Presentation is loading. Please wait.

Presentation is loading. Please wait.

Sutures Tim Brandys MD FRCSC. Objectives At the end of this teaching session the student will recognize the following: 1. The importance of suture needle.

Similar presentations


Presentation on theme: "Sutures Tim Brandys MD FRCSC. Objectives At the end of this teaching session the student will recognize the following: 1. The importance of suture needle."— Presentation transcript:

1 Sutures Tim Brandys MD FRCSC

2 Objectives At the end of this teaching session the student will recognize the following: 1. The importance of suture needle design for performance of different tasks. 2. The importance of differences in suture material for different tasks. The student will demonstrate the ability to make appropriate needle and suture material selections for different tasks.

3 Sutures Why do we care ? Why do we care ?

4 Purpose of Suturing Close the wound and provide Close the wound and provide exogenous support of wound during healing. exogenous support of wound during healing.

5 Wound Healing How long does it take ? How long does it take ? Healing: Healing: week 1 week 1 wound tensile strength 15-20% wound tensile strength 15-20% week 12 week 12 - 80% - 80%

6 Everything you wanted to know about sutures but were afraid to ask!

7 History Earliest reports of Suture date back the Ancient Egyptians in 3000 BC Oldest Known Suture was found in a Mummy from 1100 BC First detailed Description of wound sutures is from the Indian sage Sushruta in 500 BC Early Suture materials included :fibers from plants (Flax,Hemp,Cotton) or Animal products (hair,tendon,gut)

8 History

9 Lister –routine sterilization of sutures in the late 1800’s 1930’S and 1950’s synthetic sutures (polyesters,polyglycolic acid) Silk and gut sutures are the only remnants of ancient sutures still in use today

10 The Basics

11 Different needles –Different Uses

12

13 Needle Anatomy Point Point Body Body Swage Swage

14 Needle types Taper Taper atraumatic passes through tissue by stretching it. atraumatic passes through tissue by stretching it. Vascular,bowel,liver,etc Cutting Cutting –Conventional cutting –Reverse Cutting –Traumatic –Dense tissues skin,fascia Conventional Cutting Reverse Cutting Spatula Point Taper point

15 Needle Curvature 3/8 Circle 3/8 Circle ½ circle ½ circle Straight needle Straight needle

16 Suture Material What,When,Why and Where do use different suture material ?

17 The BASICS

18 Suture Characteristics Size: Diameter size indicated by number of zeros Diameter size indicated by number of zeros Example :7/0 small, number 2 large Example :7/0 small, number 2 large

19 Suture Characteristics Tensile Strength: Tensile Strength: Weight required to break divided by cross sectional area (not same as absorption time) Weight required to break divided by cross sectional area (not same as absorption time) Strength Matters

20 Suture Characteristics Memory Memory Ability suture to regain original form after tying a knot Ability suture to regain original form after tying a knotElasticity Ability to regain original form after stretch. Ability to regain original form after stretch.

21 Suture Characteristics Suture Characteristics Natural /Synthetic Natural /Synthetic Monofilament/Multifil ament Monofilament/Multifil ament Absorbable/Non absorbable Absorbable/Non absorbable

22 Natural vs. Synthetic Natural Max Reactivity Natural Max Reactivity –Gut –Silk Synthetic Braided Synthetic Braided –Polysorb*/Vicryl –Dexon*II/S Synthetic monofilaments Synthetic monofilaments –Biosyn*/Monocryl –Maxon*/PDS Reactivity - Minimum Reactivity - Minimum

23 Monofilament One strand Superior tissue passage Reduced knot security Smooth surface Stiffer material

24 Multifilament Multiple strands, braids Multiple strands, braids coatings coatings Surface interstices - capillarity Surface interstices - capillarity Difficult tissue passage Difficult tissue passage Superior knot security Superior knot security Supple strand Supple strand

25 Absorbable/Non absorbable Absorbable –dissolves Absorbable –dissolves Non absorbable- permanentNon absorbable- permanent

26 Absorbable Plain Gut Plain Gut Strength 7 days Strength 7 days absorption 60 days absorption 60 days Chromic Gut Chromic Gut Strength 14 days Strength 14 days absorption 90 days absorption 90 days

27 Absorbable Vicryl/Polysorb Vicryl/Polysorb Strength 28 days Strength 28 days Absorption 56-90 days Absorption 56-90 days

28 Absorbable Biosyn/Monocryl Biosyn/Monocryl Strength 21 days Strength 21 days Absorption 100 days Absorption 100 days

29 Absorbale Maxon/PDS 11 Maxon/PDS 11 Strength 42 days Strength 42 days Absorption 180 days Absorption 180 days

30 Nonabsorbable Silk Silk Nylon (Monosof) Nylon (Monosof) Ticron Ticron Prolene (Surgipro) Prolene (Surgipro)

31 Suture Selection Suture & Needle selection depends on tissue type,tension exerted on wound and wound location. Suture & Needle selection depends on tissue type,tension exerted on wound and wound location.

32 Suture Selection Site of operation Site of operation Healing ability of tissues Healing ability of tissues Condition of the patient Condition of the patient Risk of infection Risk of infection Post-operatives conditions Post-operatives conditions

33 What sutures would you choose and why? Closure of abdominal wall fascia Closure of abdominal wall fascia Liagation of a blood vessel Liagation of a blood vessel Closure of oral mucosa Closure of oral mucosa Subcuticular skin closure Subcuticular skin closure

34

35 Suture ?

36 Suture?

37

38

39

40


Download ppt "Sutures Tim Brandys MD FRCSC. Objectives At the end of this teaching session the student will recognize the following: 1. The importance of suture needle."

Similar presentations


Ads by Google