Introduction
Suture material
In general, for any type of skin suture, never use your hands directly to guide the needle, but clamp it in a clamp. The edges of the wound are held with surgical tweezers. This also serves to clamp the needle when the stitch direction changes.
Basically, every suture material must be sterile, tear and knot-proof, tissue-compatible and manipulable. These requirements apply to every suture material, regardless of whether it is used for the skin or organs. First, sutures can be divided into absorbable and non-absorbable material.
Resorbable sutures have the property that they dissolve after a certain time and therefore do not have to be removed manually. This offers the advantage that no further manipulation is necessary. In addition, sutures in organs, muscles or deep in the skin are possible.
It is therefore used in places that have to be temporarily adapted. However, the tensile strength of the material slowly decreases after a relatively short period of time, so that the tissue itself must then apply the tensile strength. For example, polyglycolic acid threads only have 50% of their original tensile strength after about 15 days.
After about 3 months, the threads are completely absorbed. Non-absorbable suture material is used in places with increased mechanical stress. This ensures a permanent support of the tissue strength.
A distinction is made between two different materials. On the one hand the plastic polymers, which can be monofil (non-braided) or polyfil (braided). The plastic polymers have the advantage that they have a good knot strength, a low foreign body reaction and a low risk of infection.
However, there is the risk of an allergic reaction. In such a case the threads must be removed again. Silk is the second material of non-absorbable threads.
However, since these involve a high risk of infection, they are now only used for temporary sutures. However, they are very supple and have good knotting properties, but are not very elastic. The thread thickness refers to the diameter of surgical suture material.
There are different measuring systems for thread thickness, namely the American USP system (United States Pharmacopeia) and the European EP system (European Pharmacopoeia, “Metric System”). The thickness of the thread designates the thickness and, together with the material properties, determines the tear resistance. The thread thickness is given in the form of numbers starting from the number 0.
Thickness 12-0 is the thinnest thread and is used in microsurgery. It is approximately 0.001-0.009 mm thick. The widest thread has a thickness of 7, is approx.
0.9 mm thick and is used for joint stabilization. Skin sutures are usually sutured with a 2-0 or 3-0 thread. These are approx.
0.2 to 0.3 mm thick. In principle, one tries to use the thinnest possible suture material to perform wound closure. However, the thread must be thick enough to achieve a sufficiently firm wound closure.
One tries to find the optimum compromise between tear resistance and the least possible tissue damage. The choice of thread is left to experienced surgeons and is a decision that is individually tailored to the wound. In principle, sutures with a larger diameter are used for wounds that are subject to greater tensile and shear forces.
A thinner diameter can be chosen if the wound is not subject to great stress. In addition to the thickness of the thread, a distinction can also be made between the needle-thread combination. A distinction is made between traumatic and atraumatic suturing.
In traumatic suturing, the thread must be threaded into the needle, similar to the sewing of fabrics. The advantage is that the needle can be reused and needle and thread can be combined freely. This variant is also more cost-effective.
However, it causes a greater traumatization of the tissue and an additional work step is necessary. For this reason, traumatic suturing is only used if the corresponding needle/thread combination is not available. In atraumatic suturing the thread emerges directly from the needle.
I.e. the thread does not have to be threaded anymore and causes less tissue traumatization. However, the costs are higher and the needle-thread combination is predetermined and cannot be freely selected.Atraumatic suturing is almost always used if the appropriate combination is available.
It is also used for very sensitive tissue, such as peritoneal sutures. To perform a skin suture either: The stapling devices press stainless steel staples into the tissue and bend them over so that the staples are closed and cannot be easily removed. There are different stapling devices that make different sutures depending on the requirements.
Single stapling devices are used for skin closure. The advantage of these stapling devices is a very fast closure of the wounds and fine scars. The staples are removed after about 10 days with the help of a special device.
This device bends the staples open again and removes them completely painlessly. In addition, glue can be used for skin closure/skin suturing. For this purpose there are different fibrin adhesives and butylcyanoacrylate.
This is available in ampoules or as a spray. Small skin wounds on the face can be closed with the help of air humidity and polymerization. The adhesive burns on the fresh wound for a short time, but is then no longer noticeable or visible and is absorbed after a certain time.
Narrow scars remain, which are hardly visible.
- Staplers
- Adhesives or
- Monofilament plastic threads used.
There is also the possibility of adhesive strips (Steristrip). These are used for smaller skin wounds and give a very good cosmetic result.
However, the wound edge adaptation of this skin suture is not as good as with staples or sutures, so the wounds must not be as deep to achieve a good result. In general, deeper and larger wounds must always be closed with sutures or staples, otherwise the adaptation of the wound edges cannot be guaranteed. Smaller, superficial cuts, on the other hand, can be closed quickly and painlessly with adhesive or adhesive strips. A further advantage of these measures is that no local anesthesia is required, whereas before suturing or stapling, a local anesthetic of the wound and its surroundings is always necessary.