SUTURING

Dr. Charles A Simanjuntak, dr, SpOT(K), MPd

PSPD, FKIK, Universitas Jambi
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Wound
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Measuring the Strength

• TENSILE STRENGTH--The load per cross-sectional area
unit at the point of rupture2 relating to the nature of the
material rather than its thickness.

• • BREAKING STRENGTH--The load required to break a

wound regardless of its dimension2, the more clinically
significant measurement.

• • BURST STRENGTH The amount of pressure needed to

rupture a viscus, or large interior organ
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Factors That Affect Wound Healing

• The patient’s age

• The patient’s weight
• The patient’s nutritional status
• Inadequate Blood supply to the wound site
• The patient’s immune response
• The presence of chronic disease
• Radiation therapy
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Surgical Principles

• THE LENGTH AND DIRECTION OF THE INCISION

• DISSECTION TECHNIQUE
• HEMOSTASIS
• REMOVAL OF NECROTIC TISSUE AND FOREIGN MATERIALS
• CHOICE OF CLOSURE MATERIALS
• CELLULAR RESPONSE TO CLOSURE MATERIALS-
• ELIMINATION OF DEAD SPACE IN THE WOUND
• CLOSING WITH SUFFICIENT TENSION
• STRESS PLACED UPON THE WOUND AFTER SURGERY
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Classifications of Wounds

• Clean
• Clean-contaminated wounds
• Contaminated wounds
• Dirty and infected wounds
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Types of Wound Healing

• PHASE I: INFLAMMATORY RESPONSE (DAY 1 TO DAY 5)

• PHASE II: MIGRATION/ PROLIFERATION (DAY 5 TO DAY 14)
• PHASE III: MATURATION/ REMODELING (DAY 14 THROUGH
COMPLETE HEALING)
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Sutures
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Absorbable Material:
• Surgical Gut
• Plane
• Chromic
• Polyglactin 910
• Uncoated
• Coated
• Polyglycolic Acid
• Poliglecaprone
• Polyglyconate
• Polydioxanone
• Poly (L-lactide/glycolide)6
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Nonabsorbable Materials
• Surgical Silk
• Stainless Steel Wire
• Nylon
• Polyester fiber
• Uncoated
• Coated
• Polypropylene
• Poly(hexafluoropropylene-VDF)
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Techniques
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Ligatures
• Free tie or freehand ligatures

• Stick tie, suture ligature, or transfixion suture

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Knot
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Coninuous Suturing Techniques

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Running locked
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Mattress
(Vertical, Pulley, Far-near, Horizontal)
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Tip stich
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Interrupted suturing techniques

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Interrupted
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Purse-string sutures (tabac sac)

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Subcutaneous sutures
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Needles & needle-holder

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Anatomy of a needle
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The needle eye

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Needle shapes
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Needle points & body shapes

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Needle-holder jaws
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Holding needle holder

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