Information @ a Glance

• 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 Absorbable sutures was originally made of the intestines of sheep, the so called catgut.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).

Important Techniques

• Subcuticular 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. 

• Half 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 suture.

Technology 

• 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.

• Thousands 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. 

• A 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. 

• The 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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