Surgical sutures and Staples

Sutures, also known as stitches, are sterile surgical threads used to repair cuts. They are also commonly used to close incisions from surgery. Some wounds may require an alternative method like metal staples instead of sutures. Decision about the use of sutures or staples depends on the type of wound. When sutures are used to close a wound or incision a needle is seen attached to a length of the ‘thread’ to stitch the wound. Sutures are made either from natural or synthetic material

Types of sutures

• Absorbable sutures which do not require to be removed because enzymes found in the tissues of the body naturally digest these.

• Nonabsorbable sutures will need to be removed at a later date.

Types of Absorbable Sutures

• Guts (catguts): These are natural monofilament sutures and are used for repairing internal soft tissue wounds or lacerations. These are not to be used for cardiovascular or neurological procedures as the body has strong reaction to it and often form scar tissue over it. It is not commonly used outside of gynecological surgeries.

• Polydioxanone (PDS): This synthetic monofilament absorbable suture that can be used for many types of soft tissue   wound repairs such as abdominal closures as well as for pediatric cardiac procedures.

•  Poliglecaprone (Monocryl): This synthetic monofilament suture is used for general use in soft tissue repair. This suture is commonly used to close skin in an invisible manner.

•  Polyglactin (Vicryl): This synthetic braided suture is good for repairing hand or facial lacerations. This is not to be used for cardiovascular or neurological procedures

Nonabsorbable Sutures

These types of sutures can be used generally for soft tissue repair including both cardiovascular and neurological procedures

1. Nylon-A natural monofilament suture
2. Polypropylene (Propene)-A synthetic monofilament suture
3. Silk-A braided natural suture
4. Polyester (Ethibond)-A braided synthetic suture
5. Surgical staples

Types of Suturing

•  Continuous sutures: This technique involves a series of stitches that use a single strand of suture material. This type of suture can be placed rapidly and is also strong since tension is distributed evenly throughout the suture strand.

•  Interrupted sutures: This suturing technique uses several strands of suture material to close the wound. After a stitch is made, the material is cut and tied off. If one stitch breaks, the remainder of stitches will still hold the wound together

• Deep sutures: This type of suture is placed under the layer of tissue below (deep) the skin.

• Purse-string sutures: This is a type of continuous suture that is placed around an area and tightened much like the drawstring on a bag.

• Subcutaneous sutures: These are placed in the dermis, the layer of tissue that lies below the upper layer of skin.

Suture Removal

The time when sutures are removed will depend on where they are on the body. Some general guidelines according to American Family Physicians are as given below:

1. Scalp: 7-10 days
2. Face: 3-5 days
3. Chest and trunk: 10-14 days
4. Arms: 7-10 days
5. Legs: 10-14 days
6. Hands and feet: 10-14 days
7. Palms of hands or soles: 14-21 days

Staple Removal

staples are removed using a staple extractor/remover. These are removed by sliding the lower part of the remover and wiggling the staple gently on either side until it comes out of the skin. Staples are removed from transverse incisions after 3 to 4 days and from vertical incisions after 7 to 10 days or more.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
8. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

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