HealthcareHealthcare Wound Closure technic

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

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

HealthcareHealthcare Usage of scalpel - incision / relieve tension movie

HealthcareHealthcare A selection of blades *Most useful

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

HealthcareHealthcare Mounting and removing the blade movie

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

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

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

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

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

HealthcareHealthcare Cutting with tips of the scissors only

HealthcareHealthcare 3.Dissecting Forceps Used for manipulating tissues and needles

HealthcareHealthcare The free tips must meet accurately. movie

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

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

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

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

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

HealthcareHealthcare Positioning the needle

HealthcareHealthcare Handling the needle-holder X X movie

HealthcareHealthcare Grip Finger Grip Palm Grip movie

HealthcareHealthcare Beware of Artery forceps’ jaws

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

HealthcareHealthcare Beware of *Grasping too near the tip

HealthcareHealthcare 5.Suture Needle Atraumatic Needle Traumatic Needle

HealthcareHealthcare Needle Curvatures

HealthcareHealthcare A range of lengths

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

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

HealthcareHealthcare Synthetic Absorbable

HealthcareHealthcare Synthetic NON-Absorbable

HealthcareHealthcare C/V Sutures

HealthcareHealthcare General Sutures and Others

HealthcareHealthcare Suture Size

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

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

HealthcareHealthcare Correct scalpel angle movie

HealthcareHealthcare Avoid slanting sides inwardly and outwardly movie

HealthcareHealthcare Avoid Using the blade’s point Sawing Incision movie

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

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

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

HealthcareHealthcare Taking the first bite Supporting the emerging needle movie

HealthcareHealthcare Eversion produces good healing Correct suture tension movie

HealthcareHealthcare Avoid Poor healing from failure to evert movie

HealthcareHealthcare Avoid taking small superficial bites

HealthcareHealthcare 3.Tying a knot Tying a reef knot movie

HealthcareHealthcare Reef knot sequence movie

HealthcareHealthcare Practice movie

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

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

HealthcareHealthcare One handed tie movie

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

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

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

HealthcareHealthcare Sutures evenly spaced

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

HealthcareHealthcare Avoid Too close Irregular Too far

HealthcareHealthcare Avoid Taking the unequal bites Supporting the emerging needle movie

HealthcareHealthcare Avoid-Slanting sutures movie

HealthcareHealthcare Avoid-too superficial a bite movie

HealthcareHealthcare Avoid-Sutures too tight Recommended tightness movie

HealthcareHealthcare Avoid-Sutures too lose

HealthcareHealthcare Avoid-Too fine and coarse sutures X X

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

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

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

HealthcareHealthcare To relieve tension(sometimes) movie

HealthcareHealthcare 5.Continuous wound closure Sequence movie

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

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

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

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

HealthcareHealthcare Avoid-Buttonholing and bunching up movie

HealthcareHealthcare Avoid-Leaving too wide a space movie

HealthcareHealthcare Avoid-Too shallow bite Correct technique movie

HealthcareHealthcare Avoid-Suture in the wrong layer Correct layer movie

HealthcareHealthcare THE END