dr. aidah abu elsoud alkaissi department of intensive care and anaesthesiology university of...

Dr. Aidah Abu Elsoud Alkaissi Department of Intensive Care and Anaesthesiology University of Linköping Sweden

Sutures, Needles , and Instruments

Dr. Aidah Abu Elsoud Alkaissi

An-Najah National University

Faculty of Nursing


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)


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


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


Characteristics of suture materials

• Ways to evaluate the properties of suture material:

• Physical x´s

• Handling x´s

• Tissue reaction

• Please read page 115 table 7.1


Physical x´s

• 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


Handling X´s

• 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


Tissue reaction X´s• 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)


• Please read Table 7-2, 7-3


Types of suture material

• Absorbable suture material

• Surgical gut

• Collagen sutures

• Synthetic absorbable sutureNonabsorbable sutures


Types of nonabsorbable sutures materials

• Silk

• Cotton

• Surgical Nylon

• Surgical polyster fiber

• Polypropylene

• Surgical stainless steel


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


Skin staples

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