{"id":76,"date":"2015-12-05T21:02:53","date_gmt":"2015-12-05T21:02:53","guid":{"rendered":"http:\/\/brooksidepress.org\/surgery\/?page_id=76"},"modified":"2023-08-20T20:38:27","modified_gmt":"2023-08-20T20:38:27","slug":"2-5-materials-needed-for-wound-closure","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/surgery\/?page_id=76","title":{"rendered":"2-5. MATERIALS NEEDED FOR WOUND CLOSURE"},"content":{"rendered":"

a. Instruments<\/strong>. Only a few basic instruments are required for the repair of\u00a0most wounds. Gather the following equipment:<\/p>\n

(1) Needle holder.<\/p>\n

(2) Forceps.<\/p>\n

(3) Number 15 scalpel.<\/p>\n

(4) Scissors.<\/p>\n

Watch a video: Prepartion and Handling of Sutures and Needles<\/a><\/strong><\/p>\n

b. Needles<\/strong>.<\/p>\n

(1) Straight needle\/curved needle. There are two types of needles: the\u00a0straight needle and the curved needle. The straight needle is used with hands, and the\u00a0curved needle is used with needle holders.<\/p>\n

(2) Tapered needle\/cutting needle. A tapered needle has a circular cross-sectional\u00a0configuration and leaves a small hole. A cutting needle has a triangular cross-sectional\u00a0configuration and is better able to pass through tough skin.<\/p>\n

(3) Grades of needles. Two grades of needles are the cuticular needle and\u00a0the plastic needle. The cuticular needle is designated by the letter C and FS for skin.\u00a0The plastic needle is designated by the letter P for plastic and PS for plastic surgery.\u00a0The plastic needle is honed more sharply than the cuticular needle. Also, the plastic\u00a0needle is more expensive than a cuticular needle.<\/p>\n

(4) Size of needles. The needle size is indicated by the number that follows\u00a0the needle letter. Usually, the larger the number, the smaller the needle. Small needles\u00a0are used for fine repair such as treating facial lacerations. Larger needles are used for\u00a0taking bigger bites of tissue such as scalp lacerations.<\/p>\n

c. Suture Materials<\/strong>. One of the bases upon which surgery is founded is the\u00a0suture of wounds. Many kinds of present day sutures have been known for thousands\u00a0of years, but only since Lister’s discoveries have the use of sutures been safe. Suture\u00a0is a medical term for a thread-like material that is used to stitch or approximate (bring\u00a0together) tissue edges until healing takes place. Other terms to know are gauge and\u00a0tensile strength. Gauge refers to the diameter of the suture or the distance around the\u00a0suture. Tensile strength refers to the amount of weight or pull that may be exerted on a\u00a0suture before the suture will break.<\/p>\n

(1) Suture sizes. Suture sizes range from a fine number 9-0 to heavy\u00a0number 5. Suture sizing is controlled by USP standards. Small sutures (number 0\u00a0through number 9-0) are in greater demand because the small diameter provides better\u00a0handling qualities and smaller knots. Larger sutures (number 1 through number 5) are\u00a0used as a retention stitch, that being a stitch used to reinforce a primary suture line.\u00a0The kind and size of suture used depends on the patient, the type of tissue, the\u00a0surgeon’s preference, and the available suture material.<\/p>\n

(2) Nonabsorbable sutures.<\/p>\n

(a) Silk. Silk has a number of advantages as a suture material. Silk\u00a0lies flat when it is tied. It is easy to handle and has the added advantage of forming a\u00a0secure knot when tied. But there are also disadvantages. Silk is not the ideal suture\u00a0material for routine emergency department use. Silk causes a host reaction since silk is\u00a0a foreign protein. This means that there is a high risk of infection if silk is used as\u00a0suture material. Therefore, use silk in uncontaminated wounds that are in well-perfused\u00a0areas of the body; for example, wounds on the face.<\/p>\n

(b) Cotton. Briefly, the advantages of using cotton are the same as the\u00a0advantages for using silk as a suture material. Similarly, the disadvantages of using\u00a0cotton are the same as the disadvantages of using silk.<\/p>\n

(c) Nylon and polypropylene (synthetic materials). Among the\u00a0advantages of using these synthetic materials as sutures are that these synthetic\u00a0materials pose a lower risk of infection than silk or cotton. Also, these materials are the\u00a0suture of choice for skin closure of most lacerations in the emergency room.<\/p>\n

Disadvantages include the following:<\/p>\n

1 Synthetic materials do not lie flat during the suturing process.<\/p>\n

2 Synthetic materials are more difficult to use.<\/p>\n

3 There is less security of knots.<\/p>\n

(d) Dacron. The infection potential of Dacron is greater than that of\u00a0nylon or polypropylene, but less than that of silk or cotton. Dacron is easier to work with\u00a0and holds knots better than nylon or polypropylene.<\/p>\n

(3) Metal sutures. Staples are metal sutures. For many years, staples have\u00a0been commonly used for surgical wound closure. Staples are used in emergency\u00a0rooms for some types of lacerations. The advantages of metal sutures are that they are\u00a0easier and quicker than other types of suture repair. The cost is lower, and the wound\u00a0healing results are the same as for other types of suturing. The disadvantages are that\u00a0an inexperienced person has a difficult time using these sutures. Additionally, metal\u00a0sutures can be highly irritating to the patient.<\/p>\n

(4) Absorbable sutures. Absorbable suture material is digested and\u00a0absorbed by body cells and fluids during and after healing of tissue. There are two\u00a0types of regular absorbable suture–plain cat gut and chromic cat gut. Both of these\u00a0indicate a surgical gut material that has not been treated to lengthen its absorption time\u00a0in the tissue.<\/p>\n

(a) Plain catgut. Plain catgut holds tensile strength for about seven\u00a0days. Sheep’s intestine is the source of plain suture. This suture is used in tissue\u00a0where rapid healing is expected to occur such as subcutaneous tissue and for tying\u00a0superficial blood vessels. Plain catgut suture is pale yellow in color. A disadvantage of\u00a0this type of suture is that it increases the formation of pus and has high tissue reactivity.<\/p>\n

(b) Chromic catgut. Chromic suture has been treated with chromic\u00a0oxide so that it will resist digestion or absorption for longer periods of time. Chromic\u00a0suture has the same source as plain suture. Chromic suture is used in tissue where\u00a0rapid healing is not expected to take place, such as muscle fascia, peritoneum, and\u00a0body organs. The advantage of this type of suture is that it retains its tensile strength\u00a0for about two to three weeks. As with plain catgut, chromic suture increases the\u00a0formation of pus and has high tissue reactivity.<\/p>\n

(c) Synthetic absorbable suture. Dexon\u00ae and Vyeril\u00ae are examples of\u00a0synthetic absorbable suture. Advantages include that it retains tensile strength for sixty\u00a0days or more. Also, there is low tissue reactivity and lower pus formation than with the\u00a0use of plain or chromic cat gut. A disadvantage is that this type of suture material does\u00a0not glide through tissue easily. Snags tend to occur, making knot tying more tedious.<\/p>\n

(5) Skin tapes. Steri-Strips, clearon, and skin-strips are examples of skin\u00a0tapes. Skin tapes are often used in place of sutures to repair surface lacerations.\u00a0Advantages of skin tapes are the low incidence of infection and no suture marks. Also,\u00a0the patient need not return to have sutures removed. Disadvantages are that skin tapes\u00a0are not practical in body areas that may become wet or that have motion. Young\u00a0children have a tendency to pull off skin tapes. Also, at times wound edges invert after\u00a0a skin tape has been applied.<\/p>\n","protected":false},"excerpt":{"rendered":"

a. Instruments. Only a few basic instruments are required for the repair of\u00a0most 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\u00a0straight needle and the … Continue reading 2-5. MATERIALS NEEDED FOR WOUND CLOSURE<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"parent":65,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-76","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/76","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=76"}],"version-history":[{"count":5,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/76\/revisions"}],"predecessor-version":[{"id":330,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/76\/revisions\/330"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=\/wp\/v2\/pages\/65"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/surgery\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=76"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}