Chapter 4: Table of Contents
- 4.1 Suture Materials
- 4.2 Knots
- 4.3 Miller’s Knot
- 4.4 Modified Miller’s Knot
- 4.5 Hand Ties
- 4.6 Ligatures and Suture Patterns
- 4.7 Circumferential Ligature
- 4.8 Cruciate Pattern
- 4.9 Cushing Pattern
- 4.10 Ford Interlocking Pattern
- 4.11 Intradermal Pattern
- 4.12 Lembert Pattern
- 4.13 Mattress Suture Patterns
- 4.14 Modified Transfixing Ligature
- 4.15 Purse-String and finger trap
- 4.16 Simple Continuous Pattern
- 4.17 Simple Interrupted Pattern
- 4.18 Skin Staples
- 4.19 Subcutaneous closure & How to bury a knot
- 4.20 Suture Material and Patterns Quiz
The three main components of a needle are: Attachment end, Body, Point (or tip)
The attachment end exists as either an eye or a swaged form. Eyed needles require threading of suture through the eye of the needle by the surgeon. Because of the increased diameter at the level of the eye, greater tissue trauma occurs when inserting the needle in the tissues. Swaged needles are very popular since the suture is already attached to the inside of the needle end causing less tissue trauma during insertion of the needle.
The needle body may be straight, curved or serpentine shaped. Straight needles are manipulated by hand and are used primarily for suturing skin. Curved needles are most popular and are handled using needle holders. Curved needles come in various sizes and curves. Serpentine needles are heavy duty S-shaped needles and are rarely used.
Needle points are either taperpoint, tapercut, cutting, reverse cutting, side-cutting (spatula) or blunt.
Tapered needle points are used when minimal effort is required to penetrate the tissues as they produce the smallest holes. Tapercut needles are an alternative often selected for suturing dense, fibrous tissue.
Cutting needles are preferred for use in tissues that are difficult to penetrate such as thick fascia and skin. The cutting edges are on both sides as well as on the concave curvature of the needle. As a result, cutting needles produce the largest holes when passed through tissues.
Reverse cutting needles, have their third cutting edge on the convex curvature of the needle instead, thus producing a smaller hole in tissue than the cutting needle.
Side-cutting (spatula) needles are frequently used for ophthalmic surgery. They are flat on the top and bottom with only two cutting edges on either side.
Blunt needles have a non-tapered rounded tip and are designed to dissect through friable tissue such as liver and kidney without cutting.