Second, the suture material can be classified according to the actual structure of the material. Monofilament sutures consist of a single thread. This allows the suture to more easily pass through tissues. Braided sutures consist of several small threads braided together. This can lead to better security, but at the cost of increased potential for infection.
This type of suture is applied so that the suture knot is found inside (that is, under or within the area that is to be closed off). This type of suture is typically not removed and is useful when large sutures are used deeper in the body.
sutures
These sutures are placed in your dermis, the layer of tissue that lies below the upper layer of your skin. Short stitches are placed in a line that is parallel to your wound. The stitches are then anchored at either end of the wound.
Sutures are used by your doctor to stitch shut wounds or lacerations. There are many different types of suture materials available. Additionally, there are many suture techniques that can be used. Your doctor will choose both the correct suture material and technique to use for your condition. Talk to your doctor about any concerns you have about sutures before your procedure.
Sutures are used to close deep wounds or cuts. When a deep wound is present, a doctor may need to sew the two edges of the wound together layer by layer. When this happens, sutures are left under the surface of the skin and ultimately close the wound.
This guidance provides performance criteria for surgical sutures in support of the Safety and Performance Based Pathway. Under this framework, submitters (you) planning to submit a 510(k) using the Safety and Performance Based Pathway for surgical sutures will have the option to use the performance criteria provided in this guidance to support substantial equivalence, rather than a direct comparison of the performance of the subject device to that of a predicate device.
Historically, surgeons used reusable needles with holes (called "eyes"), which are supplied separate from their suture thread. Such suture must be threaded on site, as is done in embroidery sewing. The advantage of this is that any thread and needle combination is possible to suit the job at hand. Swaged, or atraumatic, needles with sutures consist of a pre-packed eyeless needle attached to a specific length of suture thread. The suture manufacturer swages the suture thread to the eyeless atraumatic needle at the factory. The chief advantage of this is that the doctor or the nurse does not have to spend time threading the suture on the needle, which may be difficult for very fine needles and sutures. Also, the suture end of a swaged needle is narrower than the needle body, eliminating drag from the thread attachment site. In eyed needles, the thread protrudes from the needle body on both sides, and at best causes drag. When passing through friable tissues, the eye needle and suture combination may thus traumatise tissues more than a swaged needle, hence the designation of the latter as "atraumatic".[citation needed]
Finally, atraumatic needles may be permanently swaged to the suture or may be designed to come off the suture with a sharp straight tug. These "pop-offs" are commonly used for interrupted sutures, where each suture is only passed once and then tied.
Monofilament versus polyfilament: monofilament fibers have less tensile strength, but create less tissue trauma and are more appropriate with delicate tissues where tissue trauma can be more significant such as small blood vessels. Polyfilament (braided) sutures are composed of multiple fibers and are generally greater in diameter with greater tensile strength, however, they tend to have greater tissue reaction and theoretically have more propensity to harbor bacteria.[1]
Absorbable sutures are either degraded via proteolysis or hydrolysis and should not be utilized on body tissue that would require greater than two months of tensile strength. It is generally used internally during surgery or to avoid further procedures for individuals with low likelihood of returning for suture removal.[2]
Synthetic absorbable: includes Polyglactic acid, Polyglycolic acid, Poliglecaprone, Polydioxanone and Polytrimethylene carbonate. Among these are monofilaments, polyfilaments and braided sutures. In general synthetic materials will keep tensile strength for longer due to less local tissue inflammation.[2]
These sutures hold greater tensile strength for longer periods of time and are not subject to degradation. They are appropriate for tissues with a high degree of mechanical or shear force (tendons, certain skin location). They also supply the operator with greater ease of use due to less thread memory.[5]
Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes. The actual diameter of thread for a given U.S.P. size differs depending on the suture material class.
Sutures are placed by mounting a needle with attached suture into a needle holder. The needle point is pressed into the flesh, advanced along the trajectory of the needle's curve until it emerges, and pulled through. The trailing thread is then tied into a knot, usually a square knot or surgeon's knot. Ideally, sutures bring together the wound edges, without causing indenting or blanching of the skin,[16] since the blood supply may be impeded and thus increase infection and scarring.[17][18] Ideally, sutured skin rolls slightly outward from the wound (eversion), and the depth and width of the sutured flesh is roughly equal.[17] Placement varies based on the location,
Whereas some sutures are intended to be permanent, and others in specialized cases may be kept in place for an extended period of many weeks, as a rule sutures are a short-term device to allow healing of a trauma or wound.
Removal of sutures is traditionally achieved by using forceps to hold the suture thread steady and pointed scalpel blades or scissors to cut. For practical reasons the two instruments (forceps and scissors) are available in a sterile kit. In certain countries (e.g. US), these kits are available in sterile disposable trays because of the high cost of cleaning and re-sterilization.
A pledgeted suture is one that is supported by a pledget, that is, a small flat non-absorbent pad normally composed of polytetrafluoroethylene, used as buttresses under sutures when there is a possibility of sutures tearing through tissue.[23]
Topical cyanoacrylate adhesives (closely related to super glue), have been used in combination with, or as an alternative to, sutures in wound closure. The adhesive remains liquid until exposed to water or water-containing substances/tissue, after which it cures (polymerizes) and forms a bond to the underlying surface. The tissue adhesive has been shown to act as a barrier to microbial penetration as long as the adhesive film remains intact. Limitations of tissue adhesives include contraindications to use near the eyes and a mild learning curve on correct usage. They are also unsuitable for oozing or potentially contaminated wounds.[citation needed]
The earliest reports of surgical suture date to 3000 BC in ancient Egypt, and the oldest known suture is in a mummy from 1100 BC. A detailed description of a wound suture and the suture materials used in it is by the Indian sage and physician Sushruta, written in 500 BC.[25] The Greek father of medicine, Hippocrates, described suture techniques, as did the later Roman Aulus Cornelius Celsus. The 2nd-century Roman physician Galen described sutures made of surgical gut or catgut.[26] In the 10th century, the catgut suture along with the surgery needle were used in operations by Abulcasis.[27][28] The gut suture was similar to that of strings for violins, guitars, and tennis racquets and it involved harvesting sheep or cow intestines. Catgut sometimes led to infection due to a lack of disinfection and sterilization of the material.[29]
The next great leap came in the twentieth century. The chemical industry drove production of the first synthetic thread in the early 1930s, which exploded into production of numerous absorbable and non-absorbable synthetics. The first synthetic absorbable was based on polyvinyl alcohol in 1931. Polyesters were developed in the 1950s, and later the process of radiation sterilization was established for catgut and polyester. Polyglycolic acid was discovered in the 1960s and implemented in the 1970s. Today, most sutures are made of synthetic polymer fibers. Silk and, rarely, gut sutures are the only materials still in use from ancient times. In fact, gut sutures have been banned in Europe and Japan owing to concerns regarding bovine spongiform encephalopathy. Silk suture is still used today, mainly to secure surgical drains.[30]
The sutures and fontanelles are needed for the infant's brain growth and development. During childbirth, the flexibility of the sutures allows the bones to overlap so the baby's head can pass through the birth canal without pressing on and damaging their brain.
During infancy and childhood, the sutures are flexible. This allows the brain to grow quickly and protects the brain from minor impacts to the head (such as when the infant is learning to hold his head up, roll over, and sit up). Without flexible sutures and fontanelles, the child's brain could not grow enough. The child would develop brain damage.
Feeling the cranial sutures and fontanelles is one way that health care providers follow the child's growth and development. They are able to assess the pressure inside the brain by feeling the tension of the fontanelles. The fontanelles should feel flat and firm. Bulging fontanelles may be a sign of increased pressure within the brain. In this case, providers may need to use imaging techniques to see the brain structure, such as CT scan or MRI scan. Surgery may be needed to relieve the increased pressure. 2ff7e9595c
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