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Suture
- 2. Classifications ā¢ Absorbabale vs non-absorbable ā¢ Natural vs synthetic ā¢ Monofilament vs polyfilament
- 3. Absorbable Absorbable Natural Synthetic Monofilament Braided Monofilament Braided Plain Catgut Chromic catgut Polydiaxanone - PDS Polyglycolic acid- Dexon Polyglactin - Vicryl JMJ 3
- 4. Non -Absorbable Non-Absorbable Natural Synthetic Monofilament Braided Monofilament Braided Silk Wire - steel Linen Nylone - Ethilon Polypropylene - prolene Expanded polytetrafluoroethylene (ePTFE) - expanded monofilamentJMJ 4
- 5. Absorbable vs Non- absorbable ā¢ Strength of absorbable sutures are less ā¢ Non-absorbable sutures ā¢ retain strength indefinitely and are used ā¢ where strength is needed until repair is completed naturally (abdominal incision and hernia repair) JMJ 5
- 6. Natural vs Synthetic Natural ā¢ Catgut ā¢ Silk ā¢ Linen (strong inflammatory reaction) Synthetic ā¢ Dexon ā¢ Vicryl ā¢ PDS ā¢ Nylon ā¢ Polypropylene ā¢ ePTFE JMJ 6
- 7. Monofilament vs Braided Monofilament ā¢ Catgut ā¢ Polydiaxanone ā¢ Wire ā¢ Polypropylene ā¢ Nylon They are smooth Pass easily through tissue Cause less tissue reaction Braided ā¢ Polyglycolic acid Handle well ā¢ Polyglactil More risk of infection ā¢ Silk ā¢ Nylon ā¢ Linen JMJ 7
- 8. Features of a ideal suture material ā¢ Adequate tensile strength ā¢ Good knot holding property ā¢ Should be least reactive ā¢ Easy handling property ā¢ Should have less memory ā¢ Should be easily available and costeffective JMJ 8
- 9. JMJ 9
- 10. JMJ 10
- 11. JMJ 11
- 13. Plain catgut ā¢ Absorbed by inflammatory reaction and phagocytosis ā¢ Absorption time - 7 days ā¢ Used for ā¢ Subcutaneous tissue ā¢ Muscle ā¢ Circumcision in children JMJ 13
- 14. Chromic catgut ā¢ Catgut with chromic acid salt ā¢ Brown in colour ā¢ Absorption time 21 days ā¢ Used for ā¢ Suturing muscles ā¢ Fascia ā¢ External oblique aponeurosis ā¢ Ligating pedicles JMJ 14
- 15. Vicryl - Polyglactic acid ā¢ Absorbed in 90 days ā¢ Absorption is by hydrolysis ā¢ Violet in colour (braided) ā¢ Polyfilament and braided ā¢ Used for ā¢ Bowel anastomosis ā¢ Suturing muscles ā¢ Closure of peritoneum JMJ 15
- 16. Dexon - Polyglycolic acid ā¢ Creamy yellow in colour PDS- Poly Dioxanone Suture Material ā¢ Costly ā¢ But better than vicryl JMJ 16
- 17. Uses in absorbable suture materials ā¢ Bowel anastomosis (gastrojejunostomy, resection & anastomosis) ā¢ Vicryl ā¢ In cholecystojejunostomy, choledechojejunostomy ā¢ Vicryl ā¢ In suturing muscle, fascia, peritoneum, sub cutaneous tissue, mucosa JMJ 17
- 18. Uses of absorbable suture materials ā¢ Ligation of pedicles during hysterectomy ā¢ 1-zero chromic catgut ā¢ Vicryl ā¢ In circumcision ā¢ 3-zero plain or chromic catgut ā¢ Absorbable suture materials should not be used for ā¢ Suturing tendons ā¢ Nerves ā¢ Vessels (vascular anastomosis) JMJ 18
- 20. Silk ā¢ Black colour ā¢ Coated material to reduce capillary action JMJ 20
- 21. Polypropelene MEMORY - is recoiling tendency after removal from the packet. Ideally ā¢ Blue in colour suture material should have low memory ā¢ Got high memory JMJ 21
- 22. Uses of non- absorbable suture materials ā¢ In herniorraphy for repair ā¢ For closure of abdomen after laparotomy ā¢ For vascular anastomosis (6-zero), nerve suturing, tendon suturing ā¢ For tension suturing in the abdomen ā¢ For suturing of skin JMJ 22
- 23. TYPES OF SUTURING JMJ 23
- 25. Interrupted simple suturing Increase risk of infection Easy when need of draining
- 27. Subcuticular suturing Good cosmetic results
- 28. Suture Removal ā¢ Face and neck ā¢ Scalp ā¢ Limbs ā¢ Hands and feet ā¢ Abdomen 3-4 days 5-7 days 5-7 days 10-14 days 8-10 days JMJ 28
- 29. TYPES OF KNOTS JMJ 29
- 31. NEEDLES JMJ 31
- 33. Needles Cutting edge ā¢ Triangular in cross section ā¢ Skin ā¢ Tendon ā¢ Breast tissue Round body ā¢ Oval or round in cross section ā¢ GI tract ā¢ Vascular anastamosis JMJ 33