1 / 36

Suturing Basics

Suturing Basics. TOPICS. Sutures Knots Wounds (classification & healing) Wound Closure Postoperative Wound Care Local Anaesthetics Surgical Instruments Scrubbing Obtaining Haemostasis Skin Flaps. Suture Material. 3 ways of classifying suture material: Natural or Synthetic

kramon
Télécharger la présentation

Suturing Basics

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Suturing Basics

  2. TOPICS • Sutures • Knots • Wounds (classification & healing) • Wound Closure • Postoperative Wound Care • Local Anaesthetics • Surgical Instruments • Scrubbing • Obtaining Haemostasis • Skin Flaps

  3. Suture Material • 3 ways of classifying suture material: • Naturalor Synthetic • Absorbable orNon-Absorbable • MonofilamentorBraided/Twisted

  4. Silk Catgut • Natural • Silk, linen, catgut • Synthetic polymer • Polypropylene, polyester, polyamide Polypropylene Polyester

  5. Absorbable • catgut, polydioxanone, polyglycolic acid • Used for deep tissues, membranes, & subcuticular skin closure • Non-Absorbable • polyester, nylon, stainless steel • Used for skin (removed) & some deep structures (tendons, vessels, nerve repairs – not removed)

  6. Monofilament • Polypropylene • Polydioxanone • Nylon • Multifilament • Catgut (twisted) • Polyester • Silk (braided)

  7. HOW DOES THE SUTURE MATERIAL AFFECT THE SECURITY OF THE SUTURE-KNOT? • The security of any tied suture is improved by the use of certain patterns & the friction between threads. • Friction factor is affected by size of contact area between threads, tightness of tying, & suture material used. • How many knots ???

  8. So what type should I use? • The most commonly used suture materials for interrupted & exposed skin sutures are nylon & polyprolene. • Sutures that are buried, or run in the skin (eg. subcuticular suture), may use either nonabsorbable, or absorbable materials.

  9. Surgical Needle • Curvature * Most common, general use in all tissues • ¼ • 3/8 * • ½ * • 5/8 • J-shaped

  10. Using needle holder, grasp needle about 2/3rds of the way back from point.

  11. Needle Holder • Remember!!! Thumb & ring finger into needle holder’s rings (NOT your middle finger!)

  12. X NOT YOUR MIDDLE FINGER!!!

  13. Index finger stabilizes the instrument by resting on the shaft.

  14. Surgical Scissors

  15. 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!!

  16. Cutting Deep Sutures • 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!!

  17. FORCEPS • Grasp forceps between thumb & middle finger, while index finger is used for stabilization. • If possible, use forceps to grasp dermis, rather than epidermis or skin surface itself. This helps prevent marking & injuring of skin at wound edge.

  18. SIMPLE INTERRUPTED suture

  19. VERTICAL MATTRESSsuture

  20. VERTICAL MATTRESSsuture • This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin). • The 2nd ‘mini-suture’ • in the same line as the main suture • Needle is inserted to pick up just the skin (epidermis & dermis) of both wound edges. • ensures eversion of the skin edges

  21. This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin). Simple Interruptedvs.Vertical Mattress

  22. How many knots? • With a braided material, such as silk, a 3rd throw (replicating the first) would be placed to secure the knot. • If a slippery monofilament material, such as nylon were being used, one would place 5 or 6 throws of alternating construction in order to minimize knot slippage.

  23. Important points to think about: • Tightly tied sutures can cause ischaemia & wound edge necrosis. Gentle but firm knots & minimal wound tension will minimize these factors. • Remember, keep skin edges everted, NOT inverted!

  24. When can I remove the sutures? • Face:3-4 days • Scalp:5 days • Trunk:7 days • Arm or leg:7-10 days • Foot:10-14 days

  25. Now you are ready to practice!

  26. Practice! Practice! Practice!

  27. KNOTS

  28. KNOT TYINGIs it really all that important? • A patient’s life may depend on the security of one ligature. Slippage of a tie may result in a life-threatening haemorrhage.

  29. Tying Knots • Square (reef) knot • Surgeon’s knot

  30. Square knot

  31. Surgeon’s knot

  32. What’s the difference between these 2 knots? • Square knot • Surgeon’s knot

  33. Granny knot

  34. The END

More Related