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Suturing Basics

Suturing Basics. TOPICS. Sutures Knots Wounds (classification & healing) Wound Closure Postoperative Wound Care Local Anaesthetics Surgical Instruments Scrubbing Obtaining Haemostasis Skin Flaps. Suture Material. 3 ways of classifying suture material: Natural or Synthetic

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Suturing Basics

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  1. Suturing Basics

  2. TOPICS • Sutures • Knots • Wounds (classification & healing) • Wound Closure • Postoperative Wound Care • Local Anaesthetics • Surgical Instruments • Scrubbing • Obtaining Haemostasis • Skin Flaps

  3. Suture Material • 3 ways of classifying suture material: • Naturalor Synthetic • Absorbable orNon-Absorbable • MonofilamentorBraided/Twisted

  4. Silk Catgut • Natural • Silk, linen, catgut • Synthetic polymer • Polypropylene, polyester, polyamide Polypropylene Polyester

  5. Absorbable • catgut, polydioxanone, polyglycolic acid • Used for deep tissues, membranes, & subcuticular skin closure • Non-Absorbable • polyester, nylon, stainless steel • Used for skin (removed) & some deep structures (tendons, vessels, nerve repairs – not removed)

  6. Monofilament • Polypropylene • Polydioxanone • Nylon • Multifilament • Catgut (twisted) • Polyester • Silk (braided)

  7. HOW DOES THE SUTURE MATERIAL AFFECT THE SECURITY OF THE SUTURE-KNOT? • The security of any tied suture is improved by the use of certain patterns & the friction between threads. • Friction factor is affected by size of contact area between threads, tightness of tying, & suture material used. • How many knots ???

  8. So what type should I use? • The most commonly used suture materials for interrupted & exposed skin sutures are nylon & polyprolene. • Sutures that are buried, or run in the skin (eg. subcuticular suture), may use either nonabsorbable, or absorbable materials.

  9. Surgical Needle • Curvature * Most common, general use in all tissues • ¼ • 3/8 * • ½ * • 5/8 • J-shaped

  10. Using needle holder, grasp needle about 2/3rds of the way back from point.

  11. Needle Holder • Remember!!! Thumb & ring finger into needle holder’s rings (NOT your middle finger!)

  12. X NOT YOUR MIDDLE FINGER!!!

  13. Index finger stabilizes the instrument by resting on the shaft.

  14. Surgical Scissors

  15. Cutting Skin Sutures • With skin sutures, leave 3-4mm tail. • Tail = amount of suture left above knot • Tail is left because it helps prevent loosening or undoing of sutures. • REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!!

  16. Cutting Deep Sutures • Buried sutures are left within the body. • Cut the suture on the knot, leaving no tail behind. • REMEMBER: Always ask the surgeon the desired length of suture tail before cutting!!

  17. FORCEPS • Grasp forceps between thumb & middle finger, while index finger is used for stabilization. • If possible, use forceps to grasp dermis, rather than epidermis or skin surface itself. This helps prevent marking & injuring of skin at wound edge.

  18. SIMPLE INTERRUPTED suture

  19. VERTICAL MATTRESSsuture

  20. VERTICAL MATTRESSsuture • This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin). • The 2nd ‘mini-suture’ • in the same line as the main suture • Needle is inserted to pick up just the skin (epidermis & dermis) of both wound edges. • ensures eversion of the skin edges

  21. This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin). Simple Interruptedvs.Vertical Mattress

  22. How many knots? • With a braided material, such as silk, a 3rd throw (replicating the first) would be placed to secure the knot. • If a slippery monofilament material, such as nylon were being used, one would place 5 or 6 throws of alternating construction in order to minimize knot slippage.

  23. Important points to think about: • Tightly tied sutures can cause ischaemia & wound edge necrosis. Gentle but firm knots & minimal wound tension will minimize these factors. • Remember, keep skin edges everted, NOT inverted!

  24. When can I remove the sutures? • Face:3-4 days • Scalp:5 days • Trunk:7 days • Arm or leg:7-10 days • Foot:10-14 days

  25. Now you are ready to practice!

  26. Practice! Practice! Practice!

  27. KNOTS

  28. KNOT TYINGIs it really all that important? • A patient’s life may depend on the security of one ligature. Slippage of a tie may result in a life-threatening haemorrhage.

  29. Tying Knots • Square (reef) knot • Surgeon’s knot

  30. Square knot

  31. Surgeon’s knot

  32. What’s the difference between these 2 knots? • Square knot • Surgeon’s knot

  33. Granny knot

  34. The END

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