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Non-absorbable sutures are associated with an increased incidence of prolonged wound pain, and suture sinus.
Studies indicate that patients can uncover and occasionally wet stitches in the first 48 hours after minor skin excisions without increasing the incidence of wound infection.
A medical device used to hold body tissues together after an injury or surgery.
Application generally involves using a needle with thread.
A number of different shapes, sizes, and thread materials have been developed.
Medical professionals of all types typically engage in suturing.
Surgical knots are used to secure the sutures.
Eyed or reusable needles are used.
Suture must be threaded on site.
Swaged needles with sutures are pre-packed eyeless needle attached to a specific length of suture thread.
Swaged needles with sutures save the time of threading the suture on the needle, and the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site.
In eyed needles, the thread protrudes from the needle body on both sides, and causes drag.
When passing through friable tissues, the eye needle and suture combination may thus traumatize tissues more than a swaged needle.
Swaged needles are ref2242ed to as atraumatic.
Shapes of surgical needles include:
Straight
1/4 circle
3/8 circle
1/2 circle.
5/8 circle
compound curve
half curved
half curved at both ends of a straight segment
Certain needle design allows curved needles to be straight enough to be used in laparoscopic surgery, where instruments are inserted into the abdominal cavity through narrow cannulas.
Needles may also be classified by their point geometry:
taper
cutting
reverse cutting
trocar point or tapercut
blunt points for sewing friable tissues
side cutting or spatula points
Suture thread is made from numerous materials.
Original sutures were made from biological materials, such as catgut suture and silk.
Most modern sutures are synthetic: absorbable-polyglycolic acid, polylactic acid, Monocryl and polydioxanone
non-absorbable: nylon, polyester, PVDF and polypropylene.
Sutures come may be either absorbable, naturally biodegradable in the body, or non-absorbable.
Sutures must be both flexible for knotting and strong enough to hold tissue securely.
They must be hypoallergenic.
Absorbable or non-absorbable sutures are classified depending on whether the body will naturally degrade and absorb the suture material over time.
Absorbable sutures are made of polymers, and are broken down by hydrolysis and proteolytic enzymatic degradation.
Absorption of the material can be from ten days to eight weeks.
Absorbable sutures will hold the body tissues together long enough to allow healing.
Absorbable sutures will disintegrate so that they do not leave foreign material or require further procedures.
Absorbable sutures cause a transient foreign body reaction to the material.
With complete resorption only connective tissue remains
Non-absorbable sutures consist of special silk or the synthetics polypropylene, polyester or nylon.
Stainless steel wires are commonly used
For orthopedic surgery and for sternal closure in cardiac surgery stainless steel wires are frequently used.
Non-absorbable sutures can be used either on skin wound closure, where the sutures can be removed after a few weeks, or in situations that absorbable sutures will not be adequate, such as heart or bladder surgery.
Non-absorbable sutures often cause less scarring because they provoke less immune response.
Non-absorbable sutures are used where cosmetic outcome is important.
Suture sizes are defined by the United States Pharmacopeia (U.S.P.).
Suture sizes range from #5, a heavy braided suture for orthopedics, to #11-0 a fine monofilament suture for ophthalmic surgery.
Atraumatic needles are manufactured in all shapes for most sizes.
Sutures bring together the wound edges, without causing indenting or blanching of the skin, preventing the blood supply from being impeded preventing infection and scarring.
Because skin and other soft tissue can lengthen significantly under strain, continuous stitches must have an adequate amount of slack.
Some sutures are intended to be permanent, and others may be kept in place for an extended period of many weeks.
Generally sutures are of short term use, allowing healing of a trauma or wound.
Time to remove stitches vary: facial wounds 3–5 days; scalp wound 7–10 days; limbs 10–14 days; joints 14 days; trunk of the body 7–10 days.
Topical cyanoacrylate adhesives-super glue, have been used in combination with, or as an alternative to, sutures in wound closure.
The adhesive remains liquid until exposed to water-containing tissue, after which it cures and forms a bond to the underlying surface.
In surgical incisions it does not work as well as sutures as the wounds often break open.