USAGE AREAS OF SURGICAL SUTURES Katsan Katgüt San. Tic. A.Ş 1571 sokak No:22 Çınarlı/İZMİR- TÜRKİYE Tel: +90(232)4861185 Fax: +90(232)4863379 email: info@katsanas.com www.katsanas.com TRAINING PRESENTATION NO 4: EG4/REV00/130616

SCIENTIFIC CRITERIA FOR THE SELECTION OF SUTURE MATERIALS AND NEEDLES Suture material is used to keep wound together during healing process and to provide necessary support. Surgery technique, blood circulation, mechanical stress, suture material, stretching technique, infection and systemic effects are the main factors in the healing process. Main factors to be considered in the selection of suture material are type and strength of the tissue to be stitched, healing duration of tissue, characteristics of suture material and interaction between tissue and suture.

As a result of a clinical study conducted with 19 hospital and 699 surgeons in USA, it’s determined that suture preference is made according to subjective criteria and habits rather than scientific criteria. At the conclusion section of the study, importance of the suture preference based on scientific criteria is emphasized. This criteria can be listed as ; Tensile strength, Ease of passage through tissue, Knot security, Drag of tissue by suture, Short and long term reactions of tissue, Handling properties, Ease of use of use of suture, Packing property ensuring suture getting out of package with minimum memory.

SUTURE TYPES BASED ON THE FIELD OF SURGERY 1. GENERAL SURGERY SKIN PP , PA , PGCL LIGATION PGA , PGLA FASCIA PGA , PGLA , PDO ABDOMINAL CLOSURE 2. GASTROENTEROLOGY HERNIA PP STOMACH AND SMALL INTESTINE PGA , PGLA LARGE INTESTINE GALL BLADDER PERITON

SUTURE TYPES BASED ON THE FIELD OF SURGERY 3. CARDIAC SURGERY HEART VALVES PP CORONARY ARTERY 4. VASCULAR SURGERY BLOOD VESSELS PP 5. PLASTIC SURGERY SKIN PA , PP , PGA , PGLA , PGAR , PGLAR , PGCL

SUTURE TYPES BASED ON THE FIELD OF SURGERY 6. MICROSURGERY BLOOD VESSELS PA , PP NERVE PP 7. OPHTHALMOLOGY PA 8. DENTAL SURGERY PGAR , PGA , PGLA , PGLAR, SILK

SUTURE TYPES BASED ON THE FIELD OF SURGERY 9. UROLOGY KIDNEY PGA , PGLA , PDO URINARY TRACT PDO , PGA PHIMOSIS PGAR 10. GYNAECOLOGY VAGINA PGA , PGLA , PGAR , PGLAR 11. THORACIC SURGERY LUNG PGA , PGLA CHEST CLOSURE PDO

SUTURE TYPES BASED ON THE FIELD OF SURGERY 12. ORTHOPEDIC SURGERY TENDON PDO , PA , PP JOINT CAPSULE PDO SEMILUNAR CARTILAGES LIGAMENT ** They are the fields of surgery recommended by Katsan. It may vary depending on the existing conditions in the surgical intervention.

SELECTION OF SUTURE USP BASED ON THE FIELD OF SURGERY 12/0 – 7/0 = Microsurgery 6/0 = Face and blood vessels 5/0= Face, neck and blood vessels 4/0 = Mucosa, neck, hands, arms, legs, tendon, blood vessels 3/0 = arm, legs, body, intestine, blood vessel 2/0 = body, fascia, stomach, internal organs, blood vessel 0 – 1 = Abdominal Wall, strong fascia surfaces.   ** They are the fields of surgery recommended by Katsan. It may vary depending on the existing conditions in the surgical intervention.

TYPES OF NEEDLE BASED ON THE FIELD OF SURGERY ROUND NEEDLE Sharp end of the needle is round. Needle body is in the form of oval or rectangular. Usage areas: Gastrointestinal system, urogenital system, biliary system, periton, fascia, dura, nerve, muscle, myocardium, subcutaneous fat. CUTTING NEEDLE It has three cutting edges which one of them is on the concave edge.

TYPES OF NEEDLE BASED ON THE FIELD OF SURGERY REVERSE CUTTING NEEDLE It’s triangular such that has a third cutting edge in the convex curvature. This configuration provides stronger structure to needle. Usage areas: skin, fascia, ligament, tendon, nasal cavity, pharynx, oral cavity. TAPER CUT Combination of round and reverse cutting needles. Three cutting edges start from the 0.8 mm behind the round point. Usage areas: Calcified tissues, bronchia, trachea, nasal and oral cavity, fascia, periosteum, perichondrium, uterus, ovary, tendon, ligament.

TYPES OF NEEDLE BASED ON THE FIELD OF SURGERY BLUNT NEEDLE Used for parenchymatic tissues. Round body, blunt point. Usage areas: fascia, paranchymatic tissue, intestine, kidney, liver, spleen, cervix tying. SPATULA Needle has straight body and lateral cutting edges. They are needles that have cutting ends only on two edges. Edges are in the form of trapezoid, narrow side looks to convex and large side looks to concave side. Generally used in ophthalmic surgery and microsurgery.

FORMS OF NEEDLE BASED ON THE FIELD OF SURGERY 1/4: Ophthalmic and microsurgery.

FORMS OF NEEDLE BASED ON THE FIELD OF SURGERY 3/8: Generally used in all tissues. Skin stitches, eye, fascia, nerve, vessels, dura, gastrointestinal system, periosteum, muscle, myocardium, genitourinary system, tendon and pleura stitches.

FORMS OF NEEDLE BASED ON THE FIELD OF SURGERY 1/2: Generally used in all tissues. Eye, muscle, biliary system, gastrointestinal system, genitourinary system, respiratory system, skin, mouth and nasal cavity, pharynx and periton stitches.

FORMS OF NEEDLE BASED ON THE FIELD OF SURGERY Straight: General use. Skin stitches, gastrointestinal system, oral and nasal cavity, pharynx and tendon stitches.

FORMS OF NEEDLE BASED ON THE FIELD OF SURGERY 5/8: Cardiovascular surgery and cavities (oral, nasal, pelvis, umbilical)

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