Sutures Knots

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Sutures Knots

  1. 1. SURGICAL Sutures & Knots/ Operation Theater 21 Oct, 2009 Dr. Mansoor Khan Resident Surgery, MBBS, FCPS-I Khyber Teaching Hospital, Peshawar
  2. 2. 1650 BC – 2000’s AD Through the ages, Practitioners have used a wide range of materials and techniques for closing tissue… The origins of surgery can be traced back many centuries
  3. 3. In the 10th century BC, ANTS was held over the wound until it seized the wound edges in its jaws. It was then decapitated.
  4. 4. 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 tied around the edge in a figure eight.
  5. 5. The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading through the eye of the needle before use.
  6. 6. Post World War II brought the swaged-on needle. The thread fits into 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.
  7. 7. Sutures Absorbable Non-absorbable Natural Synthetic Natural Synthetic Mono-filament Multi-filament Mono-filament Multi-filament Mono-filament Multi-filament Mono-filament Multi-filament
  8. 8. Multifilament (braided)Multifilament (braided)MonofilamentMonofilament
  9. 9. SterilitySterility Low tissue reactivity Low tissue reactivity Easy handling Easy handling knot security knot security Tensile strength Tensile strength QUALITIESQUALITIES
  10. 10. ABSORBABLE! Usually lose their tensile strength within 60 days. ABSORBED by Hydrolysis or enzymatic degradation
  11. 11. Derived from the small intestine of healthy sheep. Loses 50% of tensile strength by 5-7 days. Used on mucosal surfaces. P L A I N G U T
  12. 12. Treated with chromic acid to delay tissue absorption time. 50% tensile strength by 10-14 days. Used in episiotomy repairs. C H R O M I C G U T
  13. 13. Monofilament 50% tensile strength = 30+ days Sites = need for prolonged strength, POLYDIOXANONE (PDS ®)
  14. 14. Braided, synthetic polymer 50% tensile strength for 30 days Used: subcutaneous Polyglycane 910 (vicyle ® )
  15. 15. NON-ABSORBABLE! Permanent, used for long term strength
  16. 16. Appears to be stronger then nylon and has better overall wound security. Polypropylene (Prolene® )
  17. 17. Braided Before the advent of synthetic fibers, silk was the mainstay of wound closure. Easy handling, excellent knot security. High reactivity and infection due to the absorption of body fluids by the braided fibers. S I L K
  18. 18. 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 Thick Thin Suture size USP (United States Pharmacopoeia) General
  19. 19. Bowel: 2/0 - 3/0 Fascia: 1 - 0 Ligatures: 0 - 3/0 Pedicles: 2 - 0 Skin: 2/0 - 5/0 Arteries: 2/0 - 8/0 Micro surgery 9/0 - 10/0 Corneal closure: 9/0 - 10/0 SUTURE SELECTION
  20. 20. The Suture Packaging STRAND SIZE MATERIAL STRAND LENGTH PRODUCT CODE NEEDLE CODE WITH LIFE SIZE PICTURE OF NEEDLE NEEDLE LENGTHCOLOUR POINT TYPE NEEDLE CIRCLE
  21. 21. BASIC SURGICAL KNOTS & SUTURING
  22. 22. Operation TheatresOperation Theatres
  23. 23. “Place where life saving or life improving invasive procedures are performed on human body under strict aseptic measures!!!!!!”
  24. 24. History of Hygiene • Aristotle Greek Philosopher recommends Boiling water to armies. Advises the Alexander. Recommends hygiene for healthy living
  25. 25. HAND WASHING- Semmelweis Practices, emphasizes the importance of washing hands with chlorinated water in Obstetrics to reduce maternal mortality
  26. 26. Florence Nightingale creates fundamentals in Nursing care “The Very First Requirement in hospitals that should do the sick no harm” Florence Nightingale 1860
  27. 27. • 1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas • 1880 – Johnson and Johnson introduce antiseptic surgical dressings.Beginning of Safe Operation Theatre Practices
  28. 28. “Soap, Water and Common Sense Yet the best Antiseptic” William Osler Factors which influence Safety in Hospital Environment
  29. 29. WET HANDS & APPLY SOAP RIGHT PALM OVER LEFT, LEFT OVER RIGHT PALM TO PALM FINGER INTERLACED ROTATIONAL RUBBINGROTATIONAL RUBBING OF RIGHT THUMB IN LEFT PALM & VICE VERSA BACK FINGERS TO OPPOSING FINGERS INTERLOCKED 1 3 2 5 46 H A N D S W A S H I N G
  30. 30. • Which suits the Circumstances. • Availability of Resources. • Economical. • Safe to you. • Some chemical containing compounds can cause sensitization and Allergic reactions. BEST HAND WASH IS….
  31. 31. Good Hand Washing Practices Save many Lives
  32. 32. Cleaning more Important than Disinfection and Sterilization
  33. 33. Sterilization! is absolute, removes microbes and spores too. To achieve Sterilization is Expensive, not sustainable, many times not needed. Disinfection! reduces the infections drastically.
  34. 34. • Paying great attention to Floors Using unnecessary, too many chemical not necessary • Keep the floor Clean and Dry - Bacteria are reduced, • Most Important component of Bacteria is water a dry areas causes natural death except spores
  35. 35. • Do not disturb unnecessarily, • Do not use ceiling fans they cause aerosol spread • Clean only when remodeling or accumulated ,good amount of dust. Do not disturb the Roof
  36. 36. Who/What is Important in prevention of Infections
  37. 37. Remember we are More important than many
  38. 38. Operation Theatre Safety is Responsibility Of….????????
  39. 39. Everyone……..
  40. 40. THANKS QUESTIONS PLEASE

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