Difference between revisions of "Sutures"

 
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{| border="1"
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==Chart==
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{{Suture chart}}
 +
 
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==Types==
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{| class="wikitable sortable"
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|+ Absorbable Sutures
 
|-
 
|-
| '''Area'''
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! scope="col" | '''Suture Type'''
| '''Size'''
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! scope="col" | '''Days of Tensile Strength'''
| '''Removal'''
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! scope="col" | '''Complete Absorption'''
 +
! scope="col" | '''Descriptions'''
 
|-
 
|-
| scalp
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| Chromic Gut||7-21 days||90 days||Chromium treated to decrease tissue reactivity
| 4o,5o
 
| 5-8 days
 
 
|-
 
|-
| face
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| PDS (Polydioxone)||14 days||180-240 days||Monofilament synthetic absorbable suture
| 5o,6o
 
| 3-5 days
 
 
|-
 
|-
| chest/abd
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| Vicryl (Polyglactin)||21 days||90 days||Synthetic
| 3o,4o
 
| 7-10 days
 
 
|-
 
|-
| back
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| Vicryl Rapid||10 days||42 days||Synthetic with radiation treatment for increased absorption
| 3o,4o
+
|}
| 12-14 days
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 +
{| class="wikitable sortable"
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|+ Non Absorbable Sutures
 
|-
 
|-
| upper extrem
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! scope="col"|'''Suture Type'''
| 4o,5o
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! scope="col"|'''Tensile Strength'''
| 8-10 days
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! scope="col"|'''Body Reactivity'''
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! scope="col"|'''Filament'''
 
|-
 
|-
| lower extrem
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| Nylon||High||Low||Monofilament
| 3o,4o
 
| 8-12 days
 
 
|-
 
|-
| foot
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| Silk||Low||High||Multifilament
| 3o,4o
 
| 10-12 days
 
 
|-
 
|-
| joint/extensor surface
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| Prolene (Polypropylene)||Moderate||Low||Monofilament stiff
| 3o,4o
 
| 10-14 days
 
|-
 
| joint/felxor surface
 
| 4o,5o
 
| 8-10 days
 
 
|}
 
|}
  
+2-3 days for elderly
+
==Technique==
 
+
[[File:Horizontal mattress suture.svg|thumb|Horizontal mattress]]
Special
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[[File:Vertical mattress suture.svg|thumb|Vertical mattress]]
 
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[[File:Suture, before and after, RMO.jpg|thumb|Wound before and after suture closure. The closure incorporates five simple interrupted sutures and one vertical mattress suture (center) at the apex of the wound.]]
Horizontal: excess tention, mult parallel lacs
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*Horizontal Mattress
 
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**Spreads tension over wound
Vertical: contraindication to deeps
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**Useful for high tension wounds
 
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*Vertical Mattress
== See Also ==
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**Great for wound eversion, closure of both superior and deep layers
 
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**Useful when there is a contraindication to deep sutures
Trauma:Wound Management
 
  
== Source ==
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==See Also==
 +
*[[Laceration Repair]]
  
Lampe
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==References==
 +
*Tajirian Ani et al. ''A review of sutures and other skin closure materials''. Journal of Cosmetic and Laser Therapy. 2010 Dec;12(6):296-302.
  
<br/>[[Category:Trauma]]
+
[[Category:Trauma]]

Latest revision as of 21:56, 12 August 2020

Chart

Sutures chart

Suture Usage
Area Size Type Days to Removal
Scalp Staples or 4-0 or 5-0 non absorbable 7
Ear 6-0 non absorbable 5-7
Eyelid 6-0 or 7-0 absorbable or nonabsorbable 5-7
Eyebrow 5-0 or 6-0 absorbable or nonabsorbable 5-7
Nose 6-0 absorbable or nonabsorbable 5-7
Lip 6-0 absorbable NA
Oral mucosa 5-0 absorbable NA
Other face / forehead 6-0 absorbable or nonabsorbable 5
Chest/abdomen 4-0 or 5-0 non absorbable 12-14
Back 4-0 or 5-0 non absorbable 7-10
Extremities 4-0 or 5-0 non absobrable 7-10
Hand 5-0 non absorbable 7-10
Foot / Sole 4-0 non absorable 12-14
Joint (Extensor) 4-0 non absorable 10-14
Joint (Flexor) 4-0 non absorbable 7-10
Vagina 4-0 absorbable NA
Penis 5-0 non absorbable 7-10
Scrotum 5-0 non absorbable 7-10

Note: consider use of Fast Absorbing Gut (5-0/6-0) on Ear, Eyelid, Eyebrow, Nose, Lip and Face if anticipated difficulty with suture removal

Note: Favor absorbable sutures for facial repair especially in children

Types

Absorbable Sutures
Suture Type Days of Tensile Strength Complete Absorption Descriptions
Chromic Gut 7-21 days 90 days Chromium treated to decrease tissue reactivity
PDS (Polydioxone) 14 days 180-240 days Monofilament synthetic absorbable suture
Vicryl (Polyglactin) 21 days 90 days Synthetic
Vicryl Rapid 10 days 42 days Synthetic with radiation treatment for increased absorption
Non Absorbable Sutures
Suture Type Tensile Strength Body Reactivity Filament
Nylon High Low Monofilament
Silk Low High Multifilament
Prolene (Polypropylene) Moderate Low Monofilament stiff

Technique

Horizontal mattress
Vertical mattress
Wound before and after suture closure. The closure incorporates five simple interrupted sutures and one vertical mattress suture (center) at the apex of the wound.
  • Horizontal Mattress
    • Spreads tension over wound
    • Useful for high tension wounds
  • Vertical Mattress
    • Great for wound eversion, closure of both superior and deep layers
    • Useful when there is a contraindication to deep sutures

See Also

References

  • Tajirian Ani et al. A review of sutures and other skin closure materials. Journal of Cosmetic and Laser Therapy. 2010 Dec;12(6):296-302.