Sutures and staplers

Suture size

6-0 to 8-0 (smaller) Vessel repair
5-0  
4-0 Subcuticular skin closure
3-0 Dermal stitches/skin closure
2-0  
0 (larger) Fascial closure

Suture type

  Absorbable Non-absorbable
    50% tensile strength Absorbed  
Natural Chromic gut 3-7 days 1 month *Silk
Synthetic

Monocryl (6-7)

3-4 weeks

   Nylon (Ethilon (5-6), Dermalon, *Nurolon)

*Vicryl (3-4)
(polyglactin)

3 weeks

2-3 months

 Polypropylene (Prolene)

PDS (6-8)
(polydioxanone)

6 weeks

6 months

 Dacron (*Ethibond, *Tevdek, *Ticron)

Maxon
(polyglyconate)

 3 weeks 7 months  
  • * = braided; (#) = # of knots needed
    • Monofilament will require more knots (> 5) than a braided suture (3-4) to keep from slipping
    • However, braided suture theoretically has more surface area to harbor bacteria/foster infection
  • Times given are approximately time to lose 50% of tensile strength
    • Non-absorbable = maintains full tensile strength for > 60 days
    • Choose short absorbable (Monocryl, chromic) for rapid-healing tissue (mucosa, dermal, etc.)
    • Choose longer absorbable (PDS/Maxon) for longer healing (fascia) or poor healing (diabetic, steroids)
  • Chromic = catgut treated with chromic acid to make it last longer. Dries out quickly once out of the package. Lasts longer in presence of infection.
  • Prolene tends to retain bends/folds and is finicky to handle - try to keep the tail under control as the assistant
  • Synthetic suture has less inflammatory reaction than natural (chromic, silk)

Common uses

  • Deep dermal = 3-0 Vicryl
  • Subcuticular = 4-0 Monocryl
  • Interrupted sutures for skin closure with later removal = nylon
  • Securing drain to skin = 2-0 silk or 3-0 nylon
  • Vessel repair = 6-0 Prolene
  • Fascia = 0 looped PDS

Needle types

Needle size

  • 1/2 to 5/8, referring to how much of a curve there is (3/8 is most common)
  • Straight needles are used in OB-GYN for closing C-section incisions (can sew a lot faster)
  • Suture needle sizes

Tapered (circular cross-section; non-cutting/less traumatic) - use in most situations

TP/CTX (trigger point), 1/2 circle

close abdominal fascia

 TP-1 65mm
CTX 48mm

CT (circle taper), 1/2 circle

close deep tissue after fascia; CT-2 to close uterus

 CT 40mm
CT-1 37mm
CT-2 26mm

SH (small half-circle), 1/2 circle

bowel, tissue in breast surgery

 SH 26mm
SH-1 22mm
UR (urology), 5/8 circle UR-6 26mm

RB (renal artery bypass)

delicate vessel/duct anastomosis; may use with a Castro needle holder (very delicate)

RB-1

 17mm

RB-2

 13mm

BB, 3/8 circle

also used for small vessel anastomosis

BB

 18mm
BB-1 22mm

 

Cutting (triangular cross-section; for cutting through tough skin, bone, tendon)

FS (for skin), 3/8 circle

FSLX (extra large) - close skin with a lot of tension
FSL (large) - close skin with tension
FS2 - common skin closure

 FSLX 39mm
FSL 30mm
FS2 19mm

PS (plastic surgery) with micropoint , 3/8 circle

PS2 - common skin closure
PS3 - delicate skin closure (hand surgery, face plastics)

 PS2 19mm
PS3 16mm

Staplers

  • Staple leg length - needs to be long enough to avoid over-compressing tissue, but short enough to form a tight seal for hemostasis
  • GIA = GastroIntestinal Anastomosis
    • White = 2.5 mm staple leg length (vascular)
    • Blue = 2.8 mm (bowel)
    • Green = 4.8 mm (stomach)
  • TA = ThoracoAbdominal
    • 30, 55, or 90 mm long staple line
  • Ethicon stapler
    • White = thin (2.5 mm open, 1 mm closed) (vascular)
    • Blue = regular (3.6 mm open, 1.5 mm closed)
    • Gold = regular/thick (3.8 mm open, 1.8 mm closed)
    • Green = thick (4.1 mm open, 2 mm closed)
    • Black = very thick (4.2 mm open, 2.3 mm closed)
author: admin | last edited: Sept. 11, 2022, 5:03 p.m. | pk: 93

  1. https://vvma.org/resources/Conferences/2016%20VVC%20Notes/Broaddus-%20Suture%20Selection.pdf

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