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Sutures & Drainage


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Sutures & Drainage

  1. 1. Sutures & Drainage
  2. 2. Sutures <ul><li>Suture material is a foreign body implanted into human tissues </li></ul><ul><li>During wound closure, a sterile field and meticulous aseptic technique are critical to minimize the risk of wound infection. </li></ul>
  3. 3. Ideal suture characteristics <ul><li>Sterile </li></ul><ul><li>All-purpose (composed of material that can be used in any surgical procedure) </li></ul><ul><li>Causes minimal tissue injury or tissue reaction </li></ul><ul><li>Holds securely when knotted </li></ul><ul><li>High tensile strength </li></ul><ul><li>Favorable absorption profile </li></ul><ul><li>Resistant to infection </li></ul>
  4. 4. TYPES of sutures <ul><li>The type of suture used varies on the operation, depending on the location and environment. </li></ul><ul><li>Absorbable-broken down in tissue depending on the material can be from ten days to eight weeks </li></ul><ul><li>Non-absorbable-are not metabolized by the body, and are used therefore either on skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in which absorbable sutures are not adequate </li></ul>
  5. 5. Absorbable sutures <ul><li>Natural- Prepared from beef and sheep intestine </li></ul><ul><li>Collagen </li></ul><ul><li>Surgical gut, plain </li></ul><ul><li>Surgical gut, fast-absorbing </li></ul><ul><li>Surgical gut, chromic </li></ul>
  6. 6. Absorbable sutures <ul><li>Synthetic- Chemical polymers are absorbed by hydrolysis and cause a lesser degree of tissue reaction. </li></ul><ul><li>Polyglactin 910 (Vicryl): </li></ul><ul><li>Poliglecaprone 25 (Monocryl): </li></ul><ul><li>Polydioxanone (PDS II): </li></ul>
  7. 7. Absorbable sutures <ul><li>Their uses are as follows. </li></ul><ul><li>Tying off small arteries and veins near the skin. </li></ul><ul><li>Stitches in the ureter, urinary tract, or biliary tract (where permanent sutures term a focus for stone formation). </li></ul><ul><li>Closing off tissue spaces, e.g. subcutaneous space. </li></ul><ul><li>Occasionally for closing the skin in children, where it is an advantage not to have to remove the stitches. </li></ul><ul><li>In small bowel anastomosis or stomach mucosal anastomosis </li></ul>
  8. 8. Non-absorbable sutures <ul><li>Natural </li></ul><ul><li>Surgical silk- Used for (1) repairing rapidly healing tissues that require minimal support, (2) ligating superficial blood vessels, and (3) suturing subcutaneous fatty tissue. </li></ul><ul><li>Surgical cotton- Same as silk </li></ul><ul><li>Surgical steel- Surgical steel suture is used primarily in orthopedic, neurosurgical, and thoracic applications. </li></ul>
  9. 9. Non-absorbable sutures <ul><li>Synthetic </li></ul><ul><li>Nylon - Stitching the skin, 2 Closure of the abdominal muscles, 3-Ophthalmology and microsurgery </li></ul><ul><li>Polybutester (Novofil)- Surface closure, permitting adequate tissue approximation while allowing for tissue edema and detumescence. </li></ul><ul><li>Polyester fiber (Dacron ):1-vessel anastomosis 2-placement of prosthetic materials. </li></ul><ul><li>Polypropylene (Prolene ): 1-Closure of the skin, particularly for subcuticular sutures.2-Arterial surgery 3-large bowel anastomosis and bile-duct surgery </li></ul>
  10. 10. Sizes of sutures <ul><li>Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). </li></ul><ul><li>Atraumatic needles are manufactured in all shapes for most sizes. </li></ul>
  11. 11. Suture techniques <ul><li>Common suture stitching techniques include: </li></ul><ul><li>Simple Interrupted Stitch </li></ul><ul><li>Running Stitch </li></ul><ul><li>Mattress </li></ul><ul><li>Horizontal mattress </li></ul><ul><li>Vertical mattress </li></ul><ul><li>Continuous locking </li></ul><ul><li>Subcuticular </li></ul>
  12. 12. Surgical techniques <ul><li>Continuous </li></ul><ul><li>Running stitch </li></ul>
  13. 13. Surgical techniques <ul><li>Simple interrupted </li></ul><ul><li>Subcuticular </li></ul>
  14. 14. Surgical techniques <ul><li>Mattress </li></ul>
  15. 15. Surgical needles <ul><li>Traumatic needles are needles with holes or eyes which are separate from their suture thread. </li></ul><ul><li>Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread. </li></ul>
  16. 16. Surgical needles <ul><li>There are several shapes of surgical needles, including: </li></ul><ul><li>straight </li></ul><ul><li>half curved or ski </li></ul><ul><li>1/4 circle </li></ul><ul><li>3/8 circle </li></ul><ul><li>1/2 circle </li></ul><ul><li>5/8 circle </li></ul><ul><li>compound curve </li></ul>
  17. 17. Surgical needles <ul><li>By their point geometry; examples include: </li></ul><ul><li>taper (needle body is round and tapers smoothly to a point) </li></ul><ul><li>cutting (needle body is triangular and has a sharpened cutting edge on the inside) </li></ul><ul><li>reverse cutting (cutting edge on the outside) </li></ul><ul><li>trocar point or tapercut (needle body is round and tapered, but ends in a sma </li></ul><ul><li>blunt points for sewing friable tissues </li></ul><ul><li>side cutting or spatula points </li></ul>
  18. 18. Needles
  19. 19. Other methods <ul><li>Tissue adhesives </li></ul><ul><li>Topical cyanoacrylate adhesives (&quot;liquid stitches&quot;) have been used in combination with, or as an alternative to, sutures in wound closure. </li></ul><ul><li>Surgical staples </li></ul><ul><li>Specialized surgery staples, which prove to be faster, consistent & accurate. Staple lines are less likely to leak blood, air or bowel contents. </li></ul>
  20. 20. Staples
  21. 21. Drainage <ul><li>A surgical drain is a tube used to remove pus, blood or other fluids from a wound. </li></ul><ul><li>Drains may be hooked to wall suction, a portable suction device, or they may be left to drain by gravity. </li></ul><ul><li>Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding. </li></ul>
  22. 22. Types of drains <ul><li>Jackson-Pratt drain </li></ul><ul><li>Penrose drain </li></ul><ul><li>Wound Vac System - Involves the use of enclosed foam and a suction device attached; often used for large surgical/trauma/non-healing wounds. </li></ul><ul><li>Redivac drain </li></ul><ul><li>Pigtail drain - has an exterior screw to release the internal &quot;pigtail&quot; before it can be removed </li></ul><ul><li>Davol </li></ul><ul><li>Chest tube </li></ul>
  23. 23. Complications of drainage <ul><li>Infection </li></ul><ul><li>Anastomotic leakage </li></ul><ul><li>Fistula formation </li></ul><ul><li>Bleeding </li></ul><ul><li>Erosion of adjacent tissue/vessels. </li></ul>
  24. 24. The End