Claire Dawson
Surgical sutures, also known as stitches, are a medical procedure used to hold body tissues together and approximate wound edges after an injury or surgery. Sutures are typically performed by a medical professional, such as a surgeon or an advanced practice registered nurse (APRN), and involve using a needle with an attached length of thread to stitch the wound closed. The type of suture used depends on various factors, including the characteristics and location of the wound, the specific body tissues being approximated, and the patient's overall health. While sutures are commonly performed in a hospital setting, it is important to note that attempting to suture a wound at home is not recommended.
| Characteristics | Values |
|---|---|
| Purpose | To hold body tissues together and approximate wound edges after an injury or surgery |
| Composition | A needle attached to a thread-like material |
| Types | Absorbable, Non-absorbable, Monofilament, Polyfilament, Braided, Natural, Synthetic, Continuous, Barbed, Bioactive, Biodegradable |
| Needle Types | Cutting, Taper, Trocar Point, Side Cutting or Spatula Points, Atraumatic, Swaged |
| Needle Features | Curved, Cutting or Non-cutting edge |
| Factors Influencing Type of Suture | Wound characteristics, location, thickness, and mechanical and shear forces acting on it |
| Wound Care | Keep wound clean and dry, avoid physical activities that might reopen the wound, use creams and lotions only if recommended by a doctor, follow instructions for bandages or dressings |
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What You'll Learn
Suture types: absorbable vs non-absorbable
A surgical suture, also known as a stitch, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Sutures can be broadly classified into absorbable and non-absorbable materials. They can be further sub-classified into synthetic or natural sutures, and monofilament or multifilament sutures. The suture type chosen depends on the clinical scenario and the characteristics and location of the wound or the specific body tissues being approximated.
Absorbable sutures are broken down by the body via enzymatic reactions or hydrolysis. The time it takes for absorption varies depending on the material, location of the suture, and patient factors. Absorbable sutures are commonly used for deep tissues and tissues that heal rapidly, such as small bowel anastomosis or suturing in the urinary or biliary tracts. Synthetic absorbable sutures like polyglactin 910 (Vicryl Rapide) are derived from ordinary polyglactin, which undergoes ionization to speed up its absorption without changing its mechanical properties. It dissolves in 7 to 10 days and holds well if four square knots are tied. Other absorbable sutures like Vicryl and Vicryl Plus lose 50% of their tensile strength within 3 weeks and are completely absorbed within 70 days. However, absorbable sutures may promote infection or unraveling if they remain in the body for too long.
Non-absorbable sutures, on the other hand, provide long-term tissue support and are walled off by the body's inflammatory processes until they are removed manually if needed. Non-absorbable suture materials maintain their strength over long periods, with some remaining in the body forever. Synthetic non-absorbable materials are often used as removable skin sutures due to their very low tissue reactivity. Many surgeons prefer non-absorbable sutures because they are easier to tie, less likely to break prematurely, and elicit a minimal inflammatory response. Silk is an example of a non-absorbable braided suture material made from natural fibroin filaments obtained from silkworm caterpillar cocoons. It is usually coated with wax or silicone and is commonly used in securing drains.
The ideal suture, regardless of composition, should allow the healing tissue to recover sufficiently and produce a minimal reaction. It should also be predictable, easy to handle, and knot securely.
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Needle types: cutting, taper, trocar, etc
A surgical suture, also known as a stitch, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. The needle shape, size, and thread material are all factors that determine the type of suture used.
Needles can be classified by their point geometry, with different types suited to specific procedures. Here are some common needle types:
- Taper: The body of a taper needle is round and tapers smoothly to a point.
- Cutting: Cutting needles have a triangular body with a sharpened cutting edge on the inside curve. They are designed for penetrating dense, irregular, and relatively thick tissues, such as skin sutures. Cutting needles typically have at least two opposing cutting edges, with the third cutting edge present on either the inner or outer curvature.
- Trocar point or tapercut: Trocar needles have a round and tapered body but end in a small triangular cutting point.
- Side cutting: Side-cutting needles, or spatula points, are flat on the top and bottom with a cutting edge along the front to one side. They are used for eye surgery.
- Atraumatic: Atraumatic needles are designed to minimise tissue trauma during suturing. They can be permanently swaged to the suture or designed to come off with a sharp tug, commonly used for interrupted sutures.
The selection of the appropriate needle type is crucial to ensure efficient wound closure and minimise potential complications.
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Thread types: monofilament, polyfilament, braided
Sutures, also known as stitches, are medical devices used to hold body tissues together and approximate wound edges after an injury or surgery. They are typically applied using a needle with an attached length of thread. The selection of suture type depends on the characteristics and location of the wound or the specific body tissues being approximated.
Monofilament sutures are single filaments with less surface area than multifilament or braided sutures. They have higher memory, which demands more handling care. They are also more prone to knot loosening and typically require more knots to ensure security. Monofilament sutures include synthetic materials such as nylon, polypropylene, and surgical steel, which offer great tensile strength.
Polyfilament sutures, on the other hand, are made from multiple braided or twisted filaments. They are more pliable, hold knots more securely, and are easier for surgeons to handle. However, they have increased capillarity and surface area, increasing their susceptibility to inflammation and infection. Polyfilament sutures are commonly used in soft tissue, vessel ligations, and superficial skin repairs.
Braided sutures, a type of multifilament suture, are created by braiding or wrapping multiple filaments. They are flexible, strong, and soft. They have high knot security and tensile strength but can increase tissue trauma when passing through the skin. Braided polyester sutures, for example, are made from polyethylene terephthalate and are often coated in silicone and dyed for visibility.
The choice between monofilament, polyfilament, and braided sutures depends on various factors, including the wound characteristics, tissue type, tensile strength requirements, knot security, inflammation and infection risks, handling characteristics, and cost.
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Wound care: hand washing, avoiding physical activity
Proper wound care is essential to ensure your incision heals well and you don't develop an infection. Here are some key instructions to follow for wound care, including hand washing and avoiding certain physical activities:
Hand Washing
Hand washing is one of the most effective ways to prevent the spread of germs. Before and after touching your wound or incision, be sure to wash your hands with soap and clean, running water (warm or cold) for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
Avoiding Physical Activity
While light activities like walking are generally considered safe during the recovery period, more strenuous activities should be avoided. Here are some specific guidelines:
- Avoid heavy lifting or any activities that increase your heart rate for at least the first week after surgery.
- Keep the affected limb elevated if the surgery was on a lower extremity.
- Avoid stretching, yoga, or any activities that may cause skin tension, as they can put strain on the stitches and affect wound healing.
- Swimming, hot tubs, and natural bodies of water should be avoided until the stitches are removed, as they can cause tension in the skin and potentially harm the sutured area.
- Always follow the instructions provided by your healthcare provider regarding rest and activity levels. They may recommend continued rest and limited activity to promote proper healing and prevent complications.
Remember, the recovery process can vary depending on the area of the wound and individual healing progress. It's important to follow your healthcare provider's specific instructions for wound care and seek their guidance if you have any questions or concerns.
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Removal: by doctor or automatic dissolution
There are two types of sutures: dissolvable and non-dissolvable. Dissolvable sutures are made of materials such as animal proteins or synthetic polymers, which the body can break down and absorb over time. The time it takes for the body to absorb these stitches depends on the material used and the wound's characteristics and location. For example, stitches following a joint replacement may take several months to dissolve entirely. Stitches in the mouth usually take around a week to dissolve but can take up to four weeks.
Non-dissolvable sutures are typically made of materials such as nylon or silk, which the body cannot absorb. A healthcare professional must remove these stitches once the wound has healed.
Doctors may choose to use dissolvable stitches for deeper wounds or surgical incisions. This reduces tension and makes it easier to fit the shape of the wound, lowering the risk of the wound reopening and leading to less scarring. Dissolvable stitches are also used when follow-up care is not possible or required.
It is important to follow the doctor's care instructions after receiving stitches. People should not attempt to remove any stitches without their doctor's approval, as the wound may not have fully healed.
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Frequently asked questions
Sutures, also known as stitches, are a medical device used to hold body tissues together and approximate wound edges after an injury or surgery.
Yes, sutures are done by hand. The process involves using a needle holder to pass a needle with an attached length of thread through the skin. The needle holder is then used to pull the knot to one side so it does not overlay the wound.
Sutures can be made from various materials, including natural materials such as silk, or synthetic materials such as nylon and polyester. Sutures can be absorbable or non-absorbable. Absorbable sutures are designed to be broken down and absorbed by the body over time, while non-absorbable sutures are made from materials not absorbed by the body and must be removed once the wound has healed.
It is important to keep sutures clean and dry, especially for the first 24 hours. You should also follow the care instructions provided by your doctor or nurse, including changing dressings as instructed. Avoid physical activities that might reopen the wound, and do not pick at the stitches or scabs as this may increase scarring.
Stitches are typically removed after 5 to 10 days, but this depends on the location of the sutures. Some types of sutures are dissolvable and will fall out on their own, usually within a week but sometimes taking up to several months. Your doctor or nurse will advise you on the right time to remove your sutures.
