Symposium sutures grafts and meshes amit and vipin
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This document discusses the history and types of sutures, grafts, and meshes used in surgery. It begins with a brief history of wound closure techniques dating back to ancient Egyptians and Greeks. It then covers the development of modern sutures from catgut to synthetic absorbable and non-absorbable materials. The document classifies sutures and discusses their properties. It also addresses skin grafts and the different types (split thickness, full thickness), as well as how to perform wound closure and knot tying.
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Symposium sutures grafts and meshes amit and vipin
- 1. SUTURE ,GRAFTS AND MESH DR VIPIN V NAIR ASSO PROF - DEPT OF SURGERY AFMC PUNE
- 2. Ambroise Paré, surgeon 16th century • “I dress the wound, God heals it.“
- 3. Suture is a strand of any material used for • Ligating Blood vessels • Transfixing • Approximating tissues DEFINITION
- 4. 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
- 5. Earliest Reference EDWIN SMITH PAPYRUS 1600 BC
- 6. 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. Ants
- 7. 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.
- 8. Galen AD 150 on catgut
- 10. 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.
- 11. 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.
- 13. THE IDEAL SUTURE Moynihan 1912 • Monofilament • Absorbable • Predictable absorption • Use for any Procedure • Easy to handle • Minimal Tissue Reaction • High Breaking Strength • Holds Knots Securely • Sterile
- 14. The ideal suture material Latest criteria • Not induce a significant tissue reaction • Allow secure knots • Have adequate tensile strength • Not cut through tissue • Sterile • Non-electrolytic • Non-allergenic • Cheap and sterile
- 16. CLASSIFICATION OF SUTURES ABSORBABLE NONABSORBABLE MONOFILAMENT BRAIDED SYNTHETIC NATURAL
- 17. CLASSIFICATION OF SUTURES Natural Synthetic PROLENE* Silk ETHIBOND* Stainless Steel ETHILON* Natural Synthetic Plain/F.A. Gut Chromic Gut VICRYL* MONOCRYL* VICRYL* Rapide PDS II* ABSORBABLE SUTURES NON - ABSORBABLE SUTURES
- 18. Silk Catgut • Natural – Silk, linen, catgut • Synthetic polymer – Polypropylene, polyester, polyamide Polypropylene Polyester
- 19. • Monofilament – Polypropylene – Polydioxanone – Nylon • Multifilament – Catgut (twisted) – Polyester – Silk (braided)
- 20. Absorbable Sutures VICRYL* rapide MONOCRYL* Coated VICRYL* Coated VICRYL* Plus Antibacterial Suture PDS* II • Skin • Perineum • Oral • Lacerations • Traumatology • Ligaments • Fascia • Vessel anastomosis 10 days By 42 days Wound Support Mass Absorption Typical Uses 30 days 60 days 20 days 30 days 56 - 70 days 90 - 120 days 56 - 70 days 180 - 210 days • Ligature • General • Bowel • Orthopaedics • Ligature • General • Bowel • Ophthalmic • Ligature • Mucosa • Obstetrics • Bowel • Skin
- 21. Volume % Reduction With Decreasing Size 2/0 3/0 4/0 5/0 6/0 7/0 8/0 2/0 3/0 4/0 5/0 6/0 7/0 8/0 51% 40% 49% 54% 50% 44% 51% 40% 49% 54% 50% 44%
- 22. Suture Packaging
- 23. Packaging… Expiry date Batch Number Do Not Re-use Product (re-order) Code Imperial Gauge Metric Gauge Needle size & curvature Needle type Needle point See Instructions for use Needle profile Sterilised Ethylene Oxide
- 24. Suturing Basics
- 25. Anatomy of a Surgical Needle
- 26. Use of Needle Holders Loading Needle Needle passing through skin
- 27. Using needle holder, grasp needle about 2/3rds of the way back from point.
- 28. Needle Shapes •Eye •Microsurgery •Dura •Eye •Fascia •Nerve •Muscle •Eye •Skin •Peritoneum •Cardiovascular •Oral •Pelvis •Urogenital tract •Nasal cavity •Nerve •Skin •Tendon •Eye (Anterior segment) •Laparoscopy
- 29. Round Bodied Needles • TAPERPOINT
- 30. Cutting Needles • Conventional Cutting • Reverse Cutting • PRIME • P Needle
- 31. The Right Needle Choice • The appropriate needle choice for any situation is……………. ……………The needle that will cause least possible trauma to the tissue being sutured
- 32. Choice of suture • Familiarity • Ease of handling • Tissue characteristics • Knowledge of physical and biological characteristics of the suture • Patient factors-infection,debility,obesity
- 33. Needle Holder • Remember!!! Thumb & ring finger into needle holder’s rings (NOT your middle finger!)
- 34. X NOT YOUR MIDDLE FINGER!!!
- 35. Index finger stabilizes the instrument by resting on the shaft.
- 36. FORCEPS • Grasp forceps between thumb & middle finger • Index finger is used for stabilization. • Forceps to grasp dermis, rather than epidermis or skin surface • Prevent marking & injuring of skin at wound edge.
- 37. So what type should I use? • Interrupted & exposed skin sutures are – nylon – polyprolene. • Buried or run in the skin (eg. subcuticular suture) absorbable materials – Vicryl – Monocryl
- 38. 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
- 39. Wound Closure • Basic suturing techniques: – Simple sutures – Mattress sutures – Subcuticular sutures • Goal: “approximate, not strangulate”
- 40. Simple Sutures • Simple interrupted stitch – Single stitches, individually knotted (keep all knots on one side of wound) – Used for uncomplicated laceration repair and wound closure
- 42. Mattress Sutures • Horizontal mattress stitch – Provides added strength in fascial closure; also used in calloused skin (e.g. palms and soles) – Two-step stitch: • Simple stitch made • Needle reversed and 2nd simple stitch made adjacent to first (same size bite as first stitch)
- 44. Simple Interrupted vs. Vertical Mattress • This suture is best used in creases & areas of natural inversion (eg. back of hand, or other sites of loose skin).
- 45. Subcuticular Sutures • Usually a running stitch, but can be interrupted • Intradermal horizontal bites • Allow suture to remain for a longer period of time without development of crosshatch scarring
- 46. How many knots? • Braided material – silk – 3rd throw (replicating the first) would be placed to secure the knot. • Monofilament material – nylon – place 5 or 6 throws of alternating construction.
- 47. Important points to think about: • Tightly tied sutures can cause – ischaemia & – wound edge necrosis • Remember, keep skin edges everted, NOT inverted!
- 48. Tying Knots • Square (reef) knot • Surgeon’s knot
- 49. KNOT TYING Is it really all that important? • A patient’s life may depend on the security of one ligature. Slippage of a tie may result in a life-threatening haemorrhage.
- 50. When can I remove the sutures? • Face: 3-4 days • Scalp: 5 days • Trunk: 7 days • Arm or leg: 7-10 days • Foot: 10-14 days
- 52. NEW TRENDS
- 53. Skin Adhesive • Butyl or 2-octyl Cyanoacrylate • Topical i.e. not to be put into the wound • Low tension dry & haemostatic wounds • 2-octyl cyanoacrylate provides a waterproof microbial barrier
- 54. Steri-strips • Sterile adhesive tapes • Available in different widths • Frequently used with subcuticular sutures • Used following staple or suture removal • Can be used for delayed closure
- 55. Staples • Rapid closure of wound • Easy to apply • Evert tissue when placed properly
- 56. SKIN GRAFTS
- 57. SKIN
- 58. Skin EPIDERMIS • No blood vessels. • Relies on diffusion from underlying tissues. • Stratified squamous epithelium composed primarily of keratinocytes. • Separated from the dermis by a basement membrane.
- 59. Skin DERMIS • Composed of two “sub-layers”: – Superficial papillary – Deep reticular. • The dermis contains – Collagen – Capillaries – Elastic fibers – Fibroblasts – Nerve endings
- 60. Definition Graft A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from its own blood supply and placed in a new area with a new blood supply.
- 61. Graft vs. Flap Graft Does not maintain original blood supply. Flap Maintains original blood supply.
- 62. Classification of Grafts Autografts one part of the body to another. Homografts/Allograft genetically different individual of the same species. Xenografts individual of one species to an individual of another species.
- 63. Types of Grafts Grafts are typically described in terms of thickness or depth. Split Thickness: 100% of the epidermis and a portion of the dermis. thin or thick. Full Thickness: 100% of the epidermis and dermis.
- 64. Type of Graft Advantages Disadvantages Thin Split Thickness -Best Survival -Heals Rapidly -Least resembles original skin. -Least resistance to trauma. -Poor Sensation -Maximal Secondary Contraction Thick Split Thickness -More qualities of normal skin. -Less Contraction -Looks better -Fair Sensation -Lower graft survival -Slower healing. Full Thickness -Most resembles normal skin. -Minimal Secondary contraction -Resistant to trauma -Good Sensation -Aesthetically pleasing -Poorest survival. -Donor site must be closed surgically. -Donor sites are limited.