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Today, more and more people are aware that an operating room could not solely operate without the necessary materials. Consequently, one of the most important materials needed in the operating room are the sutures. Generally, sutures are surgical guts, or silk, cotton or metal thread, 18 or more inches long, threaded on a needle. It is used mainly for sewing or suturing together the edges and the surfaces of tissue, for checking the flow of blood, fastening drainage tubes in position, etc. Sutures are either interrupted, each stitch tied separately; or continuous, the thread running in a series of stitches, only the first and last of which are tied. I. Length And Kinds The length of sutures naturally varies considerably. Each suture depends on the character of the work and the nature of the operation. For instance, deep work in the pelvis requires a much longer suture than would be necessary in suturing an area closer to the surface of a wound. Experience and judgment, along with the desire of the surgeon, must be the determining factors in details of sutures. Alternatively, there are different kinds of sutures. Each classification is unique and has its own respective function. II. Absorbable Sutures 1. Surgical Gut Surgical guts are also known as a catgut and is made from the submucous layer of a sheep's intestine. Once cleaned, dried and twisted into threads of various sizes they are prepared for use by special processes, that include innumerable inspections of gauze and tensile strength and scrupulous sterilization. The length of time for complete absorption of surgical gut in a wound varies according to the action of certain hardening agents. 2. Fascia Lata This muscle connective tissue of beef has been used in reconstructive orthopedic surgery and for the repair of hernias. It is not a true absorbable suture, but becomes part of the tissue after the wound has healed. III. The Non-absorbable Sutures 1. Silk This is prepared from the thread spun by the silkworm larva in making its cocoon. It may be twisted or braided, and it comes in sizes comparable with surgical gut. - High tensile strength - Relatively inexpensive - Less tissue reaction 2. Cotton This is made from cotton fibers. The strands are twisted and used for both internal and external suture. It should always be used wet for maximal strength. 3. Nylon - Monofilament - Multifilament - Braided - The chief disadvantage is that a triple knot must be tied 4. Wire This material has maximal flexibility and tensile strength, yet causes little or no local reaction in the tissue in which it is placed. 5. Dacron This is a synthetic polyester fiber that has greater tensile strength, minimal tissue reaction, maximal visibility, non-absorbent and non-fraying qualities. 6. Linen This is made of twisted line thread; it has sufficient tensile strength but is rarely used as suture material. 7. Silver Wire Clips Many styles of clips are available for the purpose of holding the edges of the tissue in approximation. They tend to produce some scarring when used in the skin, but may be used when the wound is infected. 8. Silkworm Gut This is made from the fluid secreted by the silkworm when they are ready to form their cocoons. The disadvantage is that they must be soaked in normal saline for about 10 minutes before use to make them pliable. 9. Mesh This type of suture is made of stainless steel, usually used for hernia repairs and large defects. It is rarely used. 10. Tantalum This is a bluish bray metal that is non-irritating to the body tissues. It is used because of its high tensile strength and its inert reaction to tissues.
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