Suture and ligature

Views:
 
Category: Entertainment
     
 

Presentation Description

aimst

Comments

Presentation Transcript

PowerPoint Presentation:

AMIST UNIVERSITY

PowerPoint Presentation:

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 HISTORY

PowerPoint Presentation:

Ants 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

PowerPoint Presentation:

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 fiber was then wound around the edge in a figure eight.

PowerPoint Presentation:

Sterilized Catgut The tough membrane of sheep intestine was provided to the surgeon pre-sterilized and required threading through the eye of the needle before use.

PowerPoint Presentation:

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 .

PowerPoint Presentation:

The Ideal Suture Minimal tissue reaction Smoothness -minimum tissue drag Low Capillarity Max tensile strength Ease of handling -Minimum memory Knot security Consistency of performance Predictable performance Cost effectiveness

PowerPoint Presentation:

SUTURE MATERIAL Natural or Synthetic Absorbable or Non-Absorbable Monofilament or Braided/Twisted 3 ways of classifying suture material :

PowerPoint Presentation:

Natural Silk, linen, catgut Synthetic polymer Polypropylene, polyester, polyamide Silk Polypropylene polyester catgut

PowerPoint Presentation:

Absorbable catgut, polydioxanone, polyglycolic acid Used for deep tissues, membranes, & subcuticular skin closure polydioxanone catgut polyglycolic acid

PowerPoint Presentation:

Non-Absorbable polyester, nylon, stainless steel Used for skin ( removed ) & some deep structures (tendons, vessels, nerve repairs – not removed ) polyester nylon stainless steel

PowerPoint Presentation:

Monofilament Polypropylene Polydioxanone Nylon polydioxanone Polypropylene nylon

PowerPoint Presentation:

Multifilament Catgut (twisted) Polyester Silk (braided)

PowerPoint Presentation:

Suture Classification Monofilament Multifilament (braided)

PowerPoint Presentation:

Braided vs Monofilament Braided Monofilament Has capillary action No capillary action Increased infection risk Less infection risk Less smooth passage Smooth tissue passage Less tensile strength Higher tensile strength Better handling Has memory Better knot security More throws required

PowerPoint Presentation:

These are absorbed within the living tissue Two main characteristics are: Tensile strength Retention Absorption rate Absorbable Sutures Maxon : Day 14: 75% Absorption: 180 days Caprosyn : Day 10: 30% Absorption: 56 days

PowerPoint Presentation:

ETHICON SUTURES Monofilament version VICRYL* Suture available for use in ophthalmic surgery MERSILENE* Suture -trochanter suture is braided

PowerPoint Presentation:

ETHICON ABSORBABLESUTURES

PowerPoint Presentation:

ABSORBABLESUTURES

PowerPoint Presentation:

CHARACTERISTICS OF NON-ABSORBABLE SUTURES Permanent Only used when long term support is required Removed when used for skin (e.g. in A+E) Tissue reaction generally low (except silk) However silk, linen and even nylon will lose tensile strength over a period of time True non-absorbable sutures include polyester, polyethylene, polybutester, polypropylene and steel

PowerPoint Presentation:

Suture Selection Bowel: 2/0 -3/0 Fascia: 1 -0 Ligatures: 0 -3/0 Pedicles: 2 -0 Skin: 2/0 -5/0 Arteries: 2/0 -8/0 Micro surgery 9/0 -10/0 Corneal closure: 9/0 -10/0

PowerPoint Presentation:

SUTURE HANDLING Package Memory Grasp strand close to needle and at end of strand and gently stretch Opening suture foil Tear in direction indicated to gain best needle exposure Arming needle Arm needles 2/3rdsdistance between tip and swage

PowerPoint Presentation:

Needles ANATOMY OF A SURGICAL NEEDLE There are three parts to a suture needles: 1. swage (connection point for the suture) 2. the body 3. point All needles are made of stainless steel

PowerPoint Presentation:

NEEDLE POINT GEOMETRY

PowerPoint Presentation:

Needle Curvature

PowerPoint Presentation:

Needles are made of steel alloy ( Surgalloy ) with a Nucoat coating so they stay sharp for multiple passes through tissue Different needle points for different tissues Choose the needle that will cause the least trauma SUMMARY OF NEEDLES

PowerPoint Presentation:

USING NEEDLE HOLDER GRASP NEEDLE ABOUT 2/3 rds OF THE WAY BACK FROM POINT.

PowerPoint Presentation:

USE OF NEEDLE HOLDERS

PowerPoint Presentation:

NEEDLE HOLDER Remember!!!Thumb & ring finger into needle holder’s rings (NOT your middle finger!)

PowerPoint Presentation:

SUTURE PACKAGING

PowerPoint Presentation:

INDEX FINGER STABILIZES THE INSTRUMENT BY RESTING ON THE SHAFT.

PowerPoint Presentation:

CUTTING SKIN SUTURES With skin sutures, leave 3-4mm tail. Tail = amount of suture left above knot Tail is left because it helps prevent loosening or undoing of sutures. REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!!

PowerPoint Presentation:

Buried sutures are left within the body. Cut the suture on the knot, leaving no tail behind. REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!! CUTTING DEEP SUTURES

PowerPoint Presentation:

With a braidedmaterial , such as silk, a 3rdthrow (replicating the first) would be placed to secure the knot. If a slippery monofilamentmaterial , such as nylonwere being used, one would place 5 or 6 throws of alternating construction in order to minimize knot slippage. KNOTS

PowerPoint Presentation:

Face:3-4days Scalp:5days Trunk:7days Armor leg:7-10days Foot:10-14days WHEN CAN I REMOVE THE SUTURES?

PowerPoint Presentation:

Thank you

authorStream Live Help