a. Instruments. Only a few basic instruments are required for the repair of most wounds. Gather the following equipment:

(1) Needle holder.

(2) Forceps.

(3) Number 15 scalpel.

(4) Scissors.

Watch a video: Prepartion and Handling of Sutures and Needles

b. Needles.

(1) Straight needle/curved needle. There are two types of needles: the straight needle and the curved needle. The straight needle is used with hands, and the curved needle is used with needle holders.

(2) Tapered needle/cutting needle. A tapered needle has a circular cross-sectional configuration and leaves a small hole. A cutting needle has a triangular cross-sectional configuration and is better able to pass through tough skin.

(3) Grades of needles. Two grades of needles are the cuticular needle and the plastic needle. The cuticular needle is designated by the letter C and FS for skin. The plastic needle is designated by the letter P for plastic and PS for plastic surgery. The plastic needle is honed more sharply than the cuticular needle. Also, the plastic needle is more expensive than a cuticular needle.

(4) Size of needles. The needle size is indicated by the number that follows the needle letter. Usually, the larger the number, the smaller the needle. Small needles are used for fine repair such as treating facial lacerations. Larger needles are used for taking bigger bites of tissue such as scalp lacerations.

c. Suture Materials. One of the bases upon which surgery is founded is the suture of wounds. Many kinds of present day sutures have been known for thousands of years, but only since Lister’s discoveries have the use of sutures been safe. Suture is a medical term for a thread-like material that is used to stitch or approximate (bring together) tissue edges until healing takes place. Other terms to know are gauge and tensile strength. Gauge refers to the diameter of the suture or the distance around the suture. Tensile strength refers to the amount of weight or pull that may be exerted on a suture before the suture will break.

(1) Suture sizes. Suture sizes range from a fine number 9-0 to heavy number 5. Suture sizing is controlled by USP standards. Small sutures (number 0 through number 9-0) are in greater demand because the small diameter provides better handling qualities and smaller knots. Larger sutures (number 1 through number 5) are used as a retention stitch, that being a stitch used to reinforce a primary suture line. The kind and size of suture used depends on the patient, the type of tissue, the surgeon’s preference, and the available suture material.

(2) Nonabsorbable sutures.

(a) Silk. Silk has a number of advantages as a suture material. Silk lies flat when it is tied. It is easy to handle and has the added advantage of forming a secure knot when tied. But there are also disadvantages. Silk is not the ideal suture material for routine emergency department use. Silk causes a host reaction since silk is a foreign protein. This means that there is a high risk of infection if silk is used as suture material. Therefore, use silk in uncontaminated wounds that are in well-perfused areas of the body; for example, wounds on the face.

(b) Cotton. Briefly, the advantages of using cotton are the same as the advantages for using silk as a suture material. Similarly, the disadvantages of using cotton are the same as the disadvantages of using silk.

(c) Nylon and polypropylene (synthetic materials). Among the advantages of using these synthetic materials as sutures are that these synthetic materials pose a lower risk of infection than silk or cotton. Also, these materials are the suture of choice for skin closure of most lacerations in the emergency room.

Disadvantages include the following:

1 Synthetic materials do not lie flat during the suturing process.

2 Synthetic materials are more difficult to use.

3 There is less security of knots.

(d) Dacron. The infection potential of Dacron is greater than that of nylon or polypropylene, but less than that of silk or cotton. Dacron is easier to work with and holds knots better than nylon or polypropylene.

(3) Metal sutures. Staples are metal sutures. For many years, staples have been commonly used for surgical wound closure. Staples are used in emergency rooms for some types of lacerations. The advantages of metal sutures are that they are easier and quicker than other types of suture repair. The cost is lower, and the wound healing results are the same as for other types of suturing. The disadvantages are that an inexperienced person has a difficult time using these sutures. Additionally, metal sutures can be highly irritating to the patient.

(4) Absorbable sutures. Absorbable suture material is digested and absorbed by body cells and fluids during and after healing of tissue. There are two types of regular absorbable suture–plain cat gut and chromic cat gut. Both of these indicate a surgical gut material that has not been treated to lengthen its absorption time in the tissue.

(a) Plain catgut. Plain catgut holds tensile strength for about seven days. Sheep’s intestine is the source of plain suture. This suture is used in tissue where rapid healing is expected to occur such as subcutaneous tissue and for tying superficial blood vessels. Plain catgut suture is pale yellow in color. A disadvantage of this type of suture is that it increases the formation of pus and has high tissue reactivity.

(b) Chromic catgut. Chromic suture has been treated with chromic oxide so that it will resist digestion or absorption for longer periods of time. Chromic suture has the same source as plain suture. Chromic suture is used in tissue where rapid healing is not expected to take place, such as muscle fascia, peritoneum, and body organs. The advantage of this type of suture is that it retains its tensile strength for about two to three weeks. As with plain catgut, chromic suture increases the formation of pus and has high tissue reactivity.

(c) Synthetic absorbable suture. Dexon® and Vyeril® are examples of synthetic absorbable suture. Advantages include that it retains tensile strength for sixty days or more. Also, there is low tissue reactivity and lower pus formation than with the use of plain or chromic cat gut. A disadvantage is that this type of suture material does not glide through tissue easily. Snags tend to occur, making knot tying more tedious.

(5) Skin tapes. Steri-Strips, clearon, and skin-strips are examples of skin tapes. Skin tapes are often used in place of sutures to repair surface lacerations. Advantages of skin tapes are the low incidence of infection and no suture marks. Also, the patient need not return to have sutures removed. Disadvantages are that skin tapes are not practical in body areas that may become wet or that have motion. Young children have a tendency to pull off skin tapes. Also, at times wound edges invert after a skin tape has been applied.