Understanding The Different Types of Sutures : Physicians Medical Urgent Care: Urgent Care

Understanding The Different Types of Sutures : Physicians Medical Urgent Care: Urgent Care

When you’ve injured yourself and require a suture, it’s important to know what your options are. Depending on the size of the wound, location and severity, your doctor may recommend a wide array of suture options.

At Physicians Medical Urgent Care, Dr. Ines Munoz De Laborde and Dr. Sveltlana Burkhead can provide medical treatment to cure a wound, apply a suture, and heal your injury.

What are sutures? 

​​Sutures, also known as stitches, are sterile surgical threads used to repair cuts. They are also commonly used to close incisions from surgery. Some wounds may require an alternative method like metal staples instead of sutures. It all depends on the wound. 

Why are sutures used? 

Sutures are used to close deep wounds or cuts. When a deep wound is present, a doctor may need to sew the two edges of the wound together layer by layer. When this happens, sutures are left under the surface of the skin and ultimately close the wound. 

Absorbable vs non-absorbable sutures

There are two varieties of sutures: absorbable and non-absorbable.

Absorbable sutures do not require your doctor to remove them. The enzymes found in the tissues of your body will naturally digest them. 

Nonabsorbable sutures will need to be removed by your doctor in the days or weeks following your procedure, or may be left in permanently. 

Suture material

Sutures are typically made from a variety of materials that are ​​natural or synthetic. Here are a few examples: 

• Nylon: Nylon creates a type of natural monofilament suture
• Polypropylene (Prolene): This material creates a monofilament suture.
• Silk: Silk sutures are typically braided and made naturally 
• Polyester: This form is synthetic and braided

Types of sutures

There are a few types of sutures that you may encounter should you need one. Examples include: 

• Gut suture: This form is a natural monofilament suture used to repair internal soft tissue wounds and is most common in gynecological surgeries.
• Polydioxanone (PDS): This synthetic monofilament suture can be used for soft tissue repairs like abdominal closures.
• Poliglecaprone:This synthetic monofilament suture is used for general use in any soft tissue repair. However, this material should be avoided in cardiovascular procedures. It’s most commonly used to close skin in an almost invisible-like manner. 
• Polyglactin: This synthetic braided suture is good for repairing hand or facial lacerations. 

Depending on your need, your doctor can make the best assessment on suture type and material. 

An injury causes trauma to the impacted area, often requiring a suture. To prevent a more serious disease, book online and visit the doctors at Physicians Medical Urgent Care for convenient and quick care when you need it most.  

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Sutures, Stitches, and Staples

Sutures, stitches and staples are used for the same purpose – to close wounds or surgical incisions – but they are not the same. For sutures, doctors use a thread or strand of material to perform wound closure. The term “stitches” refers to the surgical procedure or process of closing a wound with sutures. Staples are another material that doctors sometimes use to make sutures or stitches.

Types of Sutures and Stitches

Sutures can be either absorbable or nonabsorbable. Absorbable sutures are intended to be broken down by the body over time and eventually dissolve completely. Some materials used to make absorbable sutures are derived from animal products that have been specially processed. Other absorbable sutures are made from synthetic polymer materials such as polylactic acid (Vicryl), polyglycolic acid (Dexon), polyglyconate (Maxon) and polydioxanone (PDS).

Permanent, nonabsorbable sutures are sometimes preferred because they are resistant to body chemicals that might otherwise dissolve them too early in the healing process. Non-absorbable sutures are useful for maintaining long-term tissue wound closure (apposition) and healing. Non-absorbable sutures can be made from nylon, polypropylene (prolene), or silk.

Stitches can be divided into the following sub-types:

• Continuous stitch: This is quick to perform using the same suture line without cutting, which helps distribute the tension along the length of the stitched wound.

• Simple interrupted stitching: The same suture line can be used more than once to make separate stitches that allow for more precise closure of the tissue, especially that of skin and fascia.

• Mattress stitches: These can be placed either vertically or horizontally. Mattress stitches go deeper into the skin layers and allow for excellent closure of incision edges while minimizing tension.

• Sub-cuticular stitch: Using an absorbable suture, the stitch is made at the dermal-epidermal junction to allow for better closure so that postoperative suture removal is unnecessary. This stitch is a convenient technique to close skin incisions.

Staple types are classified according to their material or shape. Medical staples are most commonly made from titanium or stainless steel. However they can also be made from other materials like iron, chromium, nickel or plastic. Medical staples may be straight, curved or circular.

Uses of Sutures

Absorbable sutures:

• Gut sutures: Used to close tissue that requires minimal support and heals rapidly, such as that of the oral cavity mucosal layer, or procedures of superficial blood vessels
• Vicryl sutures: Best for the lower layers of skin, and approximating muscle or fatty tissue
• Maxon and monocryl sutures: Used for sub-cuticular stitches and soft tissue approximation
• PDS: Used for stitches of muscle and fascia tissue

Non-absorbable sutures:

• Prolene sutures: Used in tissue of fascia, muscle or blood vessels
• Nylon sutures: Used for closure of skin, surgical incisions or drainage tubes
• Silk sutures: Typically used to tie off blood vessels or bowel segments

Staples are usually used as an alternative to suturing to close skin incisions, in areas that are hard to stitch, or during procedures that must be performed in a short time. Circular staples are used to make end-to-end surgical closures or connections, as in a bowel resection to help reattach the separated bowel parts.

Advantages of Each

Stitching with sutures or staples are cosmetically equivalent, and the choice of material and technique used depends on the physician who performs the procedure. Generally, staples tend to allow for rapid skin closure with minimal wound inflammation, and are easier to remove than stitches. Medical staples are removed with a staple remover tool, while stitches are removed by cutting the suture next to the knot, then pulling the knot out gently until the suture is completely removed. Typically, using staples to close skin incisions work best with two health care professionals, where one aligns the skin edges with a forceps while the other makes the staples. Stitches can usually be done by one health care professional.

Precautions

Regardless of the closure technique being used, the following precautions must be considered to avoid wound breakdown, and to achieve a well-healed incision with minimal scarring:

• Ensure skin incision is located along the intrinsic tension lines for minimal scarring
• Maintain good blood supply to the wound
• Avoid over-tightening the stitches to reduce the tension and prevent any wound breakdown or unwanted scars
• Eversion (alignment) of skin edges for best healing with minimal scarring
• Usage of Steri-Strips, Band-Aids, and skin adhesive materials to strengthen incision during and after suture removal

Recovery

As soon as the wound has healed enough to withstand the expected stress or pressure on that area, the stitches or staples should be removed. If stitches are left in place beyond that period, they will most likely leave an unwanted scar. Approximate guidelines are as follows:

• Facial stitches typically remain in place for three to five days
• Extremities stitches are typically left in place for about ten days
• Joint stitches are left in place for ten to fourteen days
• Back stitches should remain in place for fourteen days
• Abdominal stitches should usually be left in place for seven days

Skin sutures: application technique, suture materials used.

Surgical sutures are the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material.

The most general principle for performing any suture is to respect the edges of the wound to be sutured. In addition, the suture should be applied, trying to accurately match the edges of the wound and the layers of the organs to be sutured. Recently, these principles have been commonly referred to as “precision”.

Depending on the tools used and the execution technique, manual and mechanical seams are distinguished. For manual sutures, ordinary and atraumatic needles, needle holders, tweezers, etc. are used, and absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. are used as suture material. are metal brackets.

When suturing wounds and forming anastomoses, sutures can be applied in one row – a single-row (one-story, single-tier) suture or in layers – in two, three, four rows. Along with the connection of the edges of the wound, the sutures also provide a stop of bleeding.

When applying a skin suture, it is necessary to take into account the depth and extent of the wound, as well as the degree of divergence of its edges. The following types of sutures are most common: nodal skin, subcutaneous nodal, subcutaneous continuous, intradermal continuous single-row, intradermal continuous multi-row.

Continuous intradermal suture is currently the most widely used, as it provides the best cosmetic result. Its features are good adaptation of the wound edges, good cosmetic effect and less disturbance of microcirculation compared to other types of sutures. The suture thread is carried out in the layer of the skin itself in a plane parallel to its surface. With this type of seam, to facilitate thread pulling, it is better to use monofilament threads. Absorbable sutures are often used, such as Biosyn, Monocryl, Polysorb, Dexon, Vicryl. From non-absorbable threads, monofilament polyamide and polypropylene are used.

No less common is a simple interrupted suture . The skin is most easily pierced with a cutting needle. When using such a needle, the puncture is a triangle, the base of which faces the wound. This shape of the puncture holds the thread better. The needle is injected into the epithelial layer at the edge of the wound, retreating from it by 4-5 mm, then obliquely carried out in the subcutaneous tissue, moving further and further away from the edge of the wound. Having reached the same level with the base of the wound, the needle turns in the direction of the midline and sticks at the deepest point of the wound. The needle must pass strictly symmetrically and in the tissues of the other edge of the wound, then the same amount of tissue enters the seam.

If it is difficult to match the edges of the skin wound, horizontal mattress U-shaped suture can be used. When applying a conventional interrupted suture to a deep wound, it is possible to leave a residual cavity. In this cavity, wound discharge can accumulate and lead to wound suppuration. It is possible to avoid suturing the wound in several floors. Floor-by-floor suturing of the wound is possible with both nodal and continuous sutures. In addition to floor-by-floor suturing of the wound in such situations, vertical mattress suture (according to Donatti) . In this case, the first injection is made at a distance of 2 cm or more from the edge of the wound, the needle is inserted as deep as possible to capture the bottom of the wound. The puncture on the opposite side of the wound is done at the same distance. When holding the needle in the opposite direction, the injection and injection are performed at a distance of 0.5 cm from the edges of the wound so that the thread passes through the layer of the skin itself. Threads should be tied when suturing a deep wound after all sutures have been applied – this facilitates manipulations in the depth of the wound. The use of the Donatti suture makes it possible to compare the edges of the wound even with their large diastasis.

The skin suture must be applied very carefully, since the cosmetic result of any operation depends on it. This largely determines the authority of the surgeon in patients. Inaccurate comparison of the edges of the wound leads to the formation of a rough scar. Excessive efforts when tightening the first knot are the cause of ugly transverse stripes located along the entire length of the surgical scar.

Silk threads are tied with two knots, catgut and synthetic – with three or more. By tightening the first knot, the stitched tissues are matched without excessive force to avoid cutting through the seams. A properly applied suture firmly connects the tissues without leaving cavities in the wound and without disturbing blood circulation in the tissues, which provides optimal conditions for wound healing. For suturing postoperative wounds, a special suture material with microprotrusions, APTOS Suture, has been developed, due to the specific nature of the threads themselves, there is no need for interrupted sutures at the beginning and end of the wound, which shortens the time for suturing and simplifies the entire procedure.

Skin sutures are most often removed on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with a significant tension of the wound edges, reduced regeneration. The sutures are removed by pulling the knot so that a part of the thread hidden in the thickness of the tissues appears above the skin, which is crossed with scissors and the entire thread is pulled out by the knot. With a long wound or a significant tension of its edges, the sutures are removed first after one, and on the following days – the rest.

Any damage to the body is associated with a violation of the integrity of the skin. A scar is a healed wound and its condition is affected by the nature of the traumatic agent (mechanical, thermal, chemical or radiation damage). The use of APTOS Suture allows to reduce the length of the wound by moderately gathering its edges, as a result of which the scar remains much smaller and less noticeable compared to the use of ordinary suture materials.

The company “Volot” produces a wide range of suture material for use in various types of operations, the quality and properties of threads, needles are evaluated by many clinics in the country.

Types of seams. Suture material. Surgical knots

1. Subject: Types of sutures. Suture material. Surgical knots.

Completed by: 6th year student
Nadezhda Zarozhina

2. Surgical sutures may look like:

nodal;
continuous ;
purse-string;
Z-shaped ;
wrap.

3. The knotted stitch

is made with separate stitches, the imposition
of each of them includes four steps:
needle insertion, its removal,
pulling the ligature and tightening it. Interrupted
sutures are the most reliable when suturing wounds: even if one thread
breaks, the others will
hold the edges of the wound. Such
sutures can be used for infected wounds, as
the spread of microbes along the line of interrupted
sutures is less likely. Knotted seam is usually
is applied to the skin and aponeuroses.

4. Continuous stitches

are a series of stitches
applied in succession with
the same thread.
Depending on the number of layers captured by
in the seam, it can be of two options.
1. Continuous seam.
2. Volumetric continuous seam.

5. Continuous seam 20051 pronounced plastic properties

(pleura, peritoneum).
Varieties of planar continuous
seam are:
– purse-string suture;
– semi-purse-string suture according to A. A. Rusanov;
– Z-stitch.

6. Planar continuous seams: 1 – purse-string, 2 – semi-purse-string, 3 – Z-shaped.

7. Volumetric continuous suture

has a number of varieties:
1. A twisted (welted) suture is most often used for
overlays on vessels and hollow organs.
2. A blanket (mattress) suture is used to connect the edges
vessels and skin.
3. A cross-shaped counter-twist suture is intended for
prevention of tissue eruption.
5. A continuous screw-in suture, eg Schmiden suture
, is applied to hollow organs.
6. A continuous pulley suture is used to approximate
ribs after an intercostal incision.

8. Varieties of a continuous volumetric seam: 1 – welt-like seam, 2 – mattress seam, 3 – cruciform counter seam. 4 –

9. Sutures are subdivided:

according to the application technique—manual and mechanical;
on the technique of applying and fixing the node – on
separate nodal and continuous;
form – into simple nodal, U-shaped, Z-shaped, purse-string, 8-shaped;
by function – for hemostatic, invaginating
(screwing), eversion; by the number of
rows – into single-row, double-row, multi-row;
according to the duration of stay in the tissue. – for removable,
after performing the function of which the suture
material is removed, and immersed, upon application of which
the suture material is not removed.

10. Suture material

is a necessary attribute and
instrument of any surgical intervention
. At present, there are a great variety of
suture materials in medicine, so there is a
need for a clear classification of
surgical threads and catgut. The development of
medical technology in the present
allows you to create truly perfect
samples for more effective healing of
surgical wounds.

11. Requirements for surgical suture material today

A. Shchupinsky back in 1965 compiled a
list of requirements for modern
suture material in surgery:
1. Suture material must withstand
sterilization.
2. Surgical threads, catgut should not
react with other tissues and
medicines, do not cause irritation
, the material should be
hypoallergenic.
3. Surgical sutures and catgut should
be quite strong and hold until
complete healing of the surgical wound.

12. Requirements for surgical suture 2

4. The knot on the surgical threads must be made without problems and
must be held firmly.
5. Surgical suture must be resistant to
infection.
6. Surgical sutures, catgut should be able to
dissolve over time, without consequences for the human body
.
7. The thread in surgery should have maneuverability, elasticity,
plasticity, be soft, lie well in the surgeon’s hand, and not have
“memory”.
8. Surgical sutures should be suitable for any type of
surgical intervention.
9. Surgical threads must not be electrified.
10. In the knot, the surgical suture must be at least as strong as the
suture itself.
11. The price of surgical threads and catgut should not be excessively
high.

13. Types of surgical sutures

According to their structure
surgical sutures
are divided into monofilament and
polyfilament.
Monofilament – single-filament
surgical suture with
smooth surface and
solid fiber.
Polyfilament – multifilament,
or polyfilament,
surgical suture,
split into twisted
suture, braided suture.

14. According to the material from which surgical threads are made, suture material is divided into:

Organic natural – catgut, silk, linen,
cellulose derivatives – kacelon, occelon,
rimin.
Inorganic natural – metallic
thread made of steel, platinum, nichrome.
Artificial and synthetic polymers –
homopolymers, polydioxanone derivatives,
polyester threads, polyolefins,
fluoropolymers, polybutesters.

15. According to their ability to dissolve in tissues, or to biodegradation, surgical sutures are divided into:

Completely absorbable.
Conditionally absorbable.
Non-absorbable.
Absorbable surgical sutures:
Catgut.
Synthetic threads.

16. Non-absorbable threads:

Made of polyester fibers (dacron or
polyesters).
Made of polypropylene (polyolefins).
From fluoropolymers.
Made of steel or titanium

17. Division of surgical sutures by thickness

To indicate the size of the sutures in surgery,
is a metric size for each diameter of the sutures,
increased 10 times.
Thread thickness 3-0 used for skin sutures,
subcutaneous sutures.
5-0 – for sutures on the skin, fingers, and in pediatric surgery
.
2-0 – for vascular ligatures.
0 to 2 for muscle sutures.
1-3 – for fascial sutures.
From 5-0 to 7-0 – for seams on vessels.
8-0 to 10-0 for sutures on nerve tissue.

18 types of knots

In surgery, there are many types of knots,
but the basic ones are simple, marine and
surgical.
the formation of the first (main) knot first
change the position of the ends of the threads in the hands –
the left end of the ligature is taken in the right hand, and
the right end is taken in the left hand, thus forming a
cross thread knot is tightened.

19. types of knots

To form a simple knot
, the second
(fixing) knot
is tied similarly to the first
, but the second stage
– shifting
the ends of the ligatures – is not
performed. The simple knot
is not strong enough, it slips
and can be stretched
by pulling one
end of the ligature out of the loops
other.