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Suture
HISTORY The origins of surgery can be traced back many centuries.  Through the ages, practitioners have used a wide range ...
In the tenth century BC, the ant was held over the wound until it seized the wound edges in its jaws. It was then decapita...
Thorns The thorn, used by African tribes to close tissue,  was passed through the skin on either side of the wound.  A str...
Sterilised Catgut The tough membrane of sheep intestine was provided  to the surgeon pre-sterilised and required threading...
Swaged On Needles Post World War II brought the swaged-on needle. The thread fits into the hollow end of the needle, allow...
Suture Classification and Selection
Practice Time!
Classification of Sutures Monofilament Multifilament Synthetic Biological Absorbable Non - Absorbable
The Ideal Suture <ul><li>Minimal tissue reaction </li></ul><ul><li>Smoothness - minimum tissue drag </li></ul><ul><li>Low ...
Sutures <ul><li>MERSILK* Suture </li></ul><ul><li>MERSILENE* Suture </li></ul><ul><li>ETHIBOND* Suture </li></ul><ul><li>P...
Multifilament (braided) Suture Classification Monofilament
Absorbable Sutures <ul><li>PLAIN GUT : </li></ul><ul><li>Derived from the small intestine of healthy  sheep. </li></ul><ul...
<ul><li>Polyglycolic acid (Dexon ® ) </li></ul><ul><li>Braided </li></ul><ul><li>Low-memory </li></ul><ul><li>50% tensile ...
Polydioxanone (PDS ® ) <ul><li>Monofilament </li></ul><ul><li>50% tensile strength = 30+ days </li></ul><ul><li>Sites = ne...
Polyglycan 910 (Vicryl ® ) <ul><li>Braided, synthetic polymer </li></ul><ul><li>50% tensile strength for 30 days </li></ul...
Non-absorbable Sutures <ul><li>Nylon (Ethilon®) :  </li></ul><ul><li>non-absorbable suture </li></ul><ul><li>monofilament ...
Non-absorbable Sutures <ul><li>Polypropylene (Prolene®) :   </li></ul><ul><li>stronge r than nylon and has better overall ...
silk <ul><li>braided  </li></ul><ul><li>Before the advent of synthetic fibers, silk was the mainstay of  wound closure . <...
Monofilament <ul><li>Advantages </li></ul><ul><li>Smooth surface </li></ul><ul><li>Less tissue trauma </li></ul><ul><li>No...
Multifilament <ul><li>Advantages </li></ul><ul><li>Strength </li></ul><ul><li>Soft & pliable </li></ul><ul><li>Good handli...
Synthetic <ul><li>Advantages </li></ul><ul><li>Non-Absorbables are inert </li></ul><ul><li>Absorbables resemble natural su...
Biological <ul><li>Advantages </li></ul><ul><li>Handling & knotting </li></ul><ul><li>Economy </li></ul><ul><li>Disadvanta...
Characteristics of Non-Absorbable Sutures <ul><li>Permanent </li></ul><ul><li>Only used when long term support is required...
Absorbable <ul><li>Advantages </li></ul><ul><li>Broken down by body </li></ul><ul><li>No foreign body left </li></ul><ul><...
Non - Absorbable <ul><li>Advantages </li></ul><ul><li>Permanent wound Support </li></ul><ul><li>Disadvantages </li></ul><u...
Suture Size 5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0 Thick Thin USP (United States Pharmacopoe...
Volume  % Reduction  With  Decreasing  Size <ul><li>2/0 </li></ul><ul><li>3/0 </li></ul><ul><li>4/0 </li></ul><ul><li>5/0 ...
Absorbable Sutures <ul><li>VICRYL *  </li></ul><ul><li>MONOCRYL * </li></ul><ul><li>Coated VICRYL* </li></ul><ul><li>Coate...
Suture Selection Bowel: 2/0 - 3/0 Fascia: 1 - 0 Skin: 2/0 - 5/0 Arteries: 2/0 - 8/0 Micro surgery 9/0 - 10/0 Corneal closu...
Needles
Anatomy of a Surgical Needle
Needle point Geometry Taper-Point <ul><li>Suited to soft tissue </li></ul><ul><li>Dilates rather than cuts </li></ul>Rever...
Needle Shapes <ul><li>Eye </li></ul><ul><li>Microsurgery </li></ul><ul><li>Dura </li></ul><ul><li>Eye </li></ul><ul><li>Fa...
Use of Needle Holders <ul><li>Loading Needle </li></ul><ul><li>Needle passing through skin </li></ul>
Staples, Adhesives & Tape <ul><li>Staples </li></ul><ul><ul><li>Quick, poor aesthetic result </li></ul></ul><ul><li>Adhesi...
Suture Label
The Suture Packaging STRAND SIZE MATERIAL STRAND LENGTH PRODUCT CODE NEEDLE CODE WITH LIFE SIZE PICTURE OF NEEDLE NEEDLE L...
Suture Techniques <ul><li>Simple Interrupted </li></ul><ul><ul><li>Used on majority of wounds </li></ul></ul><ul><ul><li>E...
Suture Techniques <ul><li>Simple Continuous </li></ul><ul><ul><li>Useful in pediatrics </li></ul></ul><ul><ul><ul><li>Rapi...
 
Horizontal Mattress
Horizontal Mattress Good for closing wound edges under high tension, And for hemostasis.
Simple, Interrupted
 
Suture Techniques <ul><li>Vertical Mattress </li></ul><ul><ul><li>Useful for everting skin edges </li></ul></ul><ul><ul><l...
Vertical Mattress Good for everting wound edges  (neck, forehead creases, concave surfaces)
 
Vertical Mattress
Suture Techniques <ul><li>Purse-string </li></ul><ul><ul><li>Useful for stellate lacerations </li></ul></ul>
 
 
Closure using Clips
<ul><li>Suture removal </li></ul><ul><ul><li>face: 3-4 days </li></ul></ul><ul><ul><li>scalp: 5 days </li></ul></ul><ul><u...
Thanks for your attention !!!
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last 2 tutorial's of general surgery by dr.abdulwa7id 'suturing'

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Suture

  1. 1. Suture
  2. 2. HISTORY The origins of surgery can be traced back many centuries. Through the ages, practitioners have used a wide range of materials and techniques for closing tissue…….. 1650 BC – 2000’s AD
  3. 3. In the tenth century BC, the ant was held over the wound until it seized the wound edges in its jaws. It was then decapitated and the ant's death grip kept the wound closed. Ants
  4. 4. Thorns The thorn, used by African tribes to close tissue, was passed through the skin on either side of the wound. A strip of vegetable fibre was then wound around the edge in a figure eight.
  5. 5. Sterilised Catgut The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading through the eye of the needle before use.
  6. 6. Swaged On Needles Post World War II brought the swaged-on needle. The thread fits into the hollow end of the needle, allowing it to pass through tissue without the double loop of thread that exists with a conventional needle, reducing tissue trauma.
  7. 7. Suture Classification and Selection
  8. 8. Practice Time!
  9. 9. Classification of Sutures Monofilament Multifilament Synthetic Biological Absorbable Non - Absorbable
  10. 10. The Ideal Suture <ul><li>Minimal tissue reaction </li></ul><ul><li>Smoothness - minimum tissue drag </li></ul><ul><li>Low Capillarity </li></ul><ul><li>Max tensile strength </li></ul><ul><li>Ease of handling - Minimum memory </li></ul><ul><li>Knot security </li></ul><ul><li>Cost effectiveness </li></ul>
  11. 11. Sutures <ul><li>MERSILK* Suture </li></ul><ul><li>MERSILENE* Suture </li></ul><ul><li>ETHIBOND* Suture </li></ul><ul><li>PROLENE* Suture </li></ul><ul><li>PRONOVA* Suture </li></ul><ul><li>ETHILON* Suture </li></ul><ul><li>NUROLON* Suture </li></ul><ul><li>Stainless Steel Wire </li></ul><ul><li>Coated VICRYL* Suture </li></ul><ul><li>PDS*II Suture </li></ul><ul><li>VICRYL* rapide Suture </li></ul><ul><li>Monofilament version VICRYL* Suture available for use in ophthalmic surgery </li></ul><ul><li>MERSILENE* Suture - trochanter suture is braided </li></ul><ul><li>ABSORBABLE </li></ul><ul><li>NON-ABSORBABLE </li></ul><ul><li>MONOCRYL* Suture </li></ul><ul><li>Coated VICRYL* Plus Suture </li></ul><ul><li>BIOLOGICAL </li></ul><ul><li>BIOLOGICAL </li></ul><ul><li>SYNTHETIC </li></ul><ul><li>SYNTHETIC </li></ul>
  12. 12. Multifilament (braided) Suture Classification Monofilament
  13. 13. Absorbable Sutures <ul><li>PLAIN GUT : </li></ul><ul><li>Derived from the small intestine of healthy sheep. </li></ul><ul><li>Loses 50% of tensile strength by 5-7 days. </li></ul><ul><li>Used on mucosal surfaces. </li></ul><ul><li>CHROMIC GUT : </li></ul><ul><li>Treated with chromic acid to delay tissue absorption time. </li></ul><ul><li>50% tensile strength by 10-14 days. </li></ul><ul><li>Used in episiotomy repairs. </li></ul>
  14. 14. <ul><li>Polyglycolic acid (Dexon ® ) </li></ul><ul><li>Braided </li></ul><ul><li>Low-memory </li></ul><ul><li>50% tensile strength = 25 days </li></ul><ul><li>Sites = subcutaneous closure skin </li></ul>
  15. 15. Polydioxanone (PDS ® ) <ul><li>Monofilament </li></ul><ul><li>50% tensile strength = 30+ days </li></ul><ul><li>Sites = need for prolonged strength, </li></ul>
  16. 16. Polyglycan 910 (Vicryl ® ) <ul><li>Braided, synthetic polymer </li></ul><ul><li>50% tensile strength for 30 days </li></ul><ul><li>Used: subcutaneous </li></ul>
  17. 17. Non-absorbable Sutures <ul><li>Nylon (Ethilon®) : </li></ul><ul><li>non-absorbable suture </li></ul><ul><li>monofilament </li></ul><ul><li>surface closures.   </li></ul>
  18. 18. Non-absorbable Sutures <ul><li>Polypropylene (Prolene®) : </li></ul><ul><li>stronge r than nylon and has better overall wound security. </li></ul>
  19. 19. silk <ul><li>braided </li></ul><ul><li>Before the advent of synthetic fibers, silk was the mainstay of wound closure . </li></ul><ul><li>workable and has excellent knot security . </li></ul><ul><li>Disadvantages : </li></ul><ul><li>high reactivity </li></ul><ul><li>infection </li></ul>
  20. 20. Monofilament <ul><li>Advantages </li></ul><ul><li>Smooth surface </li></ul><ul><li>Less tissue trauma </li></ul><ul><li>No bacterial harbours </li></ul><ul><li>No capillarity </li></ul><ul><li>Disadvantages </li></ul><ul><li>Handling & knotting </li></ul><ul><li>Ends/knot burial </li></ul><ul><li>Stretch </li></ul>
  21. 21. Multifilament <ul><li>Advantages </li></ul><ul><li>Strength </li></ul><ul><li>Soft & pliable </li></ul><ul><li>Good handling </li></ul><ul><li>Good knotting </li></ul><ul><li>Disadvantages </li></ul><ul><li>Bacterial harbours </li></ul><ul><li>Capillary action </li></ul><ul><li>Tissue trauma </li></ul>
  22. 22. Synthetic <ul><li>Advantages </li></ul><ul><li>Non-Absorbables are inert </li></ul><ul><li>Absorbables resemble natural substances </li></ul><ul><li>Absorption by hydrolysis </li></ul><ul><li>Predictable absorption </li></ul><ul><li>Strength </li></ul><ul><li>Disadvantages </li></ul><ul><li>Monofilament handling </li></ul>
  23. 23. Biological <ul><li>Advantages </li></ul><ul><li>Handling & knotting </li></ul><ul><li>Economy </li></ul><ul><li>Disadvantages </li></ul><ul><li>Tissue reactions </li></ul>
  24. 24. Characteristics of Non-Absorbable Sutures <ul><li>Permanent </li></ul><ul><li>Only used when long term support is required </li></ul><ul><li>Removed when used for skin </li></ul><ul><li>Tissue reaction generally low (except silk) </li></ul><ul><li>True non-absorbable sutures include polyester, polyethylene, polypropylene and steel </li></ul>
  25. 25. Absorbable <ul><li>Advantages </li></ul><ul><li>Broken down by body </li></ul><ul><li>No foreign body left </li></ul><ul><li>Disadvantages </li></ul><ul><li>Consideration of wound support time </li></ul>
  26. 26. Non - Absorbable <ul><li>Advantages </li></ul><ul><li>Permanent wound Support </li></ul><ul><li>Disadvantages </li></ul><ul><li>Foreign body left </li></ul><ul><li>Suture removal can be costly and inconvenient </li></ul><ul><li>Sinus & Extrusion if left in place </li></ul>
  27. 27. Suture Size 5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0 Thick Thin USP (United States Pharmacopoeia) General
  28. 28. Volume % Reduction With Decreasing Size <ul><li>2/0 </li></ul><ul><li>3/0 </li></ul><ul><li>4/0 </li></ul><ul><li>5/0 </li></ul><ul><li>6/0 </li></ul><ul><li>7/0 </li></ul><ul><li>8/0 </li></ul><ul><li>2/0 </li></ul><ul><li>3/0 </li></ul><ul><li>4/0 </li></ul><ul><li>5/0 </li></ul><ul><li>6/0 </li></ul><ul><li>7/0 </li></ul><ul><li>8/0 </li></ul><ul><li>51% </li></ul><ul><li>40% </li></ul><ul><li>49% </li></ul><ul><li>54% </li></ul><ul><li>50% </li></ul><ul><li>44% </li></ul><ul><li>51% </li></ul><ul><li>40% </li></ul><ul><li>49% </li></ul><ul><li>54% </li></ul><ul><li>50% </li></ul><ul><li>44% </li></ul>
  29. 29. Absorbable Sutures <ul><li>VICRYL * </li></ul><ul><li>MONOCRYL * </li></ul><ul><li>Coated VICRYL* </li></ul><ul><li>Coated VICRYL* Plus Antibacterial Suture </li></ul><ul><li>PDS* II </li></ul><ul><li>Skin </li></ul><ul><li>Perineum </li></ul><ul><li>Oral </li></ul><ul><li>Lacerations </li></ul><ul><li>Traumatology </li></ul><ul><li>Ligaments </li></ul><ul><li>Fascia </li></ul><ul><li>Vessel anastomosis </li></ul><ul><li>10 days </li></ul><ul><li>By 42 days </li></ul><ul><li>Wound Support </li></ul><ul><li>Mass Absorption </li></ul><ul><li>Typical Uses </li></ul><ul><li>30 days </li></ul><ul><li>60 days </li></ul><ul><li>20 days </li></ul><ul><li>30 days </li></ul><ul><li>56 - 70 days </li></ul><ul><li>90 - 120 days </li></ul><ul><li>56 - 70 days </li></ul><ul><li>180 - 210 days </li></ul><ul><li>Ligature </li></ul><ul><li>General </li></ul><ul><li>Bowel </li></ul><ul><li>Orthopaedics </li></ul><ul><li>Ligature </li></ul><ul><li>General </li></ul><ul><li>Bowel </li></ul><ul><li>Ophthalmic </li></ul><ul><li>Mucosa </li></ul><ul><li>Obstetrics </li></ul><ul><li>Bowel </li></ul><ul><li>Skin& Ligature </li></ul>
  30. 30. Suture Selection Bowel: 2/0 - 3/0 Fascia: 1 - 0 Skin: 2/0 - 5/0 Arteries: 2/0 - 8/0 Micro surgery 9/0 - 10/0 Corneal closure: 9/0 - 10/0
  31. 31. Needles
  32. 32. Anatomy of a Surgical Needle
  33. 33. Needle point Geometry Taper-Point <ul><li>Suited to soft tissue </li></ul><ul><li>Dilates rather than cuts </li></ul>Reverse cutting <ul><li>Very sharp </li></ul><ul><li>Ideal for skin </li></ul><ul><li>Cuts rather than dilates </li></ul>Conventional Cutting <ul><li>Very sharp </li></ul><ul><li>Cuts rather than dilates </li></ul><ul><li>Creates weakness allowing suture tearout </li></ul>Taper-cutting <ul><li>Ideal in tough or calcified tissues </li></ul><ul><li>Mainly used in Cardiac & Vascular procedures. </li></ul>
  34. 34. Needle Shapes <ul><li>Eye </li></ul><ul><li>Microsurgery </li></ul><ul><li>Dura </li></ul><ul><li>Eye </li></ul><ul><li>Fascia </li></ul><ul><li>Nerve </li></ul><ul><li>Muscle </li></ul><ul><li>Eye </li></ul><ul><li>Skin </li></ul><ul><li>Peritoneum </li></ul><ul><li>Cardiovascular </li></ul><ul><li>Oral </li></ul><ul><li>Pelvis </li></ul><ul><li>Urogenital tract </li></ul><ul><li>Nasal cavity </li></ul><ul><li>Nerve </li></ul><ul><li>Skin </li></ul><ul><li>Tendon </li></ul><ul><li>Eye (Anterior </li></ul><ul><li>segment) </li></ul><ul><li>Laparoscopy </li></ul>
  35. 35. Use of Needle Holders <ul><li>Loading Needle </li></ul><ul><li>Needle passing through skin </li></ul>
  36. 36. Staples, Adhesives & Tape <ul><li>Staples </li></ul><ul><ul><li>Quick, poor aesthetic result </li></ul></ul><ul><li>Adhesives </li></ul><ul><ul><li>Dermabond- painless, petroleum dissolves </li></ul></ul><ul><li>Tape </li></ul><ul><ul><li>Steri-strips </li></ul></ul>
  37. 37. Suture Label
  38. 38. The Suture Packaging STRAND SIZE MATERIAL STRAND LENGTH PRODUCT CODE NEEDLE CODE WITH LIFE SIZE PICTURE OF NEEDLE NEEDLE LENGTH COLOUR POINT TYPE NEEDLE CIRCLE
  39. 39. Suture Techniques <ul><li>Simple Interrupted </li></ul><ul><ul><li>Used on majority of wounds </li></ul></ul><ul><ul><li>Each stitch is independent </li></ul></ul>
  40. 40. Suture Techniques <ul><li>Simple Continuous </li></ul><ul><ul><li>Useful in pediatrics </li></ul></ul><ul><ul><ul><li>Rapid </li></ul></ul></ul><ul><ul><ul><li>Easy removal </li></ul></ul></ul><ul><ul><li>Provides effective hemostasis </li></ul></ul><ul><ul><li>Distributed tension evenly along length </li></ul></ul><ul><ul><li>Can also be locked with each stitch </li></ul></ul>
  41. 42. Horizontal Mattress
  42. 43. Horizontal Mattress Good for closing wound edges under high tension, And for hemostasis.
  43. 44. Simple, Interrupted
  44. 46. Suture Techniques <ul><li>Vertical Mattress </li></ul><ul><ul><li>Useful for everting skin edges </li></ul></ul><ul><ul><li>“ Far-far-near-near” </li></ul></ul>
  45. 47. Vertical Mattress Good for everting wound edges (neck, forehead creases, concave surfaces)
  46. 49. Vertical Mattress
  47. 50. Suture Techniques <ul><li>Purse-string </li></ul><ul><ul><li>Useful for stellate lacerations </li></ul></ul>
  48. 53. Closure using Clips
  49. 54. <ul><li>Suture removal </li></ul><ul><ul><li>face: 3-4 days </li></ul></ul><ul><ul><li>scalp: 5 days </li></ul></ul><ul><ul><li>trunk: 7 days </li></ul></ul><ul><ul><li>arm or leg: 7-10 days </li></ul></ul><ul><ul><li>foot: 10-14 days </li></ul></ul>
  50. 55. Thanks for your attention !!!
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