The basic tools used for Surgical sewing are vices, surgical tweezers, scissors, and peanuts for most Types of Sutures. The choice of sewing method and the material we will use depends on the depth of the wound and the structure that is stitched.
First, we look at the types of seams and needles. The needles are divided into straight and curved, but only the latter are commonly used for most Types of Sutures.
The needle is placed in a vice at a ⅔ distance from the pointed end. Depending on the purpose, they form a larger or smaller fragment of a circle (arc).
The needles are divided into prickly (circular-shaped cross-section), cutting (triangular-shaped cross-section), papercut (with stinging-cutting features), trocar (wide prickly end and cutting shaft; used for sewing hard tissues).
Currently, atraumatic needles are used, i.e. those in which the needle is integrated with the Types of Sutures, thanks to which there is no additional tissue damage caused by the needle tip.
The size of the needle can be chosen in relation to the size of the wound. Large size is available on the market from ophthalmic needles about 9 mm to orthopedic needles 65 mm.
Absorbable and non-Absorbable
The seams are divided into absorbable and non-absorbable. Non-absorbable Types of Sutures- they are not absorbed, they are used for wounds that have a longer healing process and require proximity of the wound edges (skin, vascular anastomoses).
Sutures, if not removed, disintegrate/crumble into smaller pieces after some time, losing their Non-absorbable vs. Absorbable sutures, as the name suggests, dissolve and absorb, they are used where the healing process is fast (muscles, tendons, peritoneum).
In addition, we can divide them into 3 Types of Sutures: short, medium, and long-term tissue tension maintenance.
1. CATGUT (Softcat - B, Softgut - D&G, Plain catgut - E, Catgut super - mth, Catgut plain - S, Surgigut plain - USSC) - this is a natural material with only a few days of ability to maintain its tension in tissues.
It is used for a short-term approach of deeper tissues and subcutaneous tissue, usually in the absence of tension on the edges of the wound and as a material for garters. Currently discontinued. With a short period of ability to maintain its tension in tissues
2. POLIGLACTIN 910 (Vicryl Rapide - E) is a synthetic braid that has virtually no tissue reaction. It holds for 12 days and is comparable to catgut in this respect, but its original tensile strength (with the same thread thickness) is twice as high. The use has similar to catgut.
3. GLYKOMER 631: (Biosyn - USSC) - single-fiber three-component absorbable suture. It maintains its tension in tissues for a period of about 2 weeks, it is also broken down by hydrolysis.
On the average period of the ability to maintain its tension in tissues:
4. POLIGLECAPRONE: (Monocryl - E) - a single-fiber synthetic absorbable suture with an average, 21 days (unstained form) and 28 days (stained form) period of tissue tension. It decomposes gradually by hydrolysis.
5. CHROME CATGUT: (Softcat chromic - B, Softgut chromic - D&G, Chromic catgut - S, Surgigut chromic - USSC) - maintains its tension longer, for about 28 days. It is mainly used to approach the subcutaneous tissue. Currently discontinued.
6. POLYGLYCOLIC ACID: (Dexon - P, Dexon - D&G) - is a synthetic braid, Dexon absorption time is 60-90 days, maintenance of Dexon 65% after 2 weeks, 35% after 3 weeks. It is therefore comparable with the chrome catgut, but its initial tensile strength is more than twice as high. It serves to bring most tissues even under moderate tension.
7. POLYGLACTIN 910 (Coated Vicryl - E) - is a synthetic braid, Vicryl absorption time is 56-70 days, Vicryl sustaining 75% after 2 weeks, 50% after 3 weeks.
8. LACTOMER 9-1 (Polysorb - USCC) - has properties and applications similar to Dexon and Coated Vicryl and is braided seam
On the long term ability to maintain its tension in tissues :
9. POLYDOXANONE (PDS - E) - is a single-fiber synthetic material with a long period of up to 2 months to maintain its tension in the tissues. It is used wherever it is necessary to temporarily but long-term tissue approximation. Due to its inactivity and ease of suturing and tying knots, it is also used for sewing leather.
10. POLYGLYCONATE (Maxon - D&G) has the form, properties and clinical application similar to PDS, it is also a monofilament.
Non-absorbable seams are divided into: natural (linen, silk) synthetic multi-fiber and synthetic single-fiber sutures
Synthetic multi-fiber
1.POLYESTERS - they are produced in the form of ordinary braids (Estafil - P, Dagrofil - B, Dacron - D&G, Mersilene - E, Sutulene - S) or are covered with an additional layer that facilitates slipping during sewing and/or reduces tissue reaction.
2. POLYAMIDES - (Amfil - P, Supramid - B, Surgilon - D&G, Nurolon - E, Supramid - mth, Supramid - S, Bralon - USSC).
Synthetic monofilaments
- POLYESTERS (Miralene - B, Novafil - D&G, Mersilene - E).
- POLYAMIDES (Amifil M - P, Dafilon - B, Dermalon - D&G, Ethilon - E, Medalon - mth, Nylon - mth, Surgidek - S, Monosof - USSC).
- POLYPROPYLENES (Surgilene - D&G, Prolene - E, Cardiolene - mth, Prodek - S, Surgipro - USSC).
- AMIFIL M can be used wherever non-absorbable sutures and garters are used in all surgical procedures that require high-strength sutures for wound healing. In particular for sewing fascia and skin, also as an "all-layer" protective seam.
- Sewing basics. The needle is fastened on a vice, punctured perpendicularly to the surface of the skin, after appearing on the opposite side we drag it with tweezers. The needle should be punctured and punctured at the same distance from the wound.
The seam is used to approach the edges of the wound, so we do not pull the first node and only the second one. This prevents tissue necrosis. Wounds should be closed in several layers. We stitch the skin to avoid excessive tissue tension, which can cause the wound to not close and necrosis.
Types of seams
1. Plain gusset Types of Sutures
is used to bring tissues under certain tension closer to the skin. The knots should be on one side. This Types of Sutures most often used in surgery. When tying the seam, the edges of the wound should be slightly curled, during healing, the swelling will disappear and an aesthetic flat scar will form.
2. Mattress Types of Sutures
the needle is inserted in the proximal edge of the wound and it is stuck in at a
further distance of about 1 cm. it is punctured again to distort it symmetrically on the opposite side. Used for anastomoses: muscles, fascia. A variation of this seam is a partially vertical or horizontal mattress seam and a vertical mattress.
3. Far Close Far Seam
The needle is punctured just at the distal edge of the wound, punctured on the
proximal side at a distance of 1 cm, then punctured on the distal side, about 1 cm from the edge and punctures just at the proximal edge.
4. Seam for a ship
The needle is pierced with both sides of the wound perpendicular to the axis, as a result of which the sections located outside run obliquely. This is called the continuous seam. Knots are tied at the beginning of sewing and the rest of the thread leads, ending on the other side of the wound also with a knot.
5. Deepening seam
Puncture at a certain distance from the edge of the wound, puncture right at the edge on the same side, another puncture right at the edge of the wound on the opposite side and puncture at a distance from it. Use in sewing serous membranes.
6. Clog Seam Suture
The needle is inserted about 1 cm. from the distal edge of the wound, it is carried out in tissues at an angle of 45 degrees and pricks on the proximal side the same distance from the shore.
Then it is punctured on the opposite side so that the thread is perpendicular to the wound, then it is carried out in the tissues at an angle of 45 degrees.
Towards the first puncture and pricks on the proximal side. The skin and serous membranes are sewn with this technique.
Intradermal Types of Sutures
It is applied like a typical nodular one, then it is punctured near the skin suture and sticks inside the wound right next to the pole. The needle is run like in a mattress Types of Sutures, but the thread runs horizontal under the skin surface. The seam gives very good cosmetic effects. The scar is small and pretty. After the wound heals, the knot falls off by itself, but it can also be removed as if it were stitched on the surface of the skin.
Suture removal
The seams are removed depending on the place of application. The face seams are removed fairly quickly. Stitches on the trunk and limbs remain the longest. Here, the healing time is longer and the seams are removed on the 10-14th day. The stitches are removed in the dressing room. We put on gloves, lifting the end of the seam with tweezers, cut it with a blade. We pull out the seam cut. We put on a sterile dressing.
