Difference between revisions of "Sutures"

(Source)
 
(25 intermediate revisions by 5 users not shown)
Line 1: Line 1:
== Chart ==
+
==Chart==
{|
+
{{Suture chart}}
{| class="wikitable sortable"
 
|+ Suture Usage
 
|-
 
! scope="col" |'''Area'''
 
! scope="col" |'''Size'''
 
! scope="col" |'''Type'''
 
! scope="col" |'''Days to Removal'''
 
|-
 
| Scalp||Staples or 4-0 or 5-0||non absorable||7
 
|-
 
| Ear||6-0||non absorable||5-7
 
|-
 
| Eyelid||6-0 or 7-0||absorable or nonabsorbable||5-7
 
|-
 
| Eyebrow||5-0 or 6-0||absorable or nonabsorbable||5-7
 
|-
 
| Nose||6-0 ||absorable or nonabsorbable||5-7
 
|-
 
| Lip||6-0||absorable||NA
 
|-
 
| Oral mucosa||5-0||absorable||NA
 
|-
 
| Other face / forehead||6-0||absorable or nonabsorbable||5
 
|-
 
| Chest/abdomen||4-0 or 5-0||non absorable||12-14
 
|-
 
| Back||4-0 or 5-0||non absorable||7-10
 
|-
 
| Extremities||4-0 or 5-0||non absorable||7-10
 
|-
 
| Hand||5-0||non absorable||7-10
 
|-
 
| Foot / Sole||4-0||non absorable||12-14
 
|-
 
| Joint (Extensor)||4-0||non absorable||10-14
 
|-
 
| Joint (Flexor)||4-0||non absorable||7-10
 
|-
 
| Vagina||4-0||absorable||NA
 
|-
 
| Penis||5-0||non absorable||7-10
 
|-
 
| Scrotum||5-0||non absorable||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 absorable sutures for facial repair especially in children'''
 
  
 +
==Types==
 
{| class="wikitable sortable"
 
{| class="wikitable sortable"
 
|+ Absorbable Sutures
 
|+ Absorbable Sutures
Line 59: Line 12:
 
|-
 
|-
 
| Chromic Gut||7-21 days||90 days||Chromium treated to decrease tissue reactivity
 
| 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 (Polyglactin)||21 days||90 days||Synthetic
Line 69: Line 24:
 
|-
 
|-
 
! scope="col"|'''Suture Type'''
 
! scope="col"|'''Suture Type'''
! scope="col"|'''Tensile Stength'''
+
! scope="col"|'''Tensile Strength'''
 
! scope="col"|'''Body Reactivity'''
 
! scope="col"|'''Body Reactivity'''
! scope="col"|'''Filliment'''
+
! scope="col"|'''Filament'''
 
|-
 
|-
 
| Nylon||High||Low||Monofilament
 
| Nylon||High||Low||Monofilament
 
|-
 
|-
| Silk||Low||High||multifilament
+
| Silk||Low||High||Multifilament
 
|-
 
|-
 
| Prolene (Polypropylene)||Moderate||Low||Monofilament stiff
 
| Prolene (Polypropylene)||Moderate||Low||Monofilament stiff
 
|}
 
|}
== Technique ==
 
  
 +
==Technique==
 +
[[File:Horizontal mattress suture.svg|thumb|Horizontal mattress]]
 +
[[File:Vertical mattress suture.svg|thumb|Vertical mattress]]
 +
[[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 Mattress
 
*Horizontal Mattress
 
**Spreads tension over wound
 
**Spreads tension over wound
 
**Useful for high tension wounds
 
**Useful for high tension wounds
 
*Vertical Mattress
 
*Vertical Mattress
**Great for wound eversion, closure of both sup and deep layers: contraindication to deeps
+
**Great for wound eversion, closure of both superior and deep layers
==Types==
+
**Useful when there is a contraindication to deep sutures
*Absorbable
 
**Use for deep sutures
 
**Never place if high risk for infection
 
**Good for hard to reach places (e.g. kid's mouth)
 
**Types
 
***Vicryl
 
****Lasts longer
 
***Chromic
 
****Faster, good for oral mucosa
 
**Braided
 
***Stronger but higher infection risk
 
 
 
== See Also ==
 
 
 
[[Laceration Repair]]
 
 
 
== Source ==
 
  
Tajirian Ani et al. A review of sutures and other skin closure materials Cosmet Laser Ther. 2010 Dec;12(6):296-302.
+
==See Also==
 +
*[[Laceration Repair]]
  
 +
==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.
  
 
[[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.