PRESENTATION ON SURGICAL SUTURES

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• PRESENTATION ON SURGICAL SUTURES

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HISTORY OF SUTURES

• Earliest Reference
• EDWIN SMITH PAPYRUS 1600 BC

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WOUND CLOSURE THROUGH HISTORY

• Driver Ants
• Bark Fibre
• Linen
• Gold
• Animal Intestinal Tissue
• Synthetic Absorbable

• Kangaroo Tendons
• Silver
• Cotton
• Acacia Thorns
• Cautery

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How the Surgeon Uses Suture Materials

• Ligating
• Suturing
• Transfixing

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THE IDEAL SUTUREMoynihan 1912

• Monofilament
• Use for any procedure
• Easy to Handle
• Minimal Tissue Reaction
• High Breaking Strength
• Holds Knot Securely
• Absorbable
• Predictable Absorption
• Sterile

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CLASSIFICATION OF SUTURES
ABSORBABLE NONABSORBABLE
MONOFILAMENT BRAIDED
SYNTHETIC NATURAL
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ABSORBABALE

• ADVANTAGE
• Broken down by body
• No Foreign body left
• DISADVANTAGE
• Time of Wound Support

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NONABSORBABALE

• ADVANTAGE
• Permanent Wound Support
• DISADVANTAGE
• Foreign body left
• Suture Sinus
• Suture Extrusion

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MONOFILAMENT

• ADVANTAGE
• Smooth Surface
• Low Friction
• Less Tissue Drag
• Less Tissue Trauma
• No Bacterial Harbours

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MONOFILAMENT

• DISADVANTAGE
• Handling and Knotting
• Ends/Knot Burial
• Stretch

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BRAIDED

• ADVANTAGE
• Strength
• Soft and Pliable
• Good Handling

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BRAIDED

• DISADVANTAGE
• Bacterial Harbours
• Tissue Trauma
• Tissue Drag

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SYNTHETIC

• ADVANTAGE
• Resemble Natural Substances
• Absorption by Hydrolysis
• Predictable Absorption
• Strong
• DISADVANTAGE
• Monofilament Handling

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NATURAL

• ADVANTAGE
• Handling and Knotting
• Economical
• DISADVANTAGE
• Absorption by Enzymatic Action
• Tissue Reactions
• Unpredictable Absorption

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ABSORPTION TERMINOLOGY(Absorbable Sutures)

• LOSS OF TENSILE STRENGTH
• ABSORPTION OF MASS

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LOSS OF TENSILE STRENGTH DEFENITION

• Tensile Strength retention refers to the amount
  of strength INVIVO that a suture material has
  retained.
• This can be measured in days and as a percentage
  of original strength
• Loss of Tensile strength can take place without
  any visible loss of suture bulk

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ABSORPTION OF MASS DEFENITION

• Absorption is the loss of mass of the material in
  tissue as measured in days.
• There may be mass of Suture in the wound and
  zero tensile strength retention.
• Mass absorption is important as even when
  mechanical wound support is no longer needed,
  potential adverse reactions can continue as long
  as the suture is present.

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ABSORBABLE SUTURES
Material Wound Support Absorption of Mass

PLAIN 7 - 10 60 - 90
HICRYL 28 - 30 90 - 110
CHROMIC 17 - 21 90 - 110
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HICON CATGUT SUTURES
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HICON CHROMIC GUT

• Made from Sub Mucosa of Sheep Intestine
• Cleaned and Purified for high Collagen Purity
• Individual ribbons are twisted and dried
• Chromicising done to ensure tensile strength
• Polished to controlled diameter
• Result in Virtual Monofilament
• Packed wet to keep supple

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CATGUT ABSORPTION
PLAIN CHROMIC
WOUND SUPPORT 7 10 days 17 21 days
MASS ABSORPTION 60 90 days 90 110 days
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CATGUT ABSORPTION

• Absorption by Enzymatic action
• Absorption is unpredictable
• Tissue reaction can occur

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CATGUT SUMMARY

• ABSORBABLE No Foreign body left
• MONOFILAMENT Minimal Tissue Trauma
• 98 PURE COLLAGEN Minimises Tissue Reactions
• PACKED WET Pliable, Good Handling Knotting

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SYNTHETIC ABSORBABLE
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SYNTHETIC ABSORBABLE HINCRYL SUTURES

• HICRYL

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COATED HICRYLTENSILE STRENGTH RETENTION
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COATED HINCRYL

• WOUND SUPPORT 28 32 DAYS
• MASS ABSORPTION 90 110 DAYS

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COATED HINCRYL

• Imported Raw Material
• ISO certified Manufacturing Facility
• More than 40 suture Needle Combinations
• Secure Knotting Characteristics

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HINCRYL SUMMARY

• Strong
• Good Knotting and handling Properties
• Few Tissue Reaction
• Predictable Absorption
• No Foreign body left
• Minimising problems of multifilament
• Knot slides down easily
• Minimal Tissue Reaction

• Braided
• Synthetic
• Absorbable
• Coating on Hicryl

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NON ABSORBABLE

• HISIL
• HILON
• HINSURG

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HISIL BRAIDED BLACK SILK SUTURES
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HISIL

• Easy handling
• Manufactured from imported raw silk
• Uniform diameter and smooth surface
• Assured excellent knot security
• Available in sizes 6/0 to 1 USP
• On reels (Non sterile) of 25 mts length
• Sterile Needled sutures

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HISIL

• Very Good Handling
• Very Good Knotting
• Standard for many years

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HILON

• SYNTHETIC
• NONABSORBABLE
• MONOFILAMENT

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HILON

• First Synthetic Monofilament Non absorbable
• Replaced Monofilament Silk
• Used mainly in Skin and Abdominal Closure

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HILON

• Smooth, Easy passage through tissue
• No Bacterial harbours or Capillarity
• Strong, Controlled Elasticity allows Ultra Fine
  Gauges
• Provided Long term Wound Support

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HINSURG POLYPROPELENE NONABSORBABLE SUTURES
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HINSURG

• Monofilament to replace Nylon
• Better Control of Stretching Properties
• More Pliable for handling and knotting
• Smoothest Suture Surface ever

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HINSURG

• Extends upto 30 before Breaking
• Indefinite Tensile Strength
• Excellent Handling
• Secured Knotting
• Sterilised by EO
• Inert and Non-Biodegradable