Sutures

 

  1. Suture Characteristics
    1. Tensile Strength
      1. Related to suture size (see below)
      2. Related to weight required to break a suture
    2. Knot strength
      1. Force required for a knot to slip

    1.  Configuration
      1. Monofilament (less risk of infection)
      2. Braided multifilament (easier to handle and tie)
    2. Elasticity
      1. Degree suture stretches and return to original length
    3. Memory or suture stiffness
      1. High memory: Suture stiff, difficult handling, unties
    4. Tissue reactivity (inflammatory response to suture)
      1. Reaction peaks in first 2 to 7 days

 

  1. Needles
    1. Curvature
      1. Straight needle
      2. Curved 2/8 of circle
      3. Curved 3/8 of circle (preferred needle in most cases)
      4. Curved 4/8 of circle
      5. Curved 5/8 of circle
  2. Needle Tip
    1. Tapered (used in vascular sutures)

     

      3.  Suture types recommended for skin closure

      1. Deep (dermal or buried) Absorbable Sutures
        1. Polyglecaprone 25 (Monocryl)
        2. Polydioxanone (PDS)
        3. Polyglactin-910 (Vicryl)
        4. Polyglycolic acid (Dexon)
      2. Superficial, monofilament Nonabsorbable Sutures
        1. Nylon (Ethilon)
        2. Polypropylene (Prolene)
    1. Conventional cutting needle
    2. Reverse cutting needle (preferred in most cases)

 

  1.  Suture indications by location (see suture types above)
    1. Mucosal Lacerations (mouth, Tongue or genitalia)
      1. Absorbable Suture: 3-0 or 4-0
    2. Scalp, Torso (chest, back, abdomen), Extremities
      1. Superficial Nonabsorbable Suture: 4-O or 5-O
      2. Deep Absorbable Suture: 3-O or 4-O
    3. Face, Eyebrow, Nose, Lip
      1. Superficial Nonabsorbable Suture: 6-O
      2. Deep Absorbable Suture: 5-O
    4. Ear, Eyelid
      1. Superficial Nonabsorbable Suture: 6-O
    5. Hand
      1. Superficial Nonabsorbable Suture: 5-O
      2. Deep Absorbable Suture: 5-O
    6. Foot or sole
      1. Superficial Nonabsorbable Suture: 3-O or 4-O
      2. Deep Absorbable Suture: 4-O
    7. Penis
      1. Superficial Nonabsorbable Suture: 5-O or 6-O

 

  1. Suture removal timing
    1. Scalp: 6-8 days
    2. Face, Eyelid, Eyebrow, Nose, Lip: 3-5 days
      1. Follow with papertape or steristrips
    3. Ear: 10-14 days
    4. Chest and abdomen: 8-10 days
    5. Back: 12-14 days
    6. Extremities: 12-14 days
    7. Hand: 10-14 days
    8. Foot and sole: 12-14 days
    9. Penis: 8-10 days
    10. Condition delaying Wound Healing: 14 to 21 days
      1. Chronic Corticosteroid use
      2. Diabetes Mellitus

  1. References
    1. Howell (1997) Emerg Med Clin North Am 15(2):417
    2. Moy (1991) Am Fam Physician 44(6):2123
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: