Upload
dr-harim-
View
15.169
Download
10
Embed Size (px)
Citation preview
Sutures & Drainage
Sutures
Suture material is a foreign body implanted into human tissues
During wound closure, a sterile field and meticulous aseptic technique are critical to minimize the risk of wound infection.
Ideal suture characteristics
Sterile All-purpose (composed of material that can be
used in any surgical procedure) Causes minimal tissue injury or tissue reaction Holds securely when knotted High tensile strength Favorable absorption profile Resistant to infection
TYPES of sutures
The type of suture used varies on the operation, depending on the location and environment.
Absorbable-broken down in tissue depending on the material can be from ten days to eight weeks
Non-absorbable-are not metabolized by the body, and are used therefore either on skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in which absorbable sutures are not adequate
Absorbable sutures
Natural- Prepared from beef and sheep intestine
Collagen Surgical gut, plain Surgical gut, fast-absorbing Surgical gut, chromic
Absorbable sutures
Synthetic- Chemical polymers are absorbed by hydrolysis and cause a lesser degree of tissue reaction.
Polyglactin 910 (Vicryl): Poliglecaprone 25 (Monocryl): Polydioxanone (PDS II):
Absorbable sutures
Their uses are as follows. Tying off small arteries and veins near the skin. Stitches in the ureter, urinary tract, or biliary tract (where
permanent sutures term a focus for stone formation). Closing off tissue spaces, e.g. subcutaneous space. Occasionally for closing the skin in children, where it is
an advantage not to have to remove the stitches. In small bowel anastomosis or stomach mucosal
anastomosis
Non-absorbable sutures
Natural Surgical silk- Used for (1) repairing rapidly healing tissues
that require minimal support, (2) ligating superficial blood vessels, and (3) suturing subcutaneous fatty tissue.
Surgical cotton- Same as silk
Surgical steel- Surgical steel suture is used primarily in orthopedic, neurosurgical, and thoracic applications.
Non-absorbable sutures
Synthetic Nylon- Stitching the skin, 2 Closure of the abdominal muscles, 3-
Ophthalmology and microsurgery
Polybutester (Novofil)-Surface closure, permitting adequate tissue approximation while allowing for tissue edema and detumescence.
Polyester fiber (Dacron):1-vessel anastomosis 2-placement of
prosthetic materials.
Polypropylene (Prolene): 1-Closure of the skin, particularly for subcuticular sutures.2-Arterial surgery 3-large bowel anastomosis and bile-duct surgery
Sizes of sutures
Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics).
Atraumatic needles are manufactured in all shapes for most sizes.
Suture techniques
Common suture stitching techniques include: Simple Interrupted Stitch Running Stitch Mattress Horizontal mattress Vertical mattress Continuous locking Subcuticular
Surgical techniques
Continuous
Running stitch
Surgical techniques
Simple interrupted
Subcuticular
Surgical techniques
Mattress
Surgical needles
Traumatic needles are needles with holes or eyes which are separate from their suture thread.
Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread.
Surgical needles
There are several shapes of surgical needles, including:
straight half curved or ski 1/4 circle 3/8 circle 1/2 circle 5/8 circle compound curve
Surgical needles
By their point geometry; examples include: taper (needle body is round and tapers smoothly to a
point) cutting (needle body is triangular and has a sharpened
cutting edge on the inside) reverse cutting (cutting edge on the outside) trocar point or tapercut (needle body is round and
tapered, but ends in a sma blunt points for sewing friable tissues side cutting or spatula points
Needles
Other methods
Tissue adhesivesTopical cyanoacrylate adhesives ("liquid stitches")
have been used in combination with, or as an alternative to, sutures in wound closure.
Surgical staples Specialized surgery staples, which prove to be
faster, consistent & accurate. Staple lines are less likely to leak blood, air or bowel contents.
Staples
Drainage
A surgical drain is a tube used to remove pus, blood or other fluids from a wound.
Drains may be hooked to wall suction, a portable suction device, or they may be left to drain by gravity.
Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding.
Types of drains Jackson-Pratt drain
Penrose drain
Wound Vac System - Involves the use of enclosed foam and a suction device attached; often used for large surgical/trauma/non-healing wounds.
Redivac drain
Pigtail drain - has an exterior screw to release the internal "pigtail" before it can be removed
Davol
Chest tube
Complications of drainage
Infection Anastomotic leakage Fistula formation Bleeding Erosion of adjacent tissue/vessels.
The End