Module 7 Suture materials and packaging
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Module 7: Suture materials and
packaging
Introduction
Broadly, sutures can be classified into absorbable or non-absorbable materials. They
can be further sub-classified into synthetic or natural sutures, and monofilament or
multifilament sutures. The suture type chosen varies on the clinical scenario.
Absorbable sutures are broken down by the body via enzymatic reactions or hydrolysis.
The time in which this absorption takes place varies between material, location of
suture, and patient factors. The diameter of the suture will affect its handling properties
and tensile strength. The larger the size ascribed to the suture, the smaller the diameter
is, for example, a 7-0 suture is smaller than a 4-0 suture. Suture sizes range from 11-0
to 7.
Suture Terms
When you are looking at a suture, it is important that you understand the following key
suture terms:
Absorbable:
This suture is capable of being absorbed by tissue in a given time frame,
allowing the tissue time to heal itself. The time frame varies with each type of
absorbable suture.
Non-absorbable:
This suture resists absorption by tissue. Used when a permanent
suture is required or when the suture will be removed later (e.g., on the outside of the
body).
Monofilament:
This suture consists of a single strand. This type of suture does not easily
harbor bacteria and glides through tissue smoothly. The drawback to monofilament
suture is that it can be harder to handle and does not hold a knot as well as a
multifilament suture.
Multifilament:
This suture consists of more than one strand. The strands are either
braided or twisted together. Multifilament suture is easier to handle, holds knots better,
and has greater flexibility and tensile strength than monofilament suture. The
disadvantage to multifilament is that it can harbor bacteria and therefore should not be
used in the presence of infection.
Braided:
The strands are intertwined.
Twisted:
The strands are twisted in the same direction.
Coated:
This suture is coated to ease handling and help reduce tissue drag (friction).
Natural:
This suture is made from naturally occurring plants or tissue (e.g., cotton
suture).
Synthetic:
This suture is made from manufactured materials (e.g., nylon suture).
Memory:
This suture has “memory,” which means it springs back into curls when
removed from the package. The scrub person needs to hold each end and give it one
gentle pull outward before handing it to the surgeon.
Suture Sizes
Sutures come in a variety of sizes (known as the
gauge
). Suture gauges range from 5
(heaviest suture) down to 11-0 (thinner than a strand of hair).
The gauge of suture that a surgeon chooses depends on the thickness and type of
tissue being sutured. The heavier sutures are used to approximate bone or are used to
put retention sutures in an abdominal midline incision. Sutures that are 2 to 5 gauge are
used for tendon repair or high tension structures in orthopedic surgeries. Sutures that
are 0 or 1 gauge are generally used on thick tissue (e.g., on abdominal muscle or fascia,
during orthopedic surgery). Sutures in the 4-0 to 7-0 range generally are used in plastic
surgeries or in cardiovascular and vascular surgery. Sutures in the 8-0 to 11-0 range
generally are used for surgery of the eye or in microsurgery procedures (e.g.,
microvascular, vasovasostomy) (
Fig. 4-1
).
FIGURE 4–1
Suture thickness comparison.
Example
Video: YouTube: Basics of Sutures Part 2 | The Different Types of
Suture Materials and When to Use them
Knowledge Check
1
2
3
Question 1
Sutures come in a variety of sizes known as gauge. Suture gauges range from 5 (heaviest suture) down to
11-0 (thinner than a strand of hair).
True
False
Correct
View solution
Question 2
Sutures that are 2 to 5 gauge are used for tendon repair or high tension structures in orthopedic
surgeries.
True
False
Correct
View solution
Question 3
There are sutures to retain a midline incision, but none to effectively approximate bone.
True
False
Knowledge Check
1
2
3
Question 1
Sutures themselves have one thickness, only the size of the needle changes.
True
False
Correct
View solution
Question 2
Sutures in the 8-0 to 11-0 range generally are used for surgery of the _____ or and microsurgery
procedures.
nose
ear
eye
nerves
Correct
View solution
Question 3
Sutures in the 4-0 to 7-0 range generally are used in plastic surgeries or in cardiovascular and vascular
surgery.
True
False
Question 4
Abdominal muscle or fascia in orthopedic surgery would be considered _____________
tissue.
normal
thin
thick
Delicate
Learn: ST135.07.01.02 Suture Materials
Comparison Of Suture Materials
Sutures are either absorbable or nonabsorbable. They are composed of various
materials, natural and synthetic, which make them suitable for certain procedures or
tissues.
Tables 4-1
,
4-2
, and
4-3
allow you to compare suture materials made by various
manufacturers.
Table 4-2
lists the absorbable sutures’ approximate wound support times
to allow for further comparisons.
TABLE 4-1 Nonabsorbable Sutures
SUTURE MATERIAL
COVIDIEN PRODUCT
(SYNETURE)
ETHICON PRODUCT
Monofilament nylon
Dermalon; Monosof
Ethilon
Braided nylon
Surgilon
Nurolon
Braided polyester (uncoated)
Surgidac
Mersilene
Braided polyester (coated)
Ti Cron
Ethibond
Monofilament polybutester
Novafil
—
Monofilament polybutester
(coated)
Vascufil
—
Monofilament polypropylene
Surgipro; Surgipro II
Prolene
Hexafluoropropylene VDF
—
Pronova Poly
Monofilament steel
Steel
Surgical Stainless Steel
Multistrand steel
Flexon
Surgical Stainless Steel
Silk
Sofsilk
Silk; Perma-Hand
TABLE 4-2 Other Nonabsorbable Sutures
SUTURE MATERIAL
SUTURE NAME AND MANUFACTURER
Monofilament nylon (ophthalmic)
Alcon Nylon Suture (made by Alcon)
Twisted silk (ophthalmic)
Silk suture (made by Alcon)
Monofilament polypropylene (ophthalmic)
Polypropylene suture (made by Alcon)
Braided polyester (ophthalmic)
Polyester suture (made by Alcon)
Monofilament suture coated with polycaprolate
BioSorb and BioSorb C (made by Alcon); BioSorb
C also available as a braided suture
Monofilament PTFE (polytetrafluoroethylene)
Gore-Tex (made by Gore Medical)
TABLE 4-3 Absorbable Sutures
SUTURE MATERIAL
COVIDIEN PRODUCT
(SYNETURE)
ETHICON PRODUCT
Gut fiber
Plain Gut (7–10 day wound
support)
Surgical Gut–Plain (7–10 day
wound support)
Gut fiber with chromium salt
Synthetic monofilament
polyglyconate
Chromic Gut; Mild Chromic Gut
(10–14 day wound support)
Maxon, Maxon Plus (6–week
wound support)
Surgical Gut Chromic (21–28
day wound support)
Monofilament synthetic
polyester (polyglytone 6211)
Caprosyn (10–day wound
support)
—
Coated glycolic acid polymer
Dexon II, Dexon S (3–week
wound support)
—
Monofilament polyester
Biosyn (3–week wound support)
—
Sources:
Ethicon Wound Closure Manual
(2004);
www.syneture.com
;
www.Alcon.com
.
Knowledge Check
1
2
3
4
Question 1
The composition of the materials, natural or ___________, determine whether a suture is absorbable or
non-absorbable.
expensive
synthetic
treated
One attempt
Correct
View solution
Question 2
sutures will need to be removed by your doctor at a later date or in some cases left in
permanently.
Absorbable
Nonabsorbable
Vicryl
Gut
One attempt
Correct
View solution
Question 3
PDS shouldn’t be used for cardiovascular or neurological procedures.
True
False
One attempt
Correct
View solution
Question 4
Place the suture material within the correct category, absorbable or nonabsorbable.
Absorbable
Nonabsorbable
Monofilament Polyester- Biosyn
Monofilament Polypropylene- Surgipro; Surgipro II- Prolene
Braided Polyglactin 910- Vicryl Rapide/Vicryl
Gut Fiber- Plain Gut- Surgical Plain Gut
Braided Polyester (coated)- Ti Cron- Ethibond
Silk-Sofsilk-Silk; Perma-Hand
Monofilament Polydioxanone- PDS
Braided Nylon- Surgilon- Nurolon
Monofilament Poliglecaprone- Monocryl
Monofilament Steel- Steel- Surgical Stainless Steel
Solution
Absorbable
Monofilament Polyester- Biosyn
Braided Polyglactin 910- Vicryl Rapide/Vicryl
Gut Fiber- Plain Gut- Surgical Plain Gut
Monofilament Polydioxanone- PDS
Monofilament Poliglecaprone- Monocryl
Nonabsorbable
Monofilament Polypropylene- Surgipro; Surgipro II- Prolene
Braided Polyester (coated)- Ti Cron- Ethibond
Silk-Sofsilk-Silk; Perma-Hand
Braided Nylon- Surgilon- Nurolon
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