Suturing Introduction

3 Dec

You have decided to stock sutures in with your emergency medical supplies, but while looking at the vast number of suture products available, you’re not sure which products to purchase. Let’s cover the information you need to know about sutures so you can make a more informed choice. Article submitted via Pinterest Board.  

General Rules

On eBay, sellers of suture products are required to either confirm that the buyer is a medical professional or the seller must state that the product is intended for “Veterinary” use. This is, of course, a means of skirting regulations. Bottom line here is, don’t think there is any difference between sutures for people and sutures for animals. It’s all the same stuff. When buying, look for expiration dates and that the packaging is sealed and undamaged. 

Also when purchasing sutures, understand that one type of product comes as the suture material (thread) only, meaning needles are sold separately. The suture material is threaded through the needle eye, just like in sewing. A second type is suturing material, with a needle attached to one end, or both ends. My advice is, keep it simple, and go with the suture with integral needle.

Needles

Sutures with integral needles come in a wide variety of needle shapes and sizes. Needle sizes (length) are expressed in millimeters. The higher the number, the bigger the needle. Needles are either straight or curved. Curved needles are described by the amount of their curvatures. (ie. 2/8 of a circle, 3/8 of a circle and up to 5/8 of a circle). Needle tip shapes are made in blunt, tapered, conventional cutting or reverse cutting configurations.  My advice is, purchase sutures with needles from 16 to 24 millimeters, 3/8 curve and reverse cutting tip. For our needs and individual suturing “prowess,” these will serve us well. Again, keep it simple.

Suture Material

Sutures themselves is where the real confusion hits hard. First you must consider the type of suture. (i.e. absorbable or non-absorbable material, Catgut, chromic Gut, Silk, a synthetic material, and in a braided or monofilament form). Next is the length of the suture. They can come as small as 20cm (7 3/4″) to 100cm (39 1/4″). Lastly you need to consider the diameter of the suture. A #3 suture is approximately 0.600mm and a 10/0 suture (spoken as 10-oh) is approximately 0.020mm. Unlike needles, when identifying sutures the higher the number, the smaller the diameter. Small size needles and sutures are used in micro-suture (reconstructive surgery) applications while the larger sizes are used in bone. (i.e. hip replacement surgery).

Absorbable

Absorbable sutures are made of materials that are broken down in tissue after a known period of time. Depending on the material, this is accomplished from between 10 days to 8 weeks. Generally, absorbable sutures are used below the surface of the skin, as in the case of very deep wounds. Absorbable sutures are used to draw subcutaneous tissue together, possibly in more than one layer, to avoid dead space (air or fluid filled pockets) that may be left if suturing is done at skin level only. Think in terms of closing only the top of a “U”. Absorbable sutures are also used in subcuticular suturing to minimize obvious scaring.

Catgut (or gut) and Chromic Gut sutures are rarely used, primarily due to poor tensile strength and poor knot security, and are being replaced by synthetic materials. My advice is, a synthetic, such as Poliglecaprone 25, in a 5/0 or 6/0 size with an 18mm reverse cutting needle would serve our needs best.

Non-Absorbable

A non-absorbable suture made from natural material is Silk. Though it is rarely used, it still has applications in eye, lip skin and intraoral suturing. My advice is to buy 5/0 or 6/0 size with an 18mm reverse cutting needle.

Non-absorbable sutures made from synthetic materials, such as Nylon and Braided Polyester are ideal for skin level closure using interrupted or running suture techniques. 4/0 and 5/0 with a 22mm reverse cutting needle is perfect for wounds that are not over, or immediately around joints (elbows, knees, etc.). Over joints, use 2/0 or 3/0 with a 22 or 24mm reverse cutting needle. 

Good Video http://www.youtube.com/watch/?v=NutaH-w20-k

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