 2 Weeks
PDS
- Material: Synthetic – Polydioxanone
- Absorption: 180-210 Days
  - 80% at 2 Weeks; 44% at 8 Weeks

Absorbable – Braided

Vicryl
- Material: Synthetic – Polyglactin 910
- Absorption: 56-70 Days
  - 75% at 2 Weeks, 50% at 3 Weeks, 25% at 4 Weeks

Non-Absorbable – Monofilament

Non-Absorbable – Braided

Suture Materials

Shape

Point

Tapered
- Round Body Tapered to a Point
- Separates Tissue Rather Than Cut
- Provides Smallest Diameter Hole
- Good for Soft Tissue Such as Bowel or Subcutaneous Tissue
Cutting
- Triangular Body with a Cutting Edge on Inside
- Allows Smooth & Atraumatic Penetration
- Wound & Laceration Repair
- “Reverse Cutting” – Edge on Outside

Basic Needles

Needle Shpaes

Needle Points