SUTURING

One of the methods of wound closure.

Dfn: Act of bringing tissues together (opposing) with a needle and a specialized
“thread” and holding them in apposition until healing has taken place.

Suturing material: strand of material used to ligate blood vessels and approximate
tissues together. It holds the wound edges together until the proliferative phase of
wound healing establishes collagen fibers which form a scar and hold edges
effectively.

CLASSIFICATION OF SUTURE MATERIAL

1) ABSORBABLE AND NON ABSORBABLE

A): ABSORBABLE SUTURE:

 Rapidly degraded in tissues; in less than 60 days.
 They lose significant tensile strength within the first 60 days.
 Used/ placed into subcutaneous layer/tissue to eliminate dead
space; and into the dermis to minimize tension during wound
healing.
 They should be placed well in the dermis and SubQ layer to
facilitate subsequent absorption by inflammation, enzymatic
degradation or hydrolysis. This is because if they are placed too
superficially, they may persist for a prolonged duration of time
and possess an increased tendency to be trans-dermally
eliminated from the wound. This can compromise he
appearance of the scar.
 They aren’t intended for use to close the skin. This slows
absorption and may cause epithelialization of suture tunnels
leading to permanent suture tracts and cyst formation..

Examples of absorbable sutures.

1) PLAIN CATGUT[Natural]
 Made from purified connective tissue (mainly collagen)
 Derived from;
(a) Mucosa of beef intestine
(b) Sub-mucosa of sheep jejunum.
 Yellowish white in color
 Absorbed by inflammation reaction and phagocytosis, WBC lysozyme in 7-10
days.
 Loses half of its tensile strength (approx. 60%) in 7-10 days and all its
effective strength by 2 weeks.
 Complete absorption occurs in 30-50 days. It’s not wise to use in people
predisposed to delayed wound healing.
 Tensile strength loss is faster than absorption.
 Due to exposure of foreign proteins, plain catgut causes tissues reaction and
inflammation during degeration.

USES:
 Circumcision in children
 Subcutaneous tissue, muscle, wounds in lip, etc.
 Perineal repair
Also called surgical gut/collagen.

2) CHROMIC CATGUT[Natural]
 This catgut treated with chromic acid salts. This cross links collagen
fibrils and inhibit proteolytic enzymes.
 Thus chromic catgut has increased tensile strength and half-life.
 Less foreign protein is exposed thus reduced tissue reaction.
 Brown in color and lasts for 15-60 days. Effective strength extends to 2
week (at least).
 Absorption time is 21 days.

USES:
 Suturing muscles, fascia, external oblique aponeurosis, ligating
pedicles, etc.

Advantages of GUT
 Low friction (unlike in other braided sutures).
 Handles well
 Ties secure knots
 Has excellent baseline tensile strength.

Disadvantages of GUT
 Absorbs rapidly; should not be used on tissues which require
ongoing support or are at risk of prolonged healing.
 Does not break down predictably after implantation. Exact
timing can vary considerably depending on individual patient
 factors e.g. gut absorbs more rapidly in presence of infection
and catabolic states e.g. trauma, sepsis, cancer, malnutrition.
 Triggers a moderate inflammatory reaction especially if
chromic catgut is used. This may impair wound healing and can
be painful for patients.

NB: Gut is banned for human use in Europe and Japan due to
concerns about the risk of bovine Spongiform encephalopathy
(BSE).

3) POLYGLACTIC ACID/ POLYGLACTIN (VICRYL) (Novosyn,

Demecryl, petcryl, Unisynth).
 Synthetic; less inflammatory rxn.
 Heteropolymer of 90% gylcolide and 10% lactide (lactic acid).
 Looks and feels like a fine a cotton thread used at home.
 Gets absorbed by hydrolysis in 70 days.
 Multifilament and braided.
 Comes in two(2) colors i.e. dyed(purple) and undyed(white)
 Dyed vicryl is better for deeper tissues b’se it’s easier to see and follow.
But; don’t use dyed materials on skin as they can cause a tattooing
effect.

There are 3 types of Vicryl sutures

a) Standard Vicryl; coated with polygalactin 370 and calcium stearate.

This reduces bacterial adherence, improves handling and knot tying and
allows the suture to pass through tissues smoothly without snagging.
Available as individual ties/ in long reels. These are used to tie off
blood vessels during tissue dissection.

b) Vicryl Plus; coated with the anti-septic triclosan. It significantly

reduces surgical site infections.

c) Vicryl Rapide; made from coated polygalactin but has a lower

molecular weight. This reduces its tensile strength but allows more
rapid absorption. It’s useful for simple interrupted sutures which can be
left to fall out on their own after a week or so.

 Absorbed by hydrolysis; standard vicryl plus loses 50% of

their tensile strength in 3 weeks, completely absorbed in 70–90
days.
  Vicryl Rapide; loses 50% of its tensile strength in 5days and is
completely absorbed within about 40days.

Advantages of vicryl
 Relatively low friction
 Non traumatic to tissues
 Easy to handle
 Ties secure knots
 Causes minimal tissue reactivity
 Soft and more comfortable on patients

Disadvantages of vicryl

 Can cause inflammation if implanted for more than

7days causing scars, nodules, stitch sinuses in sites
where the sutures are maintained.

USES:
 Skin and soft tissue closure
 Suture ligation of blood vessels
 Due to softness, its suitable for wounds in awkward skin
creases, sensitive areas e.g. perineum.
 Abdominal surgery to repair holes in the GIT or
Bladder, create hand sewn intestinal anastomosis.
 Secure a stoma to the skin.

NB: DON’T USE ON CARDIAC/ VASCULAR/

NERVE TISSUE.

4) POLYGLYCOLIC ACID (DEXON)

 Synthetic homopolymer of glycolic acid
 creamy yellow in color
 braided
 supplied as an uncoated /coated form
 Coated polyglycolic acid suture undyed/dyed with a green, violet or
bicolored.
  Since polyglycolic is not a naturally occurring organic substance, it
elicits less inflammatory response than surgical gut.
 Absorbed by hydrolysis.
 Polyglycolic acid has good tensile strength and excellent knot security.
 After 2(two) weeks of implantation, 65% of the initial tensile strength
remains with polyglycolic acid suture; in contrast to 0% of surgical gut
suture.

5) PDS( POLY DIOXANONE SUTURE MATERIAL)

 Synthetic, monofilament
 Made from uncoated polydiaxanone
 It comes in 2 colors i.e. purple and clear
 Looks and feels like smooth plastic
 Absorption time; by hydrolysis, slowly. It loses 50% tensile
strength in 4weeks but hardly breaks down during the first 90
days. Completely absorbed in 180 days i.e. 6 months.

Advantages
 Smooth, very strong, much longer wound support than
other absorbable sutures.
 Only causes a mild tissue reaction.
 Can maintain its strength in the presence of infection or
exposure to harsh substances e.g. urine, bile, pancreatic
juice.

Disadvantages

 Has a lot of memory

 Can be difficult to handle
 Snug down into secure knots
 Shaper than vicryl and can cut out or “cheese wire” through
tissues if pulled/tightened too hard.
 USE:
 More expensive but better than vicryl.
 Deep soft tissue closures involving fascial layers + other
strong connective tissue e.g. closing the linea alba of the
abdominal wall after a midline laparotomy.
 Close hernia defects
 Repair of holes in the bowel.
 Create intestinal/ureteric anastomosis

NB: Avoid on cardiac, vascular and nerve tissue.

 Vicryl maybe preferred if tissues are very inflamed and friable e.g.
appendicectomy or repair of a perforated duodenal ulcer, due to the risk
of chees-wiring with PDS.
 Other brand names-Monoplus, Demediox, Monotime, Duracryl,
Unisynth PDS.

6) POLIGLECAPRONE (MONOCRYL)
 Mono filament
 Made from poliglecaprone 25 with a lubricant coating.
 Comes in two colors i.e. dyed (purple) and undyed (clear)
 A plus version (monocryl plus) is coated with the antiseptic triclosan.
 Looks and feels like smooth plastic.

Absorption; by hydrolysis. Loses its tensile strength within 1 week.

Completely absorbed in 120days, (4 months).the dyed form has a slightly
longer lasting tensile strength.

ADVANTAGES

 Exceptionally smooth, and non-traumatic

 Excellent tensile strength.
 Reabsorbs quickly
  Virtually zero tissues reactivity which reduces scar formation and
better cosmetic results.
 Much easier to handle than other monofilament suture materials.

DISADVANTAGES

 Tends to have some memory (due to its bouncy, plasticky nature.

The memory making tying knots more difficult.
 Quite hard and sharp and takes longer to reabsorb than vicryl which
may cause patient discomfort particularly around knots and out
suture ends.

USES:

 Soft tissue approximation

 Subcuticular closure of skin incisions
 Facial incision closure; better than vicryl due to decreased risk of scarring.
NB: don’t use on cardiac, vascular, nerve or eye.
 Avoid on patients with very thin/fragile skin to avoid any hard knots poking
through.
Brands =Demecaprone, Advantime, Peterylmono, Uniglydemono.

GLYCOMER 631 (BIOSYN)

 Synthetic, made of polyester glycolic (60%), dioxanone (14%) and

trimethylene carbonate (26%). Monofilament.
 Have a high flexibility, low memory and minimal tissue reactivity.
 Degraded by hydrolysis
  Passes through the tissues more easily but knot security is inferior, compared
to polyglyconate.
 Absorption is complete btn 60-90 days.

POLYGLYCONATE (MAXON)

 Synthetic, monofilament
 Made of glycolic acid and trimethylene carbonate

Advantages of other sutures:

 Improved handling properties
 Lacks memory
 Passes easily through tissues
 Superior strength
 Retains 75% tensile strength at 2 weeks of implantation,
absorbed fully by 180days (6months).

B) NON ABSORSABLE SUTURES

 Retain their tensile strength for long than 60 days.

 More commonly used for;
 Dermatology and dermatosurgery (skin)
 Deep suturing to provide prolonged support.
 Herniorrhaphy for repair
 Closure of abdomen after laparotomy
 Tension suturing in abdomen
 Vascular anastomosis (6-zero), nerve suturing, tendon suturing.
 They should be just tight enough to approximate, not strangulate tissues.

1) SILK
  Natural: derived from silkworm caterpillars, species Bombyx muri of the
family Bombycidae. Its larva produces natural fibrion filaments to weave its
cocoon, from which silk is obtained.
 Multifilament, braided looks like cotton thread but more coarse than vicryl in
texture.
 Black (dyed) in color.
 Typically coated with wax/silicone to reduce tissue friction and capillarity
(nidus of ifxn).
 Induces a striking (significance) inflammatory response impairing healing and
making its removal painful.
 Comes often attached to an overly large curved needle.

Absorption; Loses approximately 50% of its strength in one year.

ADVANTAGES:

 Best handling of all suture materials

 Ties the most secure knots
 Softer, more pliable and comfortable than monofilament sutures.

DISADVANTAGES:

 Very low tensile strength (lowest)

 High capillarity thus creates a nidus for wound infxns. (hence
coated).
 Generates more friction than other suture materials.
 Rougher on the tissues.
 Significant inflammatory reactions. Due to reactivity, it is rarely
used for cutaneous closures. However, it is commonly used on
mucosal and intertriginous areas since it is soft and pliable.

USES;
  Though used for ages, silk has now been replaced by newer synthetic suture
materials, with better tensile strength, reduced tissue reactivity and lower risk
of infection.
 Primarily used in dental procedures
 Securing drains or central lines
 Stay suture to lift or retract structures intraoperatively.
 Temporary skin closure e.g. following a fasciotomy or a trauma laparotomy.

2) NYLON (Ethilon)
 Monofilament, made from nylon 6 (polyamide). Also multifilament.
 3 colors i.e. black, green, clear.
 Looks like plastic and feels stiffer than monocryl or PDS.
Absorption: Ethilon breaks down very slowly by hydrolysis, losing
tensile strength at a rate of 15-20% per year(hydrolysis).
 Becomes gradually surrounded by fibrous scar tissue. (similar to most
non absorbable suture)
 Elastic hence ideal for surface closure (epidermal, superficial).

ADVANTAGES:

 Very strong
 Very low friction
 Causes minimal tissue reactivity
 Cheap

DISADVANTAGES:

 Has a lot of memory hence suboptimal handling

 Reduced knot security. This can be improved by wetting the suture material.

USES:

 Interrupted closure of skin incisions or traumatic wounds.

  Removed in 4-14 days depending on their location. Most are removed
after 7-10days.
 Used in general s/x to close hernia defects and reinforce abdominal wall
closures.
 Very fine Ethilon is used in ophthalmology and microsurgical procedures e.g.
nerve repairs. As it breaks down over time, Ethilon cannot be used on tissues
requiring permanent support from the suture line; e.g. vascular anastomoses
and grafts.
 Other brands; Nunolon, Dermalon, Surgilon, Monosuf, Supramid,
Dafilon, Demeloon, Linex, Unilon.

3) POLYPROPYLENE (PROLENE)
 First synthetic absorbable suture
 Monofilament
 Easily passes through tissues and induces minimal host responses
 Strong (more tensile strength than nylon) has extremely low friction
and is permanent, hence ideal for suturing delicate structures like
blood vessels.
 Biologically inert; minimal tissue reactivity/scarring and resistant to
infections.

ADVANTAGES:

 Very strong i.e. tensile strength> nylon.

 Easily passes through tissues.
 Minimal reactivity/scarring.
 Expands with tissue swelling to accommodate the wound.
 Good plasticity
 Highly resistant to infection.
 Extremely low friction.
 Permanent (doesn’t break down) so lasts indefinitely.
 Does not adhere to surrounding tissues, hence removed easily.
DISADVANTAGES:

 Very difficult to handle, requires prior suturing experience before

using it for the first time.
 Bouncy and slippery
 Has considerable memory.
 Limited elasticity; can be difficult to throw knots and to snug
them down securely without snapping or stretching the thread.
 Expensive

USES:

 Suture of choice for cardiac surgery and vascular anastomoses

including microsurgical procedures.
 Used as a removable an interrupted skin suture especially on
cosmetically sensitive areas e.g. the face.
 In obstetrics, clear prolene can be used as a removable
Subcuticular skin suture after a caesarean section-no knots are
tied, so the whole suture line can simply be pulled out later.
 In general surgery, used during hernia repairs to close fascial
defects or secure mesh.

NB: It comes in 2 colors i.e. dyed (blue) and undyed (clear).

Often comes with a needle at both ends.

4) POLYESTER (ETHIBOND)
 Braided, multifilament suture
 Made from polyester (polyethylene terephthalate) with a lubricant
coating/ unwater.
 It looks and feels like a very thin shoe lace.
 2 colors i.e. green and white
 Absorption: does not break down and lasts indefinitely, becoming
gradually encapsulated by scar tissue.

ADVANTAGES;

 Soft
 Exceptionally strong.
 Easy to handle (Gd handling).
 Ties secure knots
 Minimal tissue reactivity.

DISADVANTAGES;

 Exerts more friction on tissues than monofilament sutures.

 Expensive.

USES;
 Very versatile
 Reapproximate ribs during closure of thoracotomy incisions.
 Close median sternotomy alongside/instead of a steel wire.
 Secure a prosthetic heart valves in place (cardiac s/x)
 Repair tendons (ortho s/x)
 General surgery; repair hiatus hernias, diaphragmatic injuries.
 Colorectal s/x as a drainage septum to treat anal fistulas.
 Face lifts.

5) STEEL WIRE:
 Monofilament
 Made from low-carbon 316L stainless steel alloy with added
molybdenum to resist corrosion.
 Braided from also exists (NOT commonly used).

ABSORPTION: Does not lose strength, remains in place indefinitely.

 Does not adhere to surrounding structures, gets gradually
encapsulated by fibrous scar tissue.

ADVANTAGES:

 Exceptional tensile strength i.e. strongest suture material by far.

 Long lasting security (no breakdown)
 Biologically inert; zero tissue reactivity but some react to nickel in the alloy.
 Resistant to infection.

DISADVANTAGES:

 Difficult to handle, i.e. kinks easily and it is weakened by incorrect surgical

techniques.
 Heavy steel wire can’t be tired into knots; ends are twisted together instead.
But the correct way of doing this requires expertise especially when
approximating bones and strong connective tissue.
 Very sharp, can cut through tissues or cause needle stick injuries to theatre
staff.

USES:

a) Heavy steel wire;

 Close sternum following a median sternotomy. They are easily
visible on CXRs.
 Often used in orthopedics for cerclage fixation of fractures and
large tendon repairs.
b) Fine steel wire;
 Shouldice repair i.e. Specialized inguinal repair. It is a purely
suture based technique which does not involve any mesh and
has excellent results.
 Currently a very rare operation. You can only get accredited to
perform it after several months of intensive perfection in the
Shouldice Hospital in Canada.

Other methods of wound closure:

  Skin staples
 Skin glue
 Steri-strips.

CHARACTERISTICS OF SUTURE MATERIAL:

1) Sterility
2) Tissue reaction: eliciting an immune reaction.(non-allergic)
3) Diameter: should be uniform throughout the length
4) Capillarity: transfer of absorbed fluid along the suture. It may include many
unwanted materials and organisms. Greater in multifilament than
monofilament sutures.
5) Elasticity: elongation beyond the original length without breaking and return
to original length when left free. It enables the suture to;
 Keep 2 parts of wound together in a position by elongating without
cutting/stressing tissues due to edema and
 Return to the original length upon wound retraction after reabsorption
of edema.
6) Tensile strength: force needed to break the suture. It reduces after a suture is
implanted. It sis directly proportional to the thickness off the suture.
7) Breaking strength: limit values of tensile strength at the time of suture
breakage.
8) Knot strength: the force that can cause the knot to slide.
9) Memory: incapability of a suture to change form easily. Sutures with a strong
memory tend to return to their winding form after removal from the packaging
during and after implantation due to rigidity.
10) Plasticity: ability to retain its new form and length after stretching.
 It allows a suture to accommodate wound swelling, thereby decreasing
the risk of strangulated tissue and cross hatch marks.
 However, elongated suture, upon wound retraction after edema
resorption, cannot ensure correct approximation of wound edges.
11) Pliability: ease of use of the suture material in securing a knot. Can be
regarded in terms of flexibility or easier handling of sutures.
12) Wound breaking strength: tensile strength limit of a healing wound where
the wound dehiscence occurs.

IDEAL SUTURE

 Adequate tensile strength.

 Good knot holding property
 Least reactive
 Easy handling property
 Less memory
 Easily available
 Affordable costs.

CLSASSIFICATION II

NATURAL SYNTHETIC
 Catgut  Vicryl
 Silk  Dexon
 Cotton  PDS
 Linen  Maxon
 Polyethylene
 Polyester
 polyamide
 CLASSIFFICATION III
1) MONOFILAMENT:
 Single strand (filament) of suture material.
 Less capillary action. Less risk of infection
 Less tissue drag (resistance as they pass through tissues). Well
suited for vascular surgery.
 Easy to tie down (knot). Minimize scarring BUT less tensile
strength. e.g. catgut, polyethylene, polypropylene, PDS, steel,
etc.

2) MULTIFILAMENT:
 Several strands (filaments) of suture material twisted or braided
together.
 Greater tensile strength, pliability, flexibility.
 They however have an increased tissue drag, increased
capillarity and risk of infection.
 They are coated (pseudo monofilament) to help them pass
through tissue thus enhanced handling x-tics e.g. polyester,
polyamide, vicryl, Dexon, silk, cotton.

MULTIFILAMENT MONOFILAMENT

 Has capillarity  No capillary action

 Increased infection risk  Less infection risk
 Less smooth passage(tissue  Smooth tissue
drag) passage(decreased tissue
dag)
 More tensile strength  Less tensile strength
 More pliable(better  Less pliable(has memory)
handling)
 Better knot security  Less knot security, ore
throws needed.
 CLASSIFICATION IV
Multifilament sutures can be;
a) Braided: several strands which are woven into a “braid” pattern ( by
interlacing 3 or more strands) e.g. polyester, polyamide, vicryl, Dexon,
silk. They have more tissue drag; good for orthopedic surgeries.
b) Twisted: several strands which are simply twisted together, less tissue
drag than braided e.g. cotton, linen.

CLASSIFICATION V

1) Coated

2) Uncoated

SIZE (NUMBERING) OF SUTURE MATERIAL)

Basing on USP [United States pharmaco peia] denotation.

 This numbering system was initially easy to use when there were only a few
larger suture materials (e.g. 1,2,3---)
 Size 1 was the smallest, but as technology improved, smaller and stronger
suture materials were invented.
 The size smaller than 1 was denoted 1-0, then 2-0 being even smaller.
 Thus, from 1,2,3 onwards , size of suture material increases. (Thickness).
 But from 1-0, 2-0, 3-0 onwards, the size reduces as the number of zeros
increases e.g.

3
2
1
1-0[0]
2-0[00]
3-0[000]
4-0[0000]
5-0[00000]
  Modern sutures range from size 5 (heavy braided suture for orthopedics) to 11-
0 (fine monofilament suture for ophthalmics).
 NB: USP dimensions are different for catgut e.g. 2-0 catgut is larger than 2-0
PDS. Stainless steel is typically described by the metric scale/ in gauges.
 Choose the smallest possible size with the best desirable strength. This
minimizes scar formation while maximizing tensile strength on the wound.

A table showing common suture sizes and their corresponding diameters.

USP SIZE DIAMETER

3 0.600-0.699
2 0.500-0.599
1 0.400-0.499
0[1-0] 0.350-0.399
2-0 0.300-0.399
3-0 0.200-0.249
4-0 0.150-0.199
5-0 0.100-0.149
6-0 0.070-0.099
7-0 0.050-0.069
8-0 0.040-0.069
9-0 0.030-0.039

COMMON SIZES AND THEIR USES

>=2

 Usually orthopedic surgery

 Large tendon repairs
 Thick fascial closures
 Drain sutures
 Pedical ligation

[1 0]

 Closure of fascia, drain stitches

[2-0 and 3-0]

  Bowel suturing
 Close thick skin, fascia, muscles, tendon repair

[4-0 and 5-0]

 Large vessel repair (anastomosis)

 Skin closure (hands, limbs, face)
 Tendon repair

[6-0 and 7-0]

 Small vessels repair/grafting, fine suturing on the hand/nail bed and face.

[8-0, 9-0, 10-0 and 11-0]

 Ophthalmology, microsurgical repair.

 Requires an operating microscope.

THE NEEDLE

Has 3 main parts;

1) Tip/point
2) Body
3) Eye/swage

1. TIP/POINT: extends from extreme tip of the needle up to the maximum cross
section of the body.
 Each needle point is designed to the required degree of sharpness to
smoothly penetrate specific types of tissues.

CUTTING NEEDLE POINTS

a) Conventional cutting point;

 Cutting needles have at least 2 opposing cutting edges.
 They are sharpened to cat through tough, difficult to penetrate tissue.
Care should be taken to avoid cutting though more tissue tan desired.
 Conventional cutting needles have a 3rd cutting edge on the inside
concave curvature of the needle. The shape changes from a triangular
cutting blade to that of a flattened body.
 Use; sternotomy

DISADVANTAGES;

 Cutting edge points towards the wound so that when the suture is
pulled centrally, the suture material is more likely to tear through
the skin. Thus, not used in skin closure.

b) Reverse cutting needle point;

 As sharp as a conventional cutting needle.
 But the third cutting edge is located on the outer convex
curvature of the needle.

Advantages;
 Stronger than same size conventional cutting edge
needles
 Less risk of suture material tearing through wound edge
(tissue cut out) because the hole left by the needle leaves
a wide wall of tissue against which the suture is to be
tied.

USE; i) On tough, difficult to penetrate tissue e.g. skin and tendon.

 Skin closure
 Tendon repair
 ii) Used in ophthalmic and cosmetic
surgery where minimal trauma, early
regeneration of the tissue and little
scar formation are primary concerns.

c) Side cutting spatula/ spatula needle:

 Flat on both (inner curvature) of the outer curvature. This eliminates the
undesirable tissue cut out of other cutting needles.
 Optimal width, shape and precision sharpness of this needle ensure
maximum ease of penetration and give the surgeon greater control of the
needle as it passes between or through tissue layers.

USES:
 Ophthalmic procedures; permits needle to separate/ split through
thin scleral and corneal layers and travel in the plane between
them.
 Suturing nail bed lacerations.

d) NON CUTTING NEEDLE POOINT:

a. Taper point/round needles:
 Pierce and spread tissue without cutting it.
 Needle point tapers to a sharp tip and the needle body then flattens to
an oval or regular shape.
  This increases the width of the body to help prevent twisting or
turning in the needle holder.

USES;

 When the smallest possible hole in the tissue and minimum tissue
cutting are desired.
 Used in easy to penetrate tissue e.g.
 Peritoneum
 Abdominal viscera
 Myocardium
 Dura
 Muscle
 In muscle and fascia, taper point needles minimize the potential for
tearing the thin CT lying between parallel and interlacing bands of
denser tissue.

b. Blunt point (BP)/dolphin nose needles

 Literally dissect friable tissue instead of cutting it.
 They have a taper body with a rounded, blunt point that will not cut
through tissue.

USES:
 Suture liver and kidney.
 Obstetric and gyn procedures while working in deep cavities which
are prone to space and visibility limitations.

2. BODY OF A NEEDLE
  Middle and longest part.
 Comes in a variety of shapes to assist the surgeon by making the
passage of the needle through the tissues as a traumatic as possible.

Shapes of needle bodies;

 Straight Needles; held in fingers

 Keith needle: tendon repairs
 Sims needle: Subcuticular closure
 Transchamber needle: intraocular lens
 Bunnel needle: Tendon repairs
 half curved/ski needle
 Easy passage down laparoscopic trocars

 ¼ circle needle
 Due to limited amount of pronation and supination required to pass it
through delicate tissues; used in ophthalmic and microsurgical
procedures.

 3/8 circle needle

 Curved needles allow predictable needle turn out from tissue and require
less space for maneuvering a straight needle.
 It’s commonly used for skin closure.
 Surgeon can easily manipulate the curvature with moderate wrist action
in a relatively large and superficial wound.
 Disadvantages
 Difficult to use this needle in a deep body cavity or restricted area
because a larger arc of manipulation is required.

 ½ circle needle
 Designed for use in a confined space.
 Requires more pronation and supination of the wrist as it passes through
tissues.
 Difficult to use for skin closure.

USE:
 GIT surgery
 Nasal and oral cavity surgery
 Pharynx surgery
 Pelvic surgery
 Urogenital surgery

 5/8 circle needle

 When space for manipulation is extremely limited, the 5/8 needle maybe
more important than the ½ circle needle
 Skin closure is impossible

USE:
 Anal s/x
 Urogenital s/x
 Intraoral s/x
 Cardiovascular s/x
 Compound curved
 Developed for anterior segment of ophthalmic surgery.
 Tight curvature of the tip follows into a shallower curvature throughout
the remainder of the body.
 The initial curve allows short, deep bites into the tissue.
 The curvature of the remaining portion of the body forces the needle out
of the tissue, everting the wound edges and permitting a view into the
wound.
 Equal suture bites on both sides of the corneal-scleral junction minimize
the possibility of astigmatism.

3. EYE OF A NEEDLE:
 Eye needles are now obsolete.
 All modern needles are swaged. [suture material in joined together with
needle as a continuous unit. This is convenient to use but also
minimizes trauma. Thus swaged needles are called “atraumatic”

Dimensions of the needle:

Several dimensions determine the needle size.
1) Chord length: straight line distance from point to swage of a
curved needle.
2) Needle length: distance measured along the needle itself from
the point to eye.
3) Radius: distance from the center of the circle to the body of the
needle if the curvature of the needle were continued to make a
full circle.
4) Needle diameter/gauge: thickness of the needle wire ranges
from a very fine gauge for microscopy to large heavy gauge
needles used to penetrate the sternum.
OTHER PROPERTIES OF SURGICAL NEEDLES:
 Surgical yield points: amount of angular deformity which a needle can
with stand before becoming permanently deformed. Usually 10-300 and
once deformed beyond this, never reshape the needle.

 Sharpness: especially important in cosmetic/ delicate surgery. The

sharper the needle, the less the trauma and less scaring.

 Ductility: the needles’ resistance to breaking under a given amount of

bending.
NB: searching for a broken needle part can cause added tissue trauma,
anesthetic time and ligation hence complicating an otherwise easy
procedure.
Minimize needle bending and breakage by passing needles through
tissue in the direction of the curve of the needle body. Don’t use
needles as retractors to lift tissue.

 Stability: stability in the group of a needle holder is essential for

accurate suturing.
Needles are flattened and ribbed in the grasping area (middle third of
the body) to prevent rocking, twisting and turning.
 Needles should only be grasped at the designated area. NOT at tip or
eye.
Needles should not be held with artery forceps.

IMPORTANT POINTS TO NOTE:

1) Different needle lengths are available for each suture size.
2) Needle length required depends on the thickness of tissue being
sutured.
3) Needle must pass through the tissue at 900 to the skin surface.
4) Needle must be long enough to be passed through the skin and
then grasped by forceps without damaging the tip.

OTHER EQUIPMENT USED IN SUTURING:

 Needle holder vs. artery forceps

 Scissors
 Tissue forceps
 Hemostat

NEEDLE HOLDER:
 Locking handle\short, blunt beak
 Beak is shorter and stronger than that of a hemostat (NOT used to hold
suture needle)
 Face of beaks is cross hatched to permit a positive grasp of the suture
needle.
 Has a groove (to securely hold thicker surgery needles.

USE:
 To hold a suture needle
PARTS;