Drapes and sutures
Drapes, sutures, & other closure material
Drapes are used during a minor surgical procedure for a variety of reasons. They can provide a sterile field around the surgical site and also provide modesty for the patient. Sutures and other closure materials are used when a surgical incision or other wound needs to be closed. The following sections \ discuss drapes and closure materials.
Drapes
Disposable surgical drapes are available in several materials and sizes. These typically have an opening (fenestrated) for the operative site. The drape is placed over the operative area using sterile technique after the patient’s skin preparation has been completed. If a fenestrated drape is not available, multiple non fenestrated drapes can be used to create a sterile field around the surgical site.
Sutures
The word suture is used as both a noun and a verb. As a noun, it refers to a surgical stitch or the material used to close a wound. As a verb, it refers to the act of stitching. The primary purpose of a suture is to hold the edges of a wound together until natural healing occurs.
A suture may also be used as a ligature. This is a strand of suture material used to tie off a blood vessel or strangulate tissue. If a ligature is used to tie off an internal tubular structure, it must last permanently or long enough for the structure itself to disintegrate. The ideal suture material has certain characteristics:
- Easy to handle and makes a secure knot
- Does not cause a localized tissue reaction and is nonallergenic
- Has adequate strength without cutting through tissue
- Can be sterilized
The provider will request a certain type of suture based on the specific properties of the suture material, such as rate of absorption, size of the suture, and type of needle. Both natural and synthetic suture materials are available. Sutures may be classified as either absorbable or nonabsorbable. Many suture materials are available, each having its advantages and disadvantages. Suture materials commonly used in minor surgical procedures are described in the following paragraphs.
Absorbable sutures
Absorbable sutures are dissolved by the body’s enzymes during the healing process. They are used when deep incisions or lacerations require inner layers of sutures to close the wound. Absorbable suture material is also used in areas where suture removal is difficult (e.g., oral surgery). Catgut (sheep, cattle, or pig intestine) was once the absorbable suture material of choice, but it has largely been replaced in recent years by synthetic absorbable suture material (e.g., Vicryl). Other synthetic absorbable suture materials include Dexon, polydioxanone (PDS), and Maxon. These materials remain stable longer than natural catgut (up to 11 weeks), allowing the wound to completely heal before absorption occurs.
Nonabsorbable sutures
Nonabsorbable suture material is left in place until healing is complete. It frequently is used in minor surgical procedures performed in the medical office because most of the suturing required is superficial. It can be used in areas where sutures can be easily removed after healing has taken place. Silk is a common nonabsorbable suture material because it is strong and easy to tie. It is treated with a coating to prevent tissue drag and flaking. Polyester fiber sutures (e.g., Dacron and Prolene) are among the strongest nonabsorbable sutures, along with surgical steel. These fine filaments are braided and have great strength. Nylon suture is strong and has a high degree of elasticity. It is used primarily for skin closure. Due to its elasticity and stiffness, many knots must be used because they tend to untie if placed incorrectly.
Suture sizing and packaging
Suture material is available in a variety of diameters and lengths. The diameter of the suture strand determines its size; the smaller gauges are numbered below 0 (pronounced aught), and the larger gauges are identified with numbers above 0. For instance, 2-0 suture is thinner than size 0, which is thinner than size 2. The sizes from 6-0 to 2-0 are used most frequently in the medical office. The length of the suture material may vary, with strands precut in 18-, 24-, 54-, and 60-inch lengths.
Suture sizes
| Suture Size | Diameter |
| 6-0 | 0.07 mm |
| 5-0 | 0.10 mm |
| 4-0 | 0.15 mm |
| 3-0 | 0.20 mm |
| 2-0 | 0.30 mm |
| 0 | 0.35 mm |
| 1 | 0.40 mm |
| 2 | 0.50 mm |