Sutures. What are the types of sutures? Suture techniques

SUTURE

Suture or stitches are most commonly used method to fix a cut or wound

Types

Absorbable suture: A suture that degrades and loses it tensile strength within 60 days is generally considered to be absorbable. It is of two types:

• Monofilament, e.g. Surgical gut, collagen. 
• Multifilament, e.g. polyglycolic, polyglactin. 

Nonabsorbable :

• Monofilament, e.g. polyamide, polypropylene, steel, polyester
• Multifilament, e.g. Silk, polyester braided. 

Polyglycolic acid is the most popular suture material because it is absorbable and has long-lasting tensile strength.
Catgut is pliable, easy to handle and inexpensive. Chromic catgut lasts for 2-3 weeks and is used for ligatures and tissue suture.
Braided suture is usually made of natural products(silk, linen or cotton). It is acceptable in many situations, but is contraindicated in a wound that is, or maybe, contaminated.
Synthetic monofilament suture, such as nylon polypropamide is not contraindicated in situations of contamination.
Sterilized polyester thread and nylon line produced for nonsurgical purpose are acceptable compromises when commercial suture is unavailable.

NEEDLE

Main categories of surgical needles are:

• Round bodied: Use round-bodied needles in fragile tissue, for example when performing an intestinal anastomosis.
• Cutting: Use cutting needles on the skin, and for securing structures like drains.
• Trochar: Trochar needles have a sharp tip but a round body. They are useful when it is necessary to perforate tough tissue, but when cutting the tissue would be undesirable, as in the linea alba a when closing the abdominal wall.

Suture techniques include :

 Interrupted simple: The needle should pass through tissue at 90 degrees and exit at the same angle
Continuous simple: Suture passes at 90 degrees to the line of the incision and crosses internally under the top of the incision at 45-60 degrees
Vertical matters: Vertical matters sutures are best for allowing eversion of wound edges and perfect apposition and to relieve tension from the skin edge
Horizontal matters: The two suture are aligned beside one another. The first stitches is aligned across the wound, the second begins on the side that the first ends
Subcuticular: Useful in wounds with strong skin tension, especially for patients who are prone to keloid formation
Purse string: A circular pattern  that draws together the tissue in the path of the suture when the ends are brought together and tied
Retention /tension: Insert retention sutures through the entire thickness of the abdominal wall leaving them untied at first.


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