CONSIDERATION OF SUTURE SELECTION
Suture material is used by the surgeon to keep the wound together during the wound healing and to provide the necessary support. The structural properties of the surgical threads together with the dynamic resistance including cellular, physiological and biochemical events during wound healing and the factors affecting them must be well known so that the appropriate stitch thread can be selected.
The main factors affecting wound healing are;
- surgical technique,
- blood circulation,
- mechanical stress,
- suture material,
- stitch technique,
- infection and
- systemic factors.
The main factors affecting suture material selection are;
- wound type and strength,
- wound healing time,
- properties of suture material,
- interaction between suture and tissue.
The main features to consider when choosing suture material are;
- tensile strength,
- ease of passage through the tissue,
- knot safety,
- dragging the stitch thread,
- short and long term reactions in the tissue,
- ease of use and
- packaging features that allow the package to come out with minimal memory.
The main purpose of suture selection is not to damage tissue during operation. Sharp dissection is less traumatic than blunt dissection. The wound edges are only approximated and not stretched, which accelerates healing.
There is no perfect stitch, it is the most suitable stitch. During an unsuitable suture knot, the suture surface may completely deform. There may be differences in diameter along the suture, and the surface integrity may be lost. During knotting, the filaments can be separated from the surface.
Suture materials are generally coated with the aim of facilitating their handling properties, particularly reducing tissue damage when passing through the needle path, and increasing knot reliability during knotting. The absorbable suture coating materials may be in water-soluble or insoluble form. Water-insoluble substances can be left on the suture surface longer, are soluble in hydrolysis and are produced from chemical compounds closer to the active substance.
The coating is used more often in multifilament sutures, usually monofilament sutures do not require coating. Although the coating of suture material facilitates the smooth transition and use of the tissue, it also reduces the reliability of the knot.
The following factors should be considered in the selection of the ideal suture:
- age of the patient,
- wound place is in the body,
- wound-specific characteristics,
- the presence or absence of infection,
- the preference of the surgeon’s personal suture and
- experience in the use of suture material.
Appropriate surgical suture severity severely reduces the risk of postoperative complications and, consequently, reduces the need for secondary surgery. At the same time, the time required to treat the patients is shortened and treatment costs are reduced.
Despite the deterioration of the surgical thread holding wound, the total strength of any jaw, thread and tear during the first time of surgical intervention and the time of healing of the suture must be at least equal to the strength of the tear. The decay time of the surgical thread in the biological environment should be long enough to ensure that the tissue gains its improved resilience. If the surgical thread is too weak, it can not hold the tissue for as long as it will heal, and if it is too strong, the tissue may cut from one end to the other.