Sutures for Minor Surgery

Sutures for minor surgery:

Many years of questions from GP surgeries concerning "which suture is best" has lead us to a simple formula.

The two most important factors are:

• What gauge is required? This is relevant as to the strength of the suture
• Do you require absorbable or non-absorbable? i.e. will you have to take the sutures out when healing has occurred?

When these decisions have been made just choose from our selection of sutures which experience has shown, will perform well for you. Each suture is mounted on a 1/3rd circle needle between 16mm-26mm and is reverse cutting. We have listed sutures with a range of colours and characteristics.

The needle style

The outcome of our research suggests that the two main needle styles used in minor surgery are 3/8ths of a circle and a % circle. However, experience has shown that a needle that forms 3/8ths of a circle is more common where space is not restricted; a category most minor surgery falls into. However, where space is restricted, a % circle needle is recommended where available. (1)

Our research has shown that in most minor surgery cases a reverse cutting needle gives a better result. 'A reverse cutting needle is recommended when suture placement is unavoidably near the edge of the wound or the wound is under tension'(2). This is because a reverse cutting needle has a sharp edge on the outer curve of the needle that is directed away from the wound edge, reducing the risk of the suture pulling through the tissue being sutured (3).

Length of needle

If the needle is too short it will be difficult to grasp especially after the needle has been inserted into the tissue. We recommend a 26mm needle but have listed needle lengths ranging from 16mm to 26mm, to take account of Ethicon needle length availability.

Arming a needle holder properly Swaged end, where suture attaches to the needle Suture choice. This is a decision for the individual doctor. The type of wound and its position will dictate whether an absorbable or non absorbable suture will be used. Absorbable sutures degrade rapidly and are mainly used in the deep tissue layers of a wound to minimise the risk of haematoma formation or infection occurring in dead space, and reduce closure tension. (4)

'Non absorbable sutures are most commonly used for percutaneous or skin closure'. (5)

Non absorbable sutures retain tensile strength for long periods, but need to be removed when the skin surrounding the wound has gained the necessary tensile strength. If the edges meet only under considerable tension or if the wound is deep, consider suturing the deeper layers of tissue first. (4)

Suture strength

This is a decision the doctor must make dependant on the procedure to be undertaken, because if a suture is too thin and is put under pressure, the suture could break. Suture material is classified by numbering from 1-10. Higher numbers indicate a more delicate suture. Below details the suggested guidelines for suture material and gauge for specific body regions. (5)

Suture length.

Ethicon suture lengths are usually 45cm or 75cm dependant on the code, and it is therefore, adviseable to check a sutures length is adequate for the procedure intended before ordering.

Recommended intervals for removal of skin sutures.

• Scalp - 6-8 days
• Face - 4-5 days
• Ear — 4-5 days
• Chest/abdomen — 8-10 days
• Back — 12-14 days
• Arm/leg • - 8-10 days
• Hand •—8-10 days
• Fingertip — 10-12 days
• Foot— 12-14 days

'Add 2-3 days for joint extensor surfaces.’ (5)

References.

1. http://www.dent.ohio-state.edu/courses/d664/Suturing/SuturingRev2.pdf (accessed 27,01,2012)

2. http://www.patient.co.uk/doctor/Minor-Surgery-DES.htm (accessed 21,01,2012)

3. http://emedicine.medscape.com/article/1824895-overview (accessed 30,01,2012)

4. http://www.nursingtimes.net/nursing-practice-clinical-research/understanding-the-principles-of-suturing-minor-skinlesions/204195.article (accessed 23,01,2012)

5. http://www.anwresidency.com/simulation/guide/suturing.html (accessed 22,01,2012)