Sutures & Drainage

Sutures

Suture material is a foreign body implanted into human tissues

During wound closure, a sterile field and meticulous aseptic technique are critical to minimize the risk of wound infection.

Ideal suture characteristics

Sterile All-purpose (composed of material that can be

used in any surgical procedure) Causes minimal tissue injury or tissue reaction Holds securely when knotted High tensile strength Favorable absorption profile Resistant to infection

TYPES of sutures

The type of suture used varies on the operation, depending on the location and environment.

Absorbable-broken down in tissue depending on the material can be from ten days to eight weeks

Non-absorbable-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

Absorbable sutures

Natural- Prepared from beef and sheep intestine

Collagen Surgical gut, plain Surgical gut, fast-absorbing Surgical gut, chromic

Absorbable sutures

Synthetic- Chemical polymers are absorbed by hydrolysis and cause a lesser degree of tissue reaction.

Polyglactin 910 (Vicryl): Poliglecaprone 25 (Monocryl): Polydioxanone (PDS II):

Absorbable sutures

Their uses are as follows. Tying off small arteries and veins near the skin. Stitches in the ureter, urinary tract, or biliary tract (where

permanent sutures term a focus for stone formation). Closing off tissue spaces, e.g. subcutaneous space. Occasionally for closing the skin in children, where it is

an advantage not to have to remove the stitches. In small bowel anastomosis or stomach mucosal

anastomosis

Non-absorbable sutures

Natural Surgical silk- Used for (1) repairing rapidly healing tissues

that require minimal support, (2) ligating superficial blood vessels, and (3) suturing subcutaneous fatty tissue.

Surgical cotton- Same as silk

Surgical steel- Surgical steel suture is used primarily in orthopedic, neurosurgical, and thoracic applications.

Non-absorbable sutures

Synthetic Nylon- Stitching the skin, 2 Closure of the abdominal muscles, 3-

Ophthalmology and microsurgery

Polybutester (Novofil)-Surface closure, permitting adequate tissue approximation while allowing for tissue edema and detumescence.

Polyester fiber (Dacron):1-vessel anastomosis 2-placement of

prosthetic materials.

Polypropylene (Prolene): 1-Closure of the skin, particularly for subcuticular sutures.2-Arterial surgery 3-large bowel anastomosis and bile-duct surgery

Sizes of sutures

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.

Suture techniques

Common suture stitching techniques include: Simple Interrupted Stitch Running Stitch Mattress Horizontal mattress Vertical mattress Continuous locking Subcuticular

Surgical techniques

Continuous

Running stitch

Surgical techniques

Simple interrupted

Subcuticular

Surgical techniques

Mattress

Surgical needles

Traumatic needles are needles with holes or eyes which are separate from their suture thread.

Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread.

Surgical needles

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

Surgical needles

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 sma blunt points for sewing friable tissues side cutting or spatula points

Needles

Other methods

Tissue adhesivesTopical cyanoacrylate adhesives ("liquid stitches")

have been used in combination with, or as an alternative to, sutures in wound closure.

Surgical staples Specialized surgery staples, which prove to be

faster, consistent & accurate. Staple lines are less likely to leak blood, air or bowel contents.

Staples

Drainage

A surgical drain is a tube used to remove pus, blood or other fluids from a wound.

Drains may be hooked to wall suction, a portable suction device, or they may be left to drain by gravity.

Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding.

Types of drains Jackson-Pratt drain

Penrose drain

Wound Vac System - Involves the use of enclosed foam and a suction device attached; often used for large surgical/trauma/non-healing wounds.

Redivac drain

Pigtail drain - has an exterior screw to release the internal "pigtail" before it can be removed

Davol

Chest tube

Complications of drainage

Infection Anastomotic leakage Fistula formation Bleeding Erosion of adjacent tissue/vessels.

The End