Suturing techniques & properties of skin /certified fixed orthodontic courses by Indian dental academy


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Suturing techniques & properties of skin /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Abstract Accidental sticks from suture needles are an unpublicized but common problem for anyone involved in suturing. Designing a suture needle that has activated and deactivated states could significantly decrease transmission of diseases, such as Hepatitis C or HIV-1, as a result of accidental sticks with a contaminated needle. A safe suture needle does not exist in the market today. The JABE 200, a hollow sheath with two cutaways that expose a fluid filled balloon connected to a sharp metal tip, is only armed when the needle holder clamps down
  3. 3. on the balloon, forcing the metal tip to protrude from the sheath. When the holder is unclamped, this “safer” suture needle would be unable to puncture the user’s skin because the sharp metal tip is retracted into the sheath. Future work includes making smaller scale prototypes and testing the mechanism on various types of tissues.
  4. 4. Problem Statement In order to prevent accidental needle “sticks” to a medical staff member, a reversibly arming suture needle must be developed. The device must encompass all features of a conventional needle with the added safety of needle retraction. The goal is to permanently eliminate the risk of needle puncture and infection to the operator during procedures.
  5. 5. Demand for a Safer Suture     Suture injuries account for 30% of injuries to physicians, a higher percentage than any other sharp object Contaminated suture needles account for 96% of injury-causing needles 56% of injuries occur during use Palm side of left hand is most common site of injury— about 45% occur here
  6. 6.  Needle injuries cause transmission of HIV-1, Hepatitis C, and other bloodborne pathogens  Patents    Dr. Sidney Sontag No known needle on the market that has a position in which it cannot puncture skin Large Market Potential for Safe Suture Needle
  7. 7. Existing Technology  Blunted needles    Ethicon Auto Suture Company Cut- or puncture-resistant gloves and glove liners     Genibel Glove Company ViaGARD Medical Products Whizard Protective Wear Zimmer Patient Care division
  8. 8. Difficulties     Arranging first meeting with client Delays in hearing from industry representatives Existing patents to our promising design ideas Deciding on a final design
  9. 9. Needle Anatomy and Choice  Three Needle Parts: Point, Body and Swage  Wide Variety of Needle Points    (A) Cutting: Skin, Muscle, Bone (B) Blunt: Alternative to sharp cutting-edge needle (C) Tapered: Thin Tissue, Peritoneum, GI Tract A B C
  10. 10. Suturing Techniques     Proper handling and choice of suturing needles and tools (needle holder positioning) is critical (Figure 1) Superficial Skin Wounds:  Interrupted Suture Stitch Deep Subcutaneous Wounds:  Vertical Mattress Suture (double pass, Figure 2) Wound-Edge Eversion:  Securing tissue properly so scars become less visible (Figure 3)
  11. 11. Suturing Techniques ¼ distance Figure 1 Figure 3 Figure 2
  12. 12. Suturing Techniques: Tying Knotting Technique:    1. High Risk of Needle Puncture from rapid hand movement Double tying surgeons 2. knot Wrap suture material around needle holder three times and pull needle away from surgeon 3. 4.
  13. 13. Manufacturing A Needle 1. Stainless Steel (T316L) wire drawn to diameter (Figure 4) 2. Wire cut to desired length 3. Sharpening of Point (Figure 5) Figure 4 4. Hardening & tempering 5. Swage end drilled hollow; suture material clamped in 6. Final point sharpening Figure 5
  14. 14. Properties of Skin  Heterogeneous, layered structure (Figure 6)     Epidermis prevents water loss Dermis provides most of bulk and strength Collagen most abundant material in dermis (Figure 7) Cellular elements only 10-20% tissue volume
  15. 15. Properties of Skin Figure 6 (left). Structure of the skin. The skin consists of two layers—the superficial epidermis and the deeper dermis (Corrin, 2001). Figure 7 (top). Structure of collagen. Collagen, the primary structural material of skin, is a protein consisting of three polypeptide strands arranged in a triple helix (Walshaw, 2001).
  16. 16. Design Compromise: Safety and Ease of Use Ease of Use C o n c e n tr ic T ip JA B E 200 L im itin g S h e a th S a fe ty
  17. 17. Alternative Designs: Limiting Sheath  Strengths   Increases operator awareness Weaknesses    Extra step Small hinge required Requires consistent tissue thickness
  18. 18. Alternative Designs: Trigger-Activating Needle  Strengths    Arming only slight variation from procedure Requires no additional equipment Weaknesses   Patent already exists Possible structural concerns
  19. 19. Alternative Designs: Concentric Sheath Tip  Strengths   Automatic arming Weaknesses   Automatic arming Could trap tissue
  20. 20. JABE 200 TS—    Resulted from a further iteration of design process after prototyping Combination of limiting sheath and trigger activated designs Overview:    Outer metal sheath with bilateral windows Fluid filled balloon-like trigger Mobile inner needle tip attached to one end of balloon
  21. 21. Mechanism and Explanation     Needle holder placed at windows in sheath Tightening needle holder forces fluid within balloon into body of sheath Pressure of the fluid causes the tip to protrude out of end of sheath When pressure on needle holder is released, needle tip retracts into sheath
  22. 22. Advantages of JABE 200     Defaults to “disarmed” position, requiring user to consciously activate the tip Arming mechanism varies little from current procedure, so no technique change necessary Requires no additional equipment Basic concept independently conceived by two different medical professionals
  23. 23. Disadvantages of JABE 200     Small balloon size will be difficult to manufacture and may curtail volume changes Does not protect when needle initially exits Increased cost Selecting one cutaway location that accommodates every user will be challenging
  24. 24. Progressive Prototyping   Crude models made of preliminary concepts Models inspired JABE 200    Water-filled dropper bulbs, metal connector, and heat shrink comprise balloon arming mechanism PVC tubing bent to form sheath Nail, clay, and LDPE tubing comprise needle
  25. 25. Elizabeth fitting the “Trigger-activated” model with a metal plate Briar & Elizabeth cutting leaves in the “Concentric Tip” design
  26. 26. Jeff & Angela carefully filling dropper bulbs with water Shaping PVC with the Dremel® tool created a lot of dust
  27. 27. Future for Team SWAGE Design Refinement, Testing and Evaluation     Further volume displacement and material strength research Determining proper wall thicknesses Prototyping on a smaller scale Testing on fabric and living tissues to evaluate amount of tissue trauma and force requirements
  28. 28. Needle Manufacturing, Design and Patenting      Production of actual-sized needle design Testing and evaluation of needle on tissue samples having a variety of wound geometries. Veterinary or Hospital surgery staff trials Final needle refinements Patenting process
  29. 29. References • Corrin, L. A. 10 October 2001. “Skin Structure”. • Haughton, Victor, personal communication, 8 October 2001. • International Health Care Worker Safety Center . 9 October 2001. “Sharp object injury reports by category”. • NVC Communications Co. (15 October 2001). Needles: The Manufacturing Process [On-line]. Available • Trott, A.T. Wounds and Lacerations: Emergency Care and Closure. 2nd ed. Mosby-Year Book, St. Louis. 1997. • Walshaw, J. (15 October 2001) Tertiary Structure—Fibrous and Structural Proteins. Available
  30. 30. Acknowledgements We would like to give special thanks to the following individuals for helping us throughout the design process:    Dr. Victor Haughton Dr. Sidney Sontag Mitchell Tyler
  31. 31. Thank you For more details please visit