1. HealthcareHealthcare Wound Closure technic

2. HealthcareHealthcare Instrument 1.Scalpel 3.Dissecting Forceps 4.Needle Holder 5.Suture Needles 6.Sutures 2.Scissors

3. HealthcareHealthcare 1.SCALPEL A scalpel is a razor-edged blade on handle movie

4. HealthcareHealthcare Usage of scalpel - incision / relieve tension movie

5. HealthcareHealthcare A selection of blades *Most useful

6. HealthcareHealthcare Hold the Scalpel like a pen for maximum control An overhand grip leads to loss of control

7. HealthcareHealthcare Mounting and removing the blade movie

8. HealthcareHealthcare 2.SCISSORS Use them only cutting sutures, not tissue.

9. HealthcareHealthcare Scissor blades combines parallel slicing action with a shearing action. movie

10. HealthcareHealthcare Using scissors with your non-dominant hand reverses the direction of the normal shearing force.Unless you are aware of this and consciously correct it, the scissors will fail to cut precisely. movie

11. HealthcareHealthcare Control the scissors by using thumb and ring finger. If necessary steady the scissors further with your other hand. movie

12. HealthcareHealthcare If you are operating alone, it can be helpful to swivel the scissors round in your hand while suturing rater than putting them down between sutures. movie

13. HealthcareHealthcare Cutting with tips of the scissors only

14. HealthcareHealthcare 3.Dissecting Forceps Used for manipulating tissues and needles

15. HealthcareHealthcare The free tips must meet accurately. movie

16. HealthcareHealthcare Used to manipulate tissues for the instrument in the dominant hand to dissect, cut or suture. movie

17. HealthcareHealthcare It should be held like a pen, with your hand relaxed and in the midway position between full pronation and suspination.

18. HealthcareHealthcare Grasp the wound just deep to the edge, not actually on it. X X movie

19. HealthcareHealthcare 4.Needle Holder A needle-holder has short powerful jaws and long handles, each jaw has criss-cross lines cut it into improve the grip on a curved needle. movie

20. HealthcareHealthcare Ratchet mechanism-locking and releasing- Usually three notches movie

21. HealthcareHealthcare Positioning the needle

22. HealthcareHealthcare Handling the needle-holder X X movie

23. HealthcareHealthcare Grip Finger Grip Palm Grip movie

24. HealthcareHealthcare Beware of Artery forceps’ jaws

25. HealthcareHealthcare Beware of *Holding too near the tip *Holding too near the swaged end movie

26. HealthcareHealthcare Beware of *Grasping too near the tip

27. HealthcareHealthcare 5.Suture Needle Atraumatic Needle Traumatic Needle

28. HealthcareHealthcare Needle Curvatures

29. HealthcareHealthcare A range of lengths

30. HealthcareHealthcare The point of needle 1.Taper 2.Conventional Cutting 3. Reverse Cutting movie

31. HealthcareHealthcare 6.Sutures ORIGIN ORIGIN -NATURAL,SYNTHETIC -NATURAL,SYNTHETIC BEHAVIOR BEHAVIOR -ABSORBABLE,NON-ABSORBABLE -ABSORBABLE,NON-ABSORBABLE STRUCTURE STRUCTURE -MONO,MULTIFILAMENT -MONO,MULTIFILAMENT

32. HealthcareHealthcare Synthetic Absorbable

33. HealthcareHealthcare Synthetic NON-Absorbable

34. HealthcareHealthcare C/V Sutures

35. HealthcareHealthcare General Sutures and Others

36. HealthcareHealthcare Suture Size

37. HealthcareHealthcare Suturing Techniques 1.Making a linear incision 2.Inserting a suture 3.Tying a Knot 4.Interrupted wound closure 5.Continuous wound closure

38. HealthcareHealthcare 1.Making a linear incision Holding correctly Supporting the Skin

39. HealthcareHealthcare Correct scalpel angle movie

40. HealthcareHealthcare Avoid slanting sides inwardly and outwardly movie

41. HealthcareHealthcare Avoid Using the blade’s point Sawing Incision movie

42. HealthcareHealthcare 2.Inserting a suture Minimizing trauma -Consider its path as a circular that begins before the needle touches the skin and continues after leaving it. movie

43. HealthcareHealthcare -Inserting and Removing a needle along its curvature. movie

44. HealthcareHealthcare Ensure that the needle takes an adequate bite. Taking both sides with one bite Simple interrupted suture movie

45. HealthcareHealthcare Taking the first bite Supporting the emerging needle movie

46. HealthcareHealthcare Eversion produces good healing Correct suture tension movie

47. HealthcareHealthcare Avoid Poor healing from failure to evert movie

48. HealthcareHealthcare Avoid taking small superficial bites

49. HealthcareHealthcare 3.Tying a knot Tying a reef knot movie

50. HealthcareHealthcare Reef knot sequence movie

51. HealthcareHealthcare Practice movie

52. HealthcareHealthcare Techniques for additional security Additional twist in 1st throw Building a series of throws movie

53. HealthcareHealthcare Techniques for mono-synthetic sutures Tweaking the first throw movie

54. HealthcareHealthcare One handed tie movie

55. HealthcareHealthcare Avoid-Granny knot -Caused by failing to change the direction of throw in the 2 nd stage. movie

56. HealthcareHealthcare Avoid-Slip knot -Caused by failing to change the direction of pull in the 2 nd stage in spite of correctly changing the direction of throw. movie

57. HealthcareHealthcare 4.Interrupted wound closure 4-1.Simple interrupted closure movie

58. HealthcareHealthcare Sutures evenly spaced

59. HealthcareHealthcare If the wound is long or the sides unequal,use ‘progressive halving’. movie

60. HealthcareHealthcare Avoid Too close Irregular Too far

61. HealthcareHealthcare Avoid Taking the unequal bites Supporting the emerging needle movie

62. HealthcareHealthcare Avoid-Slanting sutures movie

63. HealthcareHealthcare Avoid-too superficial a bite movie

64. HealthcareHealthcare Avoid-Sutures too tight Recommended tightness movie

65. HealthcareHealthcare Avoid-Sutures too lose

66. HealthcareHealthcare Avoid-Too fine and coarse sutures X X

67. HealthcareHealthcare Avoid-Too long a loop of suture Correct length movie

68. HealthcareHealthcare 4-2.Mattress and Pulley sutures Vertical mattress Pulley sutures movie

69. HealthcareHealthcare Removing sutures *most areas: 7-10days *facial sutures: 5days *back/legs: 10-12days *most areas: 7-10days *facial sutures: 5days *back/legs: 10-12days movie

70. HealthcareHealthcare To relieve tension(sometimes) movie

71. HealthcareHealthcare 5.Continuous wound closure Sequence movie

72. HealthcareHealthcare Inserting the suture Step1-identify the subcuticular plane Step2-Guide the needle in through the skin movie

73. HealthcareHealthcare Step3-Grasp free end of the suture with artery forceps Step4-Hold the needle holder,take a bite in the subcuticular plane movie

74. HealthcareHealthcare Completing the suture Step1-Leave the suture loose as your closure progresses Step2-Gently pull the ends of the suture movie

75. HealthcareHealthcare Step3-Cut off the needle and position the suture ends next to the wound movie

76. HealthcareHealthcare Avoid-Buttonholing and bunching up movie

77. HealthcareHealthcare Avoid-Leaving too wide a space movie

78. HealthcareHealthcare Avoid-Too shallow bite Correct technique movie

79. HealthcareHealthcare Avoid-Suture in the wrong layer Correct layer movie

80. HealthcareHealthcare THE END