- Sutures are the
stitches doctors, and especially surgeons, use to hold skin, internal
organs, blood vessels and all other tissues of the human body
together, after they have been severed by injury or surgery. They must
be strong (so they do not break), non-toxic and hypoallergenic (to
avoid adverse reactions in the body), and flexible (so they can be
tied and knotted easily).
- Absorbable sutures
are made of materials which are broken down in tissue after a given
period of time, which depending on the suture can be from ten days to
four weeks. They are used therefore in many of the inner tissues of
the body. Absorbable sutures was originally made of the intestines of
sheep, the so called catgut. The manufacturing process was similar to
that of natural musical strings for violins and guitars, and also of
natural strings for tennis racquets.
- Suture sizes are
defined by the United States Pharmacopeia (U.S.P.). Sutures were
originally manufactured ranging in size from #1 to #6, with #1 being
the smallest. A #4 suture would be roughly the diameter of a tennis
racquet string. The manufacturing techniques, derived at the beginning
from the production of musical strings, did not allow thinner
diameters. As the procedures improved, #0 was added to the suture
diameters, and later, thinner and thinner threads were manufactured,
which were identified as #00 (#2-0 or #2/0) to #000000 (#6-0 or #6/0).
or intradermal sutures give the best cosmetic result, and are simple
and quick to place. They run in the dermis in the same plane as the
subdermal plexus, the main blood supply to the skin, and
therefore do not “strangle” wounds in the same way as simple
sutures. They do not cause crosshatching, and mechanically provide the
best internal splinting of a wound. Monofilament sutures are used, as
they do not exhibit as much tissue drag as braided sutures. There are
many different ways to start and finish such a suture, but generally,
non-absorbable sutures should enter the skin at the apex of the wound,
and absorbable sutures are often tied in the dermis. Bites should be
parallel to the wound edges, and through the dermis.
buried mattress suture (Barron suture) and three corner suture used
where either a single wound edge is friable, or the knots can be
hidden on one side (such as the areola of the breast). It is a
combination of a mattress suture and a subcuticular suture. A
variation where the subcuticular component is used to close the
corners of several different lacerations is known as a three-corner
- Today's suturing
techniques are responsible for two main adverse effects. Sutures
require knots so as to ensure optimal tissue closure strength. The
goal of wound together not only with sufficient strength to prevent
dehiscence, but also with a minimal residual tension and compression
of the tissue.
of laparoscopic surgical procedures have been performed worldwide with
teleoperated robotic surgical systems. Clinical successes with these
systems in the cardiothoracic surgical arena, however, have lagged
behind for several reasons.
teleoperated robotic surgical system under clinical investigation is
the da Vinci System . Although cardiothoracic surgeons have used this
system to successfully perform coronary arterial bypass grafting,
mitral valve repair, atrial septal defect closures, and biventricular
pacemaker lead placements, they have generally found
robot-assisted minimally invasive operations to be more time consuming
than conventional open approaches.
most widely used and systematically perfect method is that of
biologically activating surgical sutures by fixing the appropriate
drugs onto them by means of chemical bonds. At the same time, chemical
bonds allow varying magnitudes and durations of biological action.
Regarding the choice of drugs and the regulation of the period of
biological action, the widest scope is shown by ionexchanging
interrelations of fibres and drugs.
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