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HISTORY 1650 BC – 2000’s ADThe origins of surgery can be traced back manycenturies. Through the ages, practitioners have used awide range of materials and techniques for closingtissue……..
Ants In the tenth century BC, the ant was held over the wound until it seized the wound edges in itsjaws. It was then decapitated and the ants death grip kept the wound closed.
Thorns The thorn, used by African tribes to close tissue,was passed through the skin on either side of the wound. A strip of vegetable fibre was then wound around the edge in a figure eight.
Sterilised CatgutThe tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading through the eye of the needle before use.
Swaged On Needles Post World War II brought the swaged-on needle. The thread fitsinto the hollow end of the needle, allowing it to pass through tissue without the double loop of thread that exists with a conventional needle, reducing tissue trauma.
Absorbable SuturesPLAIN GUT: CHROMIC GUT:Derived from the small Treated with chromic intestine of healthy acid to delay tissue sheep. absorption time.Loses 50% of tensile 50% tensile strength by strength by 5-7 days. 10-14 days.Used on mucosal Used in episiotomy surfaces. repairs.
Characteristics of Non- Absorbable Sutures• Permanent• Only used when long term support is required• Removed when used for skin• Tissue reaction generally low (except silk)• True non-absorbable sutures include polyester, polyethylene, polypropylene and steel
AbsorbableAdvantages Disadvantages• Broken down • Consideration of by body wound support time• No foreign body left
Non - AbsorbableAdvantages Disadvantages • Foreign body left• Permanent wound Support • Suture removal can be costly and inconvenient • Sinus & Extrusion if left in place
Suture Size USP (United States Pharmacopoeia)5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0 General Thin Thick
Needle point Geometry •Suited to soft tissue Taper-Point •Dilates rather than cuts •Very sharp Reverse •Ideal for skin cutting •Cuts rather than dilates •Very sharp Conventional •Cuts rather than dilates Cutting •Creates weakness allowing suture tearout •Ideal in tough or calcified tissues Taper-cutting •Mainly used in Cardiac & Vascular procedures.