Suture and Suturing-2550

7/30/2019 Suture and Suturing-2550

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SUTURE ANDSUTURE AND

SUTURINGSUTURING

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WoundWound

zzDefinitionDefinition : A bodily injury: A bodily injury causedcausedby physical means, with disruptionby physical means, with disruption

of the normal continuity ofof the normal continuity ofstructurestructure

zz Closed woundClosed wound

zz Open woundOpen wound


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Wound ClassificationWound Classification

zzClean wound : 1Clean wound : 1 -- 5 %5 %

zzClean contaminated wound : 10 %Clean contaminated wound : 10 %

zzContaminated wound : 15 %Contaminated wound : 15 %

zzDirty woundDirty wound : 30: 30 -- 40 %40 %


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Factors that affect wound healingFactors that affect wound healing

zz AgeAge

zz WeightWeight

zz NutritionNutrition

zz DehydrationDehydration

zz Blood supplyBlood supplyzz Immune responseImmune response

zz Chronic illnessChronic illness

zz Drugs and radiation therapyDrugs and radiation therapy

zz SmokingSmoking


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Basic principles in woundBasic principles in woundmanagementmanagement


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1)1) HemostasisHemostasiszzFirst priorityFirst priority

zzBloodless fieldBloodless field

zz

SutureSuture

ligationligation

zzSeromaSeroma andand hematomahematoma can leadcan lead

to infection or to a delay into infection or to a delay inwound healingwound healing


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2) Wound cleansing2) Wound cleansing

zzSterile techniqueSterile technique

zzAnesthesiaAnesthesia

zz IrrigationIrrigation


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3) Wound Exploration3) Wound Exploration


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4)4) DebridementDebridement


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5) Wound closure5) Wound closure

zzHandling of the tissueHandling of the tissuezz Incision planningIncision planning

zzRelaxed skin tension linesRelaxed skin tension lines


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zz underminingundermining


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zzChoice of suture materialChoice of suture material

zzClosing with sufficient tensionClosing with sufficient tension


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zz Tissue moistureTissue moisture

zz Dead spacesDead spaces

zz PostoperativePostoperativewound stresswound stress


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SUTURESUTURETECHNIQUESTECHNIQUES


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Simple interrupted sutureSimple interrupted suturezzThe mostThe most

commonly usedcommonly usedsuture techniques.suture techniques.

zz Goal : approximateGoal : approximate

andand evertevert thethe

wound edge.wound edge.


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Vertical mattress sutureVertical mattress suturezz Useful in inverted woundUseful in inverted wound

zz ExcellentExcellent eversioneversion and precise skinand precise skinedge approximation.edge approximation.

zzTwo bite techniqueTwo bite techniquezz First bite : approximate.First bite : approximate.

zz

Second bite : reduced tension fromSecond bite : reduced tension fromwound edge.wound edge.


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Horizontal mattress sutureHorizontal mattress suturezzTwo biteTwo bite sticthsticth techniquetechnique

zzGood tissueGood tissue evertevert

zz Fair approximateFair approximate

zzSmall simple interruptedSmall simple interrupted

zzSterile stripSterile strip

zzTake tension off the wound edgeTake tension off the wound edge


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Horizontal halfHorizontal halfburriesburries


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Running closure (baseballRunning closure (baseball stitch)stitch)

zzWoundWounds edges easilys edges easily evertevert and longand longstraight woundstraight wound

zz Not used in wound significant risk ofNot used in wound significant risk ofhematomahematoma..

zz

Safe suture material and timeSafe suture material and time


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RunningRunning lock closurelock closure


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RunningRunning lock closurelock closure

zz Significant more tissueSignificant more tissue eversioneversion..zz Reduces the skin tension more than theReduces the skin tension more than the

running closure.running closure.


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RunningRunning intracuticularintracuticular

zz Useful inUseful in keloidkeloid patientspatientszz Removal is quick and easyRemoval is quick and easy childrenchildren

zz If incision longer than 3 cm.If incision longer than 3 cm. surfacesurfacelooploop


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NONNON SUTURINGSUTURINGTECHNIQUETECHNIQUE


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STAPLESSTAPLES


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STERILESTERILE -- STRIPSSTRIPS

zzUsed to close very low tension.Used to close very low tension.zzWound edge approximate.Wound edge approximate.


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SUTURE MATERIALSUTURE MATERIALzz

DiameterDiameterzzTensile strengthTensile strength

zzTissue reactivityTissue reactivity

zz Ease of handling the suture materialEase of handling the suture material

zz Facility for typing and maintaining knotsFacility for typing and maintaining knots

zzThe absorption of the sutures by the bodyThe absorption of the sutures by the body


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6 days1 days


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S i l dlS i l dl


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Surgical needleSurgical needle


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CASE STUDY 1CASE STUDY 1


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THANK YOUTHANK YOU


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Suture and Suturing-2550

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