The document provides information about Stericat, a suture manufacturing company in India. It discusses Stericat's mission and vision of being a leading suture company offering high quality products at reasonable prices. It then details Stericat's 30 years of experience in suture manufacturing and its certifications. The rest of the document showcases Stericat's manufacturing facility and processes, product varieties, presence in hospitals, and marketing offices. It also includes sections on the history of sutures, classification of sutures, needles, labeling, and knot tying and suturing techniques.

1. Training
Training
Manual

2. 2Training

3. STERICAT PLANT
at Manesar
Company
Presentati
onTraining

4. Mission and Vision of STERICAT Sutures
Mission:
Leading suture Manufacturing and Marketing
company of India.
Vision:
Offering high quality surgical products, developed in
close relationship with our customers and thus close
to the market, for a reasonable price in order to help
the hospitals save money.
4 Training

5. 30 years of Suture Manufacturing experience
Training
ManualTraining

6. Stericat is governed by International Quality Management System an ISO 13485: 2003/CMD CAS,
ISO 9001: 2008, CE along with CE as per MDD 93/42/EEC as amended WHO GMP certified Company
Way to Entrance Reception
6Training

7. Admn. Office Changing Room
7Training

8. Changing Room
At our state of the art
CLASS 100,000 facility,
we operate with a quality assurance
system,
based on written procedures,
exhaustive in process controls
and a meticulous quality plan.
An ever attentive technical team
along with employee participation
monitors manufacturing of sutures
from raw material to finished
product stage ,
enabling us to guarantee product
reliability and Customer Satisfaction.
At Stericat, we have a full in house
testing facility to conduct all
Chemical, Instrumental and
Microbiological Tests.
8Training

9. Pouch Opening Dry Division
9Training

10. Production Control Room Wet Division
10Training

11. Winding Needle Attachment
11Training

12. Polishing Room Inspection Room
12Training

13. World Class Testing Laboratory
13Training

14. Filament Uniformity Testing
14Training

15. Filament Attachment by
Pneumatic Needle Crimping
15Training

16. Microbiology Tests & Packaging
16Training

17. Sealing Sterilisation
17Training

18. STERICAT Sutures, MESH & Speciality Products
are available:
•Human use
•Veterinary use
•Third parties ( US and European Companies)
•Global Export
Product varieties like:
•Sutures
•Pro-Set (Customized Suture Sets)
•Special Suture Sets
Training
ManualTraining

19. STERICAT FAMILY
19Corporate PresentationTraining

20. Marketing Office at South Delhi
20Training

21. Marketing Office at South Delhi
21Training

22. Marketing Office at South Delhi
22Training

23. Marketing Office at South Delhi
23Training

24. Training
Training
Manual

25. Presence in all Reputed Hospitals
 TAMIL NADU GOVT
 ANDHRA GOVT
 DELHI GOVT
 ARMY HOSPITALS
 RAILWAY HOSPITALS
 GUJRAT GOVT
 MAHARASTHRA GOVT
 RAJASTHAN GOVT
 BIHAR GOVT.
 ORISSA GOVT
 MP GOVT
 PUNJAB GOVT
 HP GOVT
 HARYANA GOVT
 &
 ALL OTHER MAJOR HOSPITALS OF REPUTE
25 Training

26. Presentation Contents
HistoryHistory
Suture classification and selectionSuture classification and selection
NeedlesNeedles
Suture labelSuture label
26Training

27. Workshop Contents
Suture presentationSuture presentation
Basic Suture Techniques VideoBasic Suture Techniques Video
Knot tying & suture exercisesKnot tying & suture exercises
Evaluation.Evaluation.
27Training

28. HISTORY
The origins of surgery can be traced back many
centuries. Through the ages, practitioners have used a
wide range of materials and techniques for closing
tissue……..
1650 BC – 2000’s AD
28Training

29. In the tenth century BC, the ant was held over
the wound until it seized the wound edges in its
jaws. It was then decapitated and the ant's death
grip kept the wound closed.
AntsAnts
29Training

30. 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.
30Training

31. Sterilised Catgut
The tough membrane of sheep intestine was provided
to the surgeon pre-sterilised and required threading
through the eye of the needle before use.
31Training

32. Swaged On Needles
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.
32Training

33. Raw Material
Biological: Linen Silk Collagen
•
Metallic: Stainless Steel
Synthetic: Polypropylene
 Polyester
 Polyamide
 Polyglycolic acid
 Polyglactin
 Poliglecaprone 25
 Polydioxanone
33
Since
1970’s
From
1950’s

34. Criteria of suture material choice
• Calibre
• Lineal tensile strength
• Knot tensile strength
• Knot security
• Thread surface
• Flexibility
• Elongation / Elasticity
• Capillarity
• Period of useful tensile strength
• Period of absorption
• Tissue reaction
Training34

35. Gut/Chromic Gut
Made of submucosa of small
intestines
Multifilament
Breaks down by
Phagocytosis: Inflammatory
reaction.
1Training

36. Suture Classification and SelectionSuture Classification and Selection
36Training

37. Suture ClassificationSuture Classification
NaturalNatural oror SyntheticSynthetic (man made)(man made)
MonofilamentMonofilament oror MultifilamentMultifilament (braided)(braided)
AbsorbableAbsorbable oror Non-AbsorbableNon-Absorbable
37Training

38. The Ideal Suture
Minimal tissue reaction
Smoothness - minimum tissue drag
Low Capillarity
Max tensile strength
Ease of handling - Minimum memory
Knot security
Consistency of performance
Predictable performance
Cost effectiveness
38Training

39. Suture Size
5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0Thick
Thin
USP (United States Pharmacopoeia)
39Training

40. Multifilament (braided)Multifilament (braided)
Suture ClassificationSuture Classification
MonofilamentMonofilament
40Training

41. Training 41

42. Training 42

43. Braided v Monofilament
Has capillary action
Increased infection risk
Less smooth passage
Less tensile strength
Better handling
Better knot security
No capillary action
Less infection risk
Smooth tissue passage
Higher tensile strength
Has memory
More throws required
43Training

44. These are absorbed within the living tissueThese are absorbed within the living tissue
Two main characteristics are:Two main characteristics are:
Tensile strength retentionTensile strength retention
Absorption rateAbsorption rate
Absorbable SuturesAbsorbable Sutures
I-COLI-COL :Day 21: 50% Absorption: 60-75 days:Day 21: 50% Absorption: 60-75 days
I-COL FastI-COL Fast :Day 06: 50% Absorption: 40-45 days:Day 06: 50% Absorption: 40-45 days
MonoColMonoCol:Day 28:50% Absorption: 180-210days.:Day 28:50% Absorption: 180-210days.
StericrylStericryl ::Day 21: 50% Absorption: 90-120daysDay 21: 50% Absorption: 90-120days..
44Training

45. Absorbable Sutures
I-COL I-COL Fast MONOCOL STERICRYL
MATERIAL
100%
Polyglycolic Acid.
100%
Polyglycolic Acid. Polydioxanone Polyglecaprone 25
STRUCTURE
Braided
( Coated )
Braided
( Coated )
Mono-filament Mono-filament
COATING
Polycaprolactone +
Calcium Stearate
Polycaprolactone +
Calcium Stearate
NA NA
50% TENSILE
STRENGTH
18-20Days 6-7 days 28 Days 18-21 Days
ABSORPTION
PROFILE
60-75Days 40-45 Days 180-210 Days 90 - 120 Days
45

46. 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)
However silk, linen and even nylon will lose tensile strength over a
period of time
True non-absorbable sutures include polyester, polyethylene,
polybutester, polypropylene and steel
46Training

47. Suture Handling
1. Package Memory:
Grasp strand close to needle and at end of strand and
gently stretch
2. Opening Suture Foil:
Tear in direction indicated to gain best needle exposure.
3. Arming needle
Arm needles 2/3rds
distance between tip and swage
47Training

48. Options to Close a Wound
 Traditional sutures
 Mechanical sutures 
 Tissue adhesives
 Adhesive suture strips 
48

49. Surgical Sutures Presentations
• Single Armed (One Needle)
• Double Armed (Two Needle)
• Loop Suture
• Pre-Cuts (Ligatures)
49
Trainning

50. Knot Tying & SuturingKnot Tying & Suturing
50Training

51. Principles of Surgical Sutures
• Wound edges approximation and ensure strength according to tissue
properties
• Suture degradation profile according to wound healing process
• Handling properties according to surgeon’s expectations ( flexibility,
smoothness, knot holding,…)
Strong tissue with slow healing Fascia
Tendons

Weak tissue with quick healing
 Muscles Intestines
51

52. STERICAT Surgical Sutures
• Suture knots
Approximate tissues
& hold wound edges
• Ligatures
• Identification of structures (Vessel loops)
52
Company Presentation

53. Most common knots in surgery
• Square knot Surgeon's knot
• Most common techniques in surgery
Continuous suture (over and over)
Simple knots
53

54. Training54
Weakest point in the suture
• Every surgeon has his own knotting technique.
• USP / EP standards determine minimum values.
Knot pull Tensile Strength

55. Classification of Surgical Sutures
Surgical sutures can be classified according to
• Raw Material
• Structure
• Absorption profile
Training55

56. Suture from STERICAT according to structure
 Multifilament: braided or twisted
 Monofilament
 Pseudo-monofilament
56Company Presentation

57. Absorbable Suture Characteristics
• Degradation profile
Enzimatic (Biological sutures) : Catgut
Hydrolysis (Synthetic sutures) : Abs. Syn.
• 50% tensile strength retention period
Short term : 7 days : I-COL FAST
Mid term : 14-21 days : I-COL ,
POLYCOL
& STERICRYL
Long term : 28-40 days : MONOCOL
• Mass absorption time
Short term : 42 days : I-COL FAST
Mid term : 60-90 days : I-COL , POLYCOL &
STERICRYL
Long term : 6 months : MONOCOL
0
20
40
60
80
100
0 3 6 9 12 15 18 21 24 28
Vicryl Rapide Safil Quick Catgut Plain
Catgut Chromic Safil Monosyn
57

58. STERICAT suture, according absorption profile
• Absorbable sutures
Degradation
50% tensile strength retention period
Mass absorption time
• Non absorbable sutures
Remain in the body forever
• “Pseudo-non absorbable sutures”
Absorbed in a 2-3 years period
Training58
I-COL® , POLYCOL ®
I-COL ® FAST
STERICRYL ®
MONOCOL ®
CATGUT Plain / Chrom
STERILENE®
STERIPOL®/
STERIBON ®
STERISTEEL®
STERILON ®
STERISIL ®
TRAINNING

59. Calibre - Diameter
• USP: United States Pharmacopoeia
-4-0 is 0000 smaller than 3-0
-Different systems for organic and synthetic materials.

 3/0
• EP: European Pharmacopoeia (Metric system)
0.01mm diameter = EP 0.1 (Minimum thread diameter x 10)
0.35mm diameter = EP 3.5
 2
Training59

60. Calibre - Diameter
Training 60

61. Lineal Tensile Strength
Maximum linear load depends on
• Thread material
• Calibre
• Structure
STRENGTH = SECURITY
Least material possible for secure hold.
61

62. Training62
Knot-pull tensile strength according to the material (Kg)
5.4
4.5
3.75
3.75
3.75
3.75
3.5
3.25
3.25
2.45
8.5
0 1 2 3 4 5 6 7 8 9
Steel monofilament
Polyglycolic acid
Glyconate
Polypropylene
Polyamide monofilament
Silk
Supramid
Polyester monofilament
Polyester braided and coated
Polyester braided
Catgut
Strength Changes with the Material

63. Knot Security
Related to:
• Flexibility.
• Elasticity.
• Suture Surface.
• Knotting technique.
• Surgeon’s experience.
• Silk, linen, catgut.
• Braided polyester,braided
absorbables.
• Monofilar absorbable and
non absorbable.
• Stainless steel.
63
2 = 1
Closed knot = Security

64. Thread surface
Friction between thread and tissue
• Tissue drag.
• Knot repositioning.
Surface smoothness depends on:
• Material.
• Structure.
• Coating.
64

65. Flexibility
Flexibility depends on:
• Material
• Structure
• Calibre
Flexibility eases:
• Handling
• Adaptation of wounds
• Knot security
Flexibility = easy handling
65
•Silk, synthetic absorbable braided
•Linen, braided polyesters
•Catgut
•Monofilaments
•Stainless steel

66. Elongation / Elasticity
Elongation: stretching of thread
-If elastic: comes back to original length
- if not: deformation occurs (thinner- longer)
Skin closure: Elasticity = Less scar
Vascular anastomosis: No elongation to keep
anastomosis closed.
Training66

67. Elasticity
From less to most elastic:
• Stainless steel
• Linen,Silk,Braided Synthetic absorbables,Braided polyester
• Catgut
• Absorbable monofilaments
• Polypropylene
• Polyester monofilament
• Nylon
Training67

68. Capillarity
Capillarity means the action by which the surface of a
liquid where it is in contact with a solid
(as in a capillary tube) is elevated or depressed
depending on the relative attraction of the molecules
of the liquid for each other and for those of the solid.
This attraction of molecules means for sutures that
liquid like blood or even bacteria may by elevated /
transported through a suture thread.
Capillarity encourages infection causing suture
sinuses and abscesses.
Training68

69. Capillarity and Suture material
 No capillarity:
• Stainless steel
• Monofilaments (Synth. Absor., Polyester, Polypropylene and Polyamide)
 Not likely to have capillarity:
• PGA
• Coated polyester
• Catgut
• Coated silk
 Capillarity:
• Linen
• Braided polyester
Training69

70. Period of useful tensile strength = 50%
Training70
days0
50
100
%
Wound
healing
process
Tensile strength
retention loss
absorbable suture
Suture useful
x

71. Period of useful tensile strength
 Suture material 50 % Period useful tensile strenght
 Polyglycolic acid 18-21 days
 Poliglecaprone 14 days
 Polydioxanone 28-35 days
0
10
20
30
40
50
60
70
80
90
100
0 8 16 25 30
days
%woundhealing
Skin
Colon
Stomach
Aponeurosis
Urinary Bladder
71

72. Period of mass absorption
 Polyglycolic Acid I-COL 60-75 days
 Polyglactin 910 POLYCOL 60-75 days
 Polyglycolic acid I-COL FAST 40–45 days
 POLIGLECAPRONE 25 STRICRYL 90-120 days
 CATGUT PLAIN /CHROMIC STERICAT 90 days
 Polydioxanone MonoCOL 180 – 210 days
Training72

73. Actual absorbable suture range
Term Short Mid Long
Monofilament STERICRYL® MonoCOL®
Polyfilament I-COL® FAST I-COL / POLYCOL®
73
Absorbable: Until when useful? Tensile strength

74. ABSORBABLES SUTURES
 I-COL VIOLET
 I-COL FAST
 POLYCOL
 STERICRYL
 MONOCOL
 CATGUT.
Training 74Company Presentation

75. PGA and Sterilization
As PGA is susceptible to degradation from moisture
and gamma rays:
Low humidity ethylene oxide gas sterilization
procedures are used and moisture-proof packaging.
Acceleration of in vivo degradation due to gamma
irradiation has been exploited to create devices where
early fragmentation is desired.
This is how we create I-COL FAST where we
accelerate the degradation profile of the suture, by
breaking down the molecules.
Training75

76. Tissue Reaction
Related to:
• Material
• Amount of suture
 Calibre
 Knot type
• Structure / Capillarity
Low Tissue Reaction = Security
76

77. I-COL VIOLET
Training 77
Mid-term
braided and coated
synthetic absorbable suture,
made of pure polyglycolic
acid (violet or undyed).
High tensile strength
Secure holding of first throw
Excellent knotting ability
Smooth passage through
tissue
Easy handling
Sizes available:USP 2 to 10/0
Surgical Specialties
Gastrointestinal Surgery.
Gynaecology / Obstetrics.
Ophthalmic surgery.
Orthopaedics.
Urology.
Skin closure. (intra, sub, skin)
Neurosurgery.
Company Presentation

78. I-COL® FAST
Training 78
Short-term
synthetic absorbable braided
and
coated
suture(POLYCAPROLACTON
E+CALCIUM CITRATE),
made of low molecular weight
polyglycolic acid.
High initial tensile strength
Predictable and constant
degradation rate
Good knot security
Excellent handling properties
Quick mass absorption
Used in Specialties
Gynaecology / Obstetrics. (e.g. episiotomies)
Ophthalmic surgery. (e.g. conjunctiva suturing)
Oral surgery. (e.g. oral mucosa)
Paediatric surgery.
Skin closure. (Intra, sub, skin)
Ligatures.
Company Presentation

79. STERICRYL.
Training 79
Mid-term
absorbable synthetic undyed
monofilament
Suture made of
poliglecaprone 25
Superior initial knot tensile
strength
Ideal degradation profile for soft
tissues
Smooth tissue passage
Excellent knot security
Quick mass absorption
Sizes available:6/0 to 1
Used in Specialties
Gastrointestinal surgery.
Gynaecology / obstetrics.
Urology.
Plastic and reconstructive surgery.
Skin closure. (Intra, sub, skin)
Ligatures.
Company Presentation

80. MONOCOL
Training 80
Synthetic long-term
absorbable monofilament suture
made of polydioxanone,
dyed violet.
High knot tensile strength
Outstanding strength retention for
extended wound support
Very flexible, Pliable and easy to knot
Conveniently eligible
Smooth passage through tissue
Sizes available :7/0 to 2
Also available in Loop 150cm, size 1,
40mm heavy
Used in specialties.
Abdominal wall closure.
Orthopaedics.
Paediatric cardiovascular surgery
Company Presentation

81. NON-ABSORBABLE SUTURES
 STERILENE
 STERIPOL
 STERILON
 STERISIL
 STERISTEEL
Training 81Company Presentation

82. Training 82
Cardio-vascular range of sutures
Sterilene
Steripol
Steristeel
Company Presentation

83. STERILENE
Training 83
Synthetic
non-absorbable monofilament
suture
made of Polypropylene,
Blue colour - enhanced visibility.
Smooth passage through tissue
Excellent knot run down and
security
Optimal elasticity and elongation
properties
Sizes available:10/0 to 2
Used in specialties.
Vascular surgery,
Cardiac surgery,
Plastic and reconstructive surgery,
Skin closure. (intra, sub, skin)
Neurosurgery.
Microsurgery.
Gastrointestinal surgery.
Company Presentation

84. STERILON®
 Synthetic
 non-absorbable monofilament
suture
 made of polymers Polyamide
6/6.6 (dyed blue),
 Polyamide 6.6 (dyed black)
 or Polyamide 6 (undyed).
 Flexible, easy to handle and tie
 Smooth passage through
tissue
 Excellent histocompatibility
 Sizes available: 11/0 to 1
Training
Used in specialties
Skin closure. (intra, sub, skin)
Plastic and reconstructive
surgery.
Microsurgery.
Ophthalmic surgery.
Neurosurgery.
84Company Presentation

85. STERIPOL/STERIBON
Training 85
Silicone coated,
Multifilament braided Polyester fibers.
Unique PTFE oval pledget design improving
adaptability to underlying anatomical structures
Improved passage through tissue
Excellent knot run-down properties
Minimised tissue drag and sawing
Optimal knot security
Available in single packs (1, 2 sutures) or
Multipacks (4, 8 sutures) either green or white.
Pledget sizes:3x3 & 6x3,oval & rectangular.
Sizes available:6/0 to 5(green & white)
Used in Specialties
Cardiac surgery (valve replacement)
Orthopaedics
Company Presentation

86. STERISIL®
Training 86
non-absorbable,
braided and coated suture,
made of natural silk filaments
available in black.
Excellent handling properties
Good knot security
Sizes available:9/0 to 6
Used in Specialties
General surgery
Skin closure
Oral surgery
Ophthalmic surgery (Virgin silk)
Neurosurgery
Ligatures Company Presentation

87. STERISTEEL®
Training 87
Non-absorbable twisted or
monofilament suture
made of corrosion-resistant steel
for orthopaedic and Cardiac
surgery.
USP 5/0 (1 metric) to USP 7 (9
metric)
Exceptional tensile strength
Excellent tissue compatibility
Sizes available:USP 5/0 to 7
Steristeel® - Sternum Closure
Company Presentation

88. Needles
88Training

89. Training
ManualTraining

90. Basic components for the needle
A. Points of needle:
1. Cutting points : it used to penetrate when tissue is
difficult to be penetrated as skin and tendon
2. Reverse cutting
3. Taper point : these needles are used in soft tissue such as
intestine and peritoneum, the sharp point at the tip of
needle
4. Blunt point : these are using for suturing friable tissue
such as liver and kidney
1Training

91. Basic components for the needle
B. Body of needle :
1.Straight
2.Curved
C. Eyed of needle:
The eye is the segment of needle where the suture strand is
attached
1.Eyed needle :Like of any household sewing needle
2. French eye needle : It has a slit from the inside if the eye to
the end of the needle through which the
suture is drawn
3.Eyeless needle : The suture strand the needle are one unit
1Training

92. Cutting vs Reverse Cutting
Cutting
Reverse
cutting
92Training

93. Points of Needles
Cutting
Cutting edge on
inside of circle
Skin
Traumatic
93Training

94. Points of Needles
Reverse Cutting
Cutting edge on
outside of circle
Skin
Less traumatic than
cutting
1Training

95. Points of Needle
Taper point
1Training

96. Shapes of Needles
3/8 circle
1/2 circle
Straight
Specialty
1Training

97. Needle CurvatureNeedle Curvature
Corporate
presentatio
nTraining

98. Training
ManualTraining

99. Taper Blunt
Conventional TAPERCUT Reverse cutting
99Training

100. Needle point Geometry
Taper-Point
•Suited to soft tissue
•Dilates rather than cuts
Reverse
cutting
•Very sharp
•Ideal for skin
•Cuts rather than dilates
Convention
al Cutting
•Very sharp
•Cuts rather than dilates
•Creates weakness allowing suture tearout
Taper-
cutting
•Ideal in tough or calcified tissues
•Mainly used in Cardiac & Vascular
procedures.
100Training

101. Medical Grade Class Steel Types
101Training

102. Summary of Needles
1. Needles are made of steel alloy (Medical Grade).
STERICAT we use controlled hardness of VPN 525 to 625
with a coating so they stay sharp for multiple passes through
tissue.
2. Different needle points for different tissues .
3. Choose the needle that will cause the least trauma.
102Training

103. Suture Label
103Training

104. The Suture Packaging
104
STRAND SIZE
MATERIAL
STRAND
LENGTH
COLOUR
NEEDLE CIRCLE
POINT
TYPE
NEEDLE LENGTH
PRODUCT CODE
Training

105. Outer Pack Label
105Training

106. 106Training

107. SPECIALITY PRODUCTS
 HERNIA REPAIR –
STERILENE MESH,
STERIFLEX MESH,
STERILENE MESH KIT
 C-SECTION KIT
 STERISLING-Transobturator Sling System
107Training

108. SPECIALITY PRODUCTS
 HERNIA REPAIR –
STERILENE MESH,
STERIFLEX MESH,
STERILENE MESH KIT
 C-SECTION KIT
 STERISLING-Transobturator Sling System
Training 108Company Presentation

109. STERILENE® Mesh
Training 109
STERILENE ® Mesh
is made from monofilament
polypropylene,
Rapid healing and tissue
penetration
Closed, rounded edges
Thin mesh structure
Excellent transparency
Good handling
Well tolerated
Good stability
Used in Specialties
Hernia repair.
Reconstruction of the chest wall.
Reinforcement of fascial tissue,
when non-absorbable
reinforcement material is required
For conventional and minimally invasive
techniques.
Company Presentation

110. STERILENE MESH® ULTRA LIGHT
Training 110
Lightweight polypropylene
mesh
Improved bicompatibility
Soft and pliable
Thinner,
more conformable
Flexible,
strong and secure
Full transparency
Easy placement.
Used in Specialties.
Inguinal hernia.
Incisional hernia.
Reconstruction of chest wall.
For conventional and minimally
invasive techniques.
Company Presentation

111. STERISLING
Training 111Company Presentation

112. STERISLING Trans-Obturator Needle
System
The Transobturator Needle System consists of Two Curved
Medical Grade Stainless Steel reusable passers.
They are used to place Sling for Female patients of Stress
Urinary Incontinence (SUI) with minimal blind passage.
Making it very safe, It never enters the Reptropubic space &
Abdominal wall.
Decreased risk of: Bowel, Bladder Injury & Major Bleeding.
Training Company Presentation

113. Training
Training
Manual
Hernia is a sac lined by peritoneum that protrudes through a defect in
the layers of the abdominal wall.
Generally, a hernia mass is composed of a peritoneal sac, into which
organs or other abdominal tissues can slip.
Most hernias occur in the abdominal cavity.
Although a hernia can develop on any part of the abdominal wall.
The areas near the natural openings in the groin areas (inguinal
hernias),
below the groin (femoral hernias),
through the naval (umbilical hernias)
through old surgical incisions (incisional hernias) are the most
common.

114. Trend – Mesh Materials
Training115
Standard
Super-LightLightUniversal-lightTraditional Mesh
1997 2002 20052004
Light,
Large
porous
Heavy,
Small
porous
Lightweight Meshes are the new Standard.

115. Training
Training
Manual

116. TYPES OF HERNIA
Inguinal Hernias-
Indirect Inguinal Hernias
This occurs due to a weakness in the abdominal wall present at birth.
In men, this weakness is caused by a space that is created as the testes
and spermatic cord descend by way of the inguinal canal (a / ½ inch
canal)
Direct Inguinal Hernia
They are most common in men and usually later in life, most often
after 40, Direct inguinal hernias are due to an acquired wear and tear
in the abdominal wall.
Training 117

117. Training 118

118. Training 119
Congenital Diaphragmatic Hernia is a birth defect in which abdominal organs
protrude up into the chest cavity.
Femoral Hernia is the protrusion of abdominal fat or part of the intestines
through the abdominal muscles into the upper thigh area.
Hiatal Hernia is the protrusion of a portion of the stomach through an opening
in the diaphragm called the hiatus. Hiatal hernia is also called a hiatus hernia.
Incisional Hernia is a hernia that develops through a previous surgical
incision. This can occur anywhere on the abdomen or back.
Inguinal Hernia is the protrusion of abdominal fat or part of the intestines
through the abdominal muscles into the groin area (also called the inguinal
canal). Inguinal hernia is the most common type of hernia.
Umbilical Hernia is the protrusion of part of the intestines or abdominal lining
through the abdominal wall around the belly button. It most often occurs in
infants ages six months and younger.

119. ENDOSCOPIC HERNIA REPAIR
(Minimally invasive surgery )
There are two forms of Endoscopic Hernia repairs:-
Trans-Abdominal Pre-Peritoneal (TAPP), this repair
involves entry into the abdominal cavity with peritoneal
incision and dissection, Hernia reduction,
Mesh placement, and Closing Peritoneum.
In Totally Extra-Peritoneal (TEP) Hernia repair the
abdominal cavity is not entered. The working space is
created by pre-peritoneal dissection.
Mesh is placed without peritoneal incision.
Training 120

120. Advantages of large-pore sized, lightweight, monofilament
Polypropylene Meshes :
 Improved biocompatibility
 Diminished foreign body sensation
 Less postoperative pain
 Lower rate of seroma formation
 Faster recovery
 Optimal incorporation into the surrounding tissue
 Better elasticity while maintaining the dymanics of the abdominal
wall
 Better handling characteristics
 Easy modeling to the body tissue
Training121
ENDOSCOPIC HERNIA REPAIR
(Minimally invasive surgery )

121. Training
Training
Manual
a) Midline
b) Right or
Left
Paramedian
c) McBurnny
d) Oblique inguinal
e)Sub-costal (Kocher’s)

122. Training
Training
Manual
a. Midline The most commonly used incision, made
longitudinally in the center of the abdomen
along the linea alba nad between the muscles.
Can provide access to all quadrants,.
i.e: Gastrectomy.
b Right or Left
Paramedian
Vertical incision, lateral and parallel to the
midline. Used for specific surgical
procedures, e.g. Splenectomy.
c McBurnny The incision generally used for an
Appendectomy.
d Oblique Inguinal Incision made in area of groin for
Herniorrhaphy
e Sub-costal
(Kocher’s)
Incision made below the ribs generally for
Gallbladder procedures.

123. Training
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Manual
Skin Protective covering
Sub-cutaneous tissue Fatty layer under the
skin. (Thickness will vary
considerably according to
individual’s weight.
Fascia (Anterior and Posterior) –
a layer of firm connective
tissue that covers muscles.
Muscle Fibrous tissue formed into
sheaths
Peritoneum Thin membranous lining of
abdominal cavity beneath the
posterior fascia

124. Training 125

125. Training
Training
Manual
SKIN
SUBCUTANEOUS FAT
Anterior Fascia
Muscle
Posterior Fascia
Peritoneum

126. TISSUE LAYERS OF THE ABDOMEN
Skin Protective covering, The final layer closed.
Sub-cutaneous tissue Closing the sub- cutaneous tissue eliminates the
possibility of dead spaces where accumulation of tissue
fluids can delay healing processes and cause infection.
Sub-cutaneous layer is thin
Fatty layer under the skin. (Thickness will vary
considerably according to individual’s weight.
Fascia (anterior & posterior)Layer of firm connective tissue
that covers muscles.
Muscle Fibrous tissue formed into sheaths
Peritoneum Thin membranous lining of abdominal cavity
beneath the posterior fascia.
Training 127

127. Training
Training
Manual
Posterior
Fascia
(fascia on the posterior side of the muscle sheath) where it does
exist, is included in this layer.
Note: Where extreme obesity or stress is encountered,
surgeon will place retention sutures through all layers of the
abdomen for extra security. Most often, retention sutures are
put in prior to closure of the peritoneum.
Muscle Is frequently reflected rather than cut, and therefore does not
require closure. If muscles have been transected they may be
closed separately or together with the anterior fascia.
Fascia
(anterior)
Is relied upon to re-establish postoperative abdominal wall
strength. Therefore, anterior fascia closures are of extreme
importance. Care must be taken in approximating the fascia to
insure that there is sufficient distance from the incision line to
the closure bite, otherwise the fascia may tear before it is
healed from sudden stress such as a cough.

128. Training
Manual
Peritoneum 2-0 or 3-0
Muscles 1-0 or 1
Linea Albas 1
Sheath 1-0 or 1
Subcutaneous Fat 3-0
Esophagus 3-0 Silk
Stomach 2-0
Anastomosis 2-0 or 3-0
Kidney 1-0
Urinary Bladder 2-0
Gynaec. Operations 1-0 and 1
Ovarian Surgery 2-0
Tuboplasty 10-0 or 8-0
Vasovasostomy 10-0 and 1
Tendons 4-0 Polyester or 5-0 Stainless Steel

129. Training Training

130. S. No. NEEDLE DESCRIPTION Length SIZE CODE LAYER
I-COL-FAST (P.G.A.) Polyglycolic Acid
1 3/8 CIRCLE REVERSE CUTTING (P.POINT) 26mm, 70cm. . .3/0 SFN2732 SKIN
2 1/2 CIRCLE REVERSE CUTTING 30mm, 90cm. .1/0 SFN2761 EPISIOTOMY REPAIR
3 1/2 CIRCLE CUT TAPER 35mm, 90cm. .2/0 SFN2762(H) AS ABOVE
4 1/2 CRB & 1/2 C REVERSE CUTTING, (Double Armed) 36mm, 140cm .2/0 SFN2777 AS ABOVE
MONOCOL ( P.D.) Polydioxanon
5 1/2 CRB 40mm, 90cm. .1/0 SFN9371(H) MUSCLE
6 1/2 CRB 40mm, 90cm. 1 SFN9347 MUSCLE
7 1/2 CIRCLE RB, HEAVY LOOP 40mm, 150cm. 1 SFN9261 LOOP, SINGLE LAYER
POLYCOL ( Polyglactin 910 )
8 1/2 CIRCLE R.B. (Double Armed) 40mm, 90cm & 140cm 0,1/0 SPL2346 FASIA,MUSCLE
9 ½ CRB 30mm, 90cm. .2/0 SPL2317 BOWLE ANASTOMOMIS
10 ½ CRB 30mm, 90cm. .1/0 SPL2338 FASIA MUSCLE
11 1/2 CIRCLE REVERSE CUTTING (ORTHO) 36mm. 90cm. .1/0 SPL2534X FASIA MUSCLE(ORTHO)
12 ½ CRB 40mm, 115cm. 1 SPP2347LS FASIA MUSLE
13 ½ CRB 20mm, 70cm. .3/0 SPP2437 FASIA MUSLE
14 ½ CRB 30mm, 90cm. .2/0 SPP2317 BOWLE ANASTOMISIS
15 ½ CRB 30mm, 90cm. .1/0 SPP2338 BOWLE ANASTOMISIS
16 ½ C REVERSE CUTTING (ORTHO) 36mm, 90cm. .1/0 2534X FASIA MUSLE(ORTHO)
17 ½ CRB 40mm, 90cm. .1/0 SPP2346 FASIA MUSLE
18 ½ CRB 40mm, 90cm. .2/0 SPP2345 PERITONEOM
19 ½ CRB 40mm, 90cm. 1 SPP2347 FASIA MUSLE
20 1/2 C.REVERSE CUTTING 40mm, 90cm. .2/0 SPP2382 SKIN ,TOUGH ISSUE
21 1/2C. REVERSE CUTTING (ORTHO) 40mm, 90cm. 1 SPP2421X FASIA MUSLE(ORTHO)
CATGUT CHROMIC
22 ½ CRB 20mm, 76cm. .3/0 SFN4237 BOWEL ANASTOMISIS
23 ½ CRB 30mm, 76cm. .2/0 SFN4241 BOWEL ANASTOMISIS
24 ½ CRB 30mm, 76cm. .1/0 SFN4242 BOWEL ANASTOMISIS
25 ½ CRB (HEAVY) 40mm, 76cm. 1 SFN4259 GYNEC. 'c' -SECTION
26 ½ CRB (HEAVY) 45mm, 100cm. 2 SFN4228 GYNEC.HYSTRECTOMY
27 3/8 CRB 16mm, 76cm. .4/0 SFN5048 URO
28 3/8 CIRCLE CUTTING 16mm, 76cm. .4/0 SFN4280 PLASTIC
Training Training Manual

131. STERISIL ( Baided Silk )
29 3/8 C.SPATULATED (P.POINT) 6mm, 38cm. .6/0 SFS-5043 OPTHAL
30 ½ CRB 20mm, 76cm. .3/0 SFS-5087 BOWL ANASTOMISIS
31 ½ CRB 25mm, 76cm. .3/0 SFS-5070 BOWL ANASTOMISIS
32 3/8 C.REVERSE CUTTING 26mm, 76cm. .3/0 SFS-5028 SUBCUTICULAR,SKIN
33 ½ CRB 30mm,76cm. .2/0 SFS-5333 INTESTINAL ANASTOMOSIS
34 ½ CRB 30mm, 76cm. .1/0 SFS-5334 INTESTINAL ANASTOMOSIS
35 3/8 C.REVERSE CUTTING 45mm, 76cm. .2/0 SFS-5036 SUBCUTICULAR,SKIN
36 3/8 C.REVERSE CUTTING 45mm, 76cm. .1/0 SFS-5037 (SKIN) SUBCUTICULAR,SKIN
37 3/8C. REVERSE CUTTING 60mm, 76cm. 1 SFS-5062A TOUGH SKIN
STERICRYL ( Poliglecaprone 25 )
38 3/8 C.REVERSE CUTTING 16mm, 70cm. .4/0 STR1205 SUBCUTICULAR,SKIN
39 3/8C.CUTTING(P.POINT) 25mm, 70cm. .3/0 STR1326 SUBCUTICULAR,SKIN
STERILON ( Monofilament Polyamide) NYLON
40 3/8 CIRCLE SPATULATED (P.POINT) 6mm, 38cm. .10/0 SFN3718 OPTHAL
41 3/8 CIRCLE SPATULATED (P.POINT) 6mm, 38cm. .9/0 SFN-3715 OPTHAL
42 3/8 CIRCLE SPATULATED, (P.POINT) 6mm, 38cm. .8/0 SFN-3322 OPTHAL
43 3/8 CIRCLE SPATULATED (P.POINT), (D. Armed) 6mm, 38cm. .10/0 SFN-3719 OPTHAL
44 3/8 CIRCLE R.CUTTING 10mm, 38cm. .4/0 SFN-3326 PLASTIC
45 3/8 CIRCLE R.CUTTING 10mm, 70cm. .6/0 SFN-3320 PLASTIC
46 3/8 CIRCLE R.CUTTING 10mm, 70cm. .5/0 SFN-3323 PLASTIC
47 3/8 CIRCLE R.CUTTING(P.PONT) 12mm, 70cm. .5/0 SFN-3317 PLASTIC
48 3/8 CIRCLE R.CUTTING(P.PONT) 12mm, 70cm. SFN-3318 PLASTIC
49 3/8 CIRCLE R.CUTTING 26mm, 70cm. .3/0 SFN-3328 SKIN
50 1/2 CRB 40mm, 150cm. .1/0 SFN-3340 LOOP
51 1/2 CRB (HEAVY) 40mm, 100cm. .1/0 SFN-3346 RECTUS/MUCLSE
52 1/2 CRB (HEAVY) 40mm, 100cm. 1 SFN-3347 RECTUS/MUCLSE
53 3/8 CIRCLE REVERSE CUTTING 45mm, 70cm. .2/0 SFN-3336 SKIN
54 1/2 CRB (HEAVY) 50mm, 150cm. 1 SFN-3348 LOOPTraining 132

132. Suture Selection
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
133Training

133. STERICAT FAMILY
134Corporate PresentationTraining