Sutures & Drainage

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  • 1. Sutures & Drainage
  • 2. 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.
  • 3. 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
  • 4. 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
  • 5. Absorbable sutures
    • Natural- Prepared from beef and sheep intestine
    • Collagen
    • Surgical gut, plain
    • Surgical gut, fast-absorbing
    • Surgical gut, chromic
  • 6. 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):
  • 7. 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
  • 8. 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.
  • 9. 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
  • 10. 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.
  • 11. Suture techniques
    • Common suture stitching techniques include:
    • Simple Interrupted Stitch
    • Running Stitch
    • Mattress
    • Horizontal mattress
    • Vertical mattress
    • Continuous locking
    • Subcuticular
  • 12. Surgical techniques
    • Continuous
    • Running stitch
  • 13. Surgical techniques
    • Simple interrupted
    • Subcuticular
  • 14. Surgical techniques
    • Mattress
  • 15. 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.
  • 16. 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
  • 17. 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
  • 18. Needles
  • 19. Other methods
    • Tissue adhesives
    • Topical 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.
  • 20. Staples
  • 21. 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.
  • 22. 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
  • 23. Complications of drainage
    • Infection
    • Anastomotic leakage
    • Fistula formation
    • Bleeding
    • Erosion of adjacent tissue/vessels.
  • 24. The End