Suture, Needles, Staplers, Wound Closure Techniques, & Wound Closure Devices

1. Suture, Needles, Staplers, Wound Closure Techniques, & Wound Closure Devices ST230 Concorde Career College

2. Objectives • Define the term suture as a noun and as a verb. • List the specifications for suture material and describe the importance of each. • Describe the suture selection process.

3. Objectives • List and describe the ideal characteristics for suture material and surgical needles. • Identify the types and sizes of suture material, provide examples of each, and describe the type of tissue usage appropriate for each type.

4. Objectives • Identify the types and sizes of surgical needles, provide examples of each, and describe the type of tissue usage appropriate for each type. • Describe suture packaging, list the information found on the suture package, and explain its importance.

5. Objectives • Identify types of stapling and ligating devices and provide examples of when each may be utilized.

6. Objectives • Identify types of alternative wound closure materials, tissue adhesives, and tissue repair and replacement materials and provide examples of when each may be utilized.

7. Definition Suture Noun

8. Definition Suture Verb (It’s what you do…)

9. Brief Suture History • 3000 BCE - Linen strips and animal sinew (tendon) were used to close wounds with needles made of bone • 600 BCE - Cotton, leather, horsehair, and bark fiber from trees was used to close wounds

10. Brief Suture History • Lister (late 1800s) was the first to use a bacteriocide (carbolic acid) on suture • Suture manufacture and sterilization started in the early 20th Century • First synthetic absorbable suture was produced in the 1960s

11. Brief Suture History Sinew (wolverine)

12. Brief Suture History Suture Needle (buffalo bone)

13. Specifications for Suture Material • Must be sterile and sterile technique must be used when handling • Uniform tensile strength • Uniform size • Appropriate diameter for tissue type • Provide knot security • Cause minimal foreign body tissue reaction

14. Suture Selection • Characteristics of the suture material • Age • Weight • Allergy status • General tissue condition • Surgical site disease • Comorbid condition(s) • Surgeon preference • Suture availability • Cost • Mentor influence

15. Ideal Suture Characteristics • Pliable • Easy to tie secure knots • Tensile strength (will not fray or break) • Glide through tissue effortlessly • Inert • Nonallergenic • Inexpensive

16. Tensile Strength Tensile strength of absorbable and non-absorbable sutures is critical both during and after surgical procedures. Breaking strength and elongation can be measured using either a "straight pull" test or a "knot pull" test.

17. Types of Suture Material • Natural • Absorbable • Monofilament • Synthetic • Nonabsorbable • Multifilament

18. Types of Suture Material Natural Raw Silk Magnified 1300 X

19. Types of Suture Material Synthetic Nylon

20. Types of Suture Material Absorbable Plain

21. Types of Suture Material Nonabsorbable Silk

22. Types of Suture Material Monofilament

23. Types of Suture Material Multifilament Twisted

24. Types of Suture Material Multifilament Braided

25. Suture Packaging

26. Suture Sizes

27. Ideal Needle Characteristics • Stainless steel (corrosion resistant) • Slim without compromising strength • Stable in the needle holder • Carries suture through tissue with minimal tissue trauma • Sharp • Sterile • Inexpensive

28. Needle Eye Types • Open • Closed • Swaged • Swaged (CV)

29. Needle Sizes & Types

30. Needle Sizes & Types

31. Needle Sizes & Types Microsurgical suture with needle

32. Anatomy of a Needle • Eye • Point • Body • Shape • Chord Length

33. Needle Points • Taper – most internal tissues • Cutting – Skin and other tough tissues • Reverse Cutting – Tendon sheath, bone, cornea, other tough tissues • Blunt – Liver and other friable tissues

34. Commonly Used Needle Codes (Ethicon) • CP • CT • CTX • CV • FS • FSL • FSLX • KS • MO • SH • TF • OS • UR • PS • RB • S

35. Suture Handling Needle holder is clamped onto the needle approximately 1/3 the distance from the swage to the point

36. Suture Handling Suture is removed from the package placing tension on the swage

37. Suture Handling Needle holder correctly armed

38. Suture Handling Passing the armed needle holder

39. Suture Handling Rapid (control) Release Step 1

40. Suture Handling Rapid (control) Release Step 2

41. Simple Suture • Interrupted • Running (continuous)

42. Mattress Suture • Vertical • Horizontal

43. Suturing Techniques Retention Suture

44. Suturing Techniques Figure of Eight Suture

45. Suturing Techniques Tendon Suture (Connell’s Technique)

46. Tie Terms • Free-tie • Place a suture (no needle) into the surgeons hands • Stick-tie • Suture on a needle (use a needle holder) • Tie on a pass • Place the suture (no needle) on an instrument (tonsil/right angle) • Ligate • To tie

47. Stapling Devices

48. Skin Stapler Surgical Skin Stapler

49. Skin Staples - Shape

50. Skin Stapler Skin staples in place