Did you know Suture Materials.

Definition.

Suture materials are all materials used for ligating or tissue approximation and hold it until the tissue healing.
Since 2000 BC, the use of threads of fur has been done to stitch the wound. Along with the times, materials for surgical sutures evolving and varies from silk, linen, cotton, tendons or intestines of animals, even now there has been used material from stainless metal thread.

Classification.

Thread for suturing wounds can be divided on several criteria, namely :

Absorption (absorbable or non-absorbable)
Originally Materials (nature or synthetic)
Origin fiber (monofilament or polyfilament)
Coating (coated or uncoated)

1. Absorption.

Yarn absorbed in limited time in the body. The length is in the body can be adapted to organ sewn by selecting the appropriate type of yarn. Wherever possible threads do not disintegrate before the relevant organ really tight and strong enough. For example, the fascia must be sewn with thread a long time absorption, due to fascia healing takes a long time (up to several months). With some reason, sometimes even used thread to sew fascia is not absorbed. Thread is not absorbed will be lifelong. These threads are used for example in connection with dacron graft blood vessels, where blood vessels are living organ would have no connection with the graft which is an inanimate object. Here stitching with thread serves to maintain the unification was absorbed earlier. It should be remembered that the stitches here is a foreign object or less will result in a reaction of the body's tissues. Therefore, for the purpose of minimizing the reaction, use inert material and provide minimal reaction.
Plain and chromic catgut and collagen is absorbed yarns example, being polyamide (nylon) and silk (silk, zyde) is an example of the thread is not absorbed. Advantages of unabsorbed thread is able to provide permanent support will never run out but leaving foreign objects in the body.

2. Origin of Material.

Natural yarns derived from natural materials, such as hair, fur, cotton, linen and catgut. These threads have been used since time immemorial, easily available and relatively inexpensive.
Synthetic yarns are more expensive, but has many advantages in terms of absorption is predictable and generally has been adapted to the organ to be sutured. Examples of synthetic yarns, polyglycolic acid, polypropylene, polyamide, polyester, polyglactin, polydioxanone, polyglyconate, polynylidene, polybutylester and stainless steel. These threads are generally sold in packs and special dosage forms.

3. Fiber Yarn.

Single fiber yarns are generally more flexible but the knot strength (knotting security) is usually smaller, so the easy-open seam knot. The advantage is the stitches (stitching mark) fine. While much better fiber yarn knot strength, because the braided fiber yarn making more abrasive and biting. It should be noted that the cracks were found on the threads is a gathering place that can become a focal nidus of infection that is difficult to recover because it is difficult to achieve macrophages. Frequent sinus formation or wounds that are difficult to heal on the use of fiber yarns lot. This thread stitches with more rough and real.
Many fiber yarn can be divided into two, namely in the form of thread woven braided hair braided like (for example, polyester, polyglycolic acid, polyamide (polyfilament and silk), and twisted braid which consists of fibers wound / untwisted (eg cotton and linen) . Polyamide (nylon) can be found in two forms, namely single fibrous and fibrous lot.

4. Coating.

Coating thread (coated) has a variety of purposes, can to get a more coarse thread so that better knot strength, to secure the braid so it appears more neat and sturdy, to close the gaps (pore) on the webbing so that there is no place for nesting germs , as well as to minimize tissue reaction.
Polyglycolic acid and polydioxanone are many and layered fibrous threads. Sutera given a layer of wax so that the thread is stiffer and more bite, and to close the gaps in the thread.
Criteria for the use of threads that are eligible for surgical sutures, among others,
Has a tensile strength (tensile strength) were good according to size.
Easy to use and has a low resistance when applied in network
Having a good knot security, stillborn is not easy to loose and loose.
Having a good sterile packaging and easy-open so safe to use by the surgical personnel.
Minimal reaction on the network and is not likely to increase the growth of bacteria.

Yarn size (size).

Thread with a large size used to sew a tough structure / clay. To sew fine structure, for example in eye surgery, used yarns ranging in size from 00000 (5/0) to 7/0. The more zeros her, the more subtle size. For microsurgery, worn thread size 8/0 to 10/0. It must be remembered, the greater the size of the thread, the greater the foreign bodies that we enter into the patient's body, which means that the greater the tissue reaction.

Tensile strength (tensile strength).

Tensile strength test performed in laboratory, tensile strength is defined as the applied load per unit area and expressed in psi or kg / cm2 or it could also be defined as the force needed to break the stitches were expressed by lb or kg.
The stronger the tensile strength of a thread, the greater the power to close up the wound. Yarns of this type is mainly used to hold the wound area is a high load, for example the abdomen and extremities. Generally, the most excellent tensile strength on stainless steel yarn, synthetic yarn and being on the weakest in natural yarn.

Stronger
Stainless steel
Tensile strength

Moderate
Polyamide, polypropylene

Weaker
Natural (silk, catgut)

Reaction tissue (tissue reaction).

Tissue reaction to the ligature has the following characteristics:
Ranging between 1-3 days, since the yarn is a foreign object in the body.
The reaction that occurs depends on the physical form of yarn (monofilament, braided) or from their chemical structure.
The reaction in the form of absorption or removal of the yarn material. The faster the absorption, the greater the cellular response network.
Natural ingredients tend to stimulate reactions polymorphonuclear leukocytes (PMN) and macrophages, whereas synthetic materials stimulate macrophages and giant cell reaction (giant cell). The amount of tissue reaction will slow wound healing. Likewise, the end result is influenced by the wound healing tissue reaction. Generally more severe tissue reaction, see end cuts will be less good.

Absorption (Absorption).

There are two mechanisms of absorption ligature. First, absorption through enzymatic mechanisms, for example, occurs in catgut and collagen. Here proteolytic enzymes that are stored in the lysosomes of PMN would destroy the thread.
Second, is the mechanism that affects the hydrolysis of water contained in the yarn. Disorders of the water in the threads will cause more fragile thread then destroyed. Hydrolysis will increase with changes in pH.

Security knot (knotting security).

The more coarse fiber of a yarn, the higher the coefficient of friction (coefficient of friction). Thus, the higher the knot security. Many fiber yarn generally has a higher knot security than single fiber yarns. Yarn coating also played a role, candles were used coats the silk threads will cause more abrasive, so it is not easy to loose knot. But please remember, flexibility (pliability) fibrous thread much smaller than a single fiber yarn, making it more difficult to manipulate during suturing. Anyway revocation of wound yarn easier when the single-fiber yarns and slippery. Should also be considered that many fibrous threads will leave a mark (stiching marks) is worse than a single fibrous threads. Besides coefficient of friction, the type and number of ties knot also plays a role in determining the safety of a knot.
For skin in areas of high tension (eg, abdomen and extremities), used yarns with good knot security. Usually aesthetic interest to be number two in this area.
To obtain sufficient knot security, usually carried out in accordance with the type of thread manipulation. Slippery thread should be knotted more than coarse threads. This is in accordance with the law "approximation, no strangulation" (pressed and not ensnare) in suturing the wound.

Surgical needles.

Needle (needle) is an integral part in a suture technique, so knowing the basic concept of the needle can help in mastering the technique of suturing. A large part of the needle is made of corrosive-resistant stainless steel and attached to the end of the thread through the swage, namely holes found on the base of the needle, where threads can be embedded within it. Needle should be sufficiently rigid so as to allow to be able to penetrate the network without becoming hooked, diameter sufficient without causing damage to surrounding tissue, as thin as possible so as not to cause leakage. The tip of the needle should be sharp to penetrate tissue well and a large enough size so as to bring the thread without taking part in bringing the surrounding tissue. Needle should also have a three-dimensional sharpness that allows us to hold the well by using a needle holder without causing damage to other tissues that are not necessary.
Election adapted to the network and the region of surgery.

General criteria that must be owned by surgical needles among others :

Contains a stainless material (stainless steel)
Strong to penetrate tissue
small to not cause trauma to the tissues
sharp
Stable when used with the instrument (needle holder)
Anatomy Surgical Needles (surgical needle)

In the standard surgical needle that there are several parts :

Needle Point, the tip of the needle is relatively sharper and has a diameter smaller than that all parts of the Needle.

Swage is the base of the needle that has a handle in the form of holes or slits for the thread.

Cord Length is the distance between the needle point and swage when drawn straight line, while the length is the distance between the needle and the needle swage point by following the curved outer ring needle.

Radius is the distance between the center of curvature of the needle with the needle itself.

Needle Diameter is the thickness of the needle on each section.

Characteristics Surgical Needle.

The most important characteristic of the surgical needle is :

Sharpness and curvature
Needle length and diameter of the needle (size)
Eye needle and needle-sectional shape
Type attachment with sewing thread to needle
Sharpness and curvature
Sharpness and curvature of the needle is closely related to its function. Often a special needle is only for one type of operation only, eg J-shaped, which is used only for femoral hernia surgery alone.

The length and diameter of the needle.

The potential length of the needle, is determined by the thickness of the material used and the rigidity, ductility and strength of a needle determines the size needle. In fact needle with a diameter of 66 mm with an ultra-thin gauge wire will be more easily bent or broken when compared with short needle thick diameter. Better long needle used for suturing fascia and skin with a needle materials and stronger material. Short Needle is often used to sew visceral and blood vessels.

Eyes and needle cross section.

Point hole formed by the needle is determined by the very end of the needle eye to the greatest transverse diameter of the needle. There are four types of holes formed by the needle: is Conventional Cutting, Reverse cutting, Taper Point and Blunt. Conventional Cutting and Reverse Cutting: use in suturing the skin, periosteum, tendons. Taper is used to easily penetrate tissue and to obtain minimal injuries.
Blunt, to sew the liver and spleen.

The type of sewing thread to needle attachment.

Needle generally already attached to the thread which we will use. The technology began to be known the last few decades. Traditionally all the needle has two eyes on the base and sewing thread must be inserted in the eye of the needle before use.

There are two kinds of attachment of the needle-thread, the first is the type of eye, which today has begun rarely used because it is less practical in its user and cause trauma to the tissue that is sutured.
The second type is swedged, where the yarn has been coupled with a needle in the package. It is preferred because this type cause minimal trauma to the tissue, besides the use of needles also can not be repeated, thereby reducing the risk of disease transmission to patients.
Thank you for reading this article. Written and posted by Bambang Sunarno. sunarnobambang86@gmail.com
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name: Bambang Sunarno.
http://primadonablog.blogspot.com/2015/06/did-you-know-suture-materials.html
DatePublished: June 21, 2015 at 15:41

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