sutures knots
DESCRIPTION
TRANSCRIPT
SURGICALSutures & Knots/Operation Theater
*Mansoor Khan
26 May, 2010
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
In the 10th century BC, ANTS was held over the wound until it seized the wound edges in its jaws. It was then decapitated.
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.
The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading
through the eye of the needle before use.
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.
Sutures
Absorbable Non-absorbable
Natural Synthetic Natural Synthetic
Mono-filament
Multi-filament
Mono-filament
Multi-filament
Mono-filament
Multi-filament
Mono-filament
Multi-filament
Multifilament (braided)Multifilament (braided)MonofilamentMonofilament
SterilitySterility
Low tissue reactivity
Low tissue reactivity
Easyhandling
Easyhandling
knot security
knot security
Tensile strength
Tensile strength
QUALITIESQUALITIES
ABSORBABLE!Usually lose their tensile strength within
60 days.ABSORBED by
Hydrolysis or enzymatic degradation
Derived from the small intestine of healthy sheep.
Loses 50% of tensile strength by 5-7 days.
Used on mucosal surfaces.
PLAIN
GUT
Treated with chromic acid to delay tissue absorption time.
50% tensile strength by 10-14 days.
Used in episiotomy repairs.
CHROMIC
GUT
Monofilament50% tensile strength = 30+ days
Sites = need for prolonged strength,
P
OLYDIOXANONE (P
DS ®)
Braided, synthetic polymer50% tensile strength for 30 days
Used: subcutaneous
Polyglycane 910 (vicyle ®)
NON-ABSORBABLE!Permanent, used for long term strength
Appears to be stronger then nylon and has better overall
wound security.
Polypropylene (Prolene®)
Braided Before the advent of synthetic fibers,
silk was the mainstay of wound closure.Easy handling, excellent knot security.
High reactivity and infection dueto the absorption of body fluids
by the braided fibers.
S
I
L
K
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
Bowel: 2/0 - 3/0Fascia: 1 - 0Ligatures: 0 - 3/0Pedicles: 2 - 0Skin: 2/0 - 5/0Arteries: 2/0 - 8/0Micro surgery 9/0 - 10/0Corneal closure: 9/0 - 10/0
SUTURE SELECTION
Operation TheatresOperation Theatres
“Place where life saving or life improving invasive procedures are performed on human
body under strict aseptic measures!!!!!!”
History of Hygiene
• Aristotle Greek Philosopher recommends
Boiling water to armies. Advises the Alexander.
Recommends hygiene for healthy living
HAND WASHING- Semmelweis
Practices, emphasizes the importance of washing hands with chlorinated water in Obstetrics to reduce maternal mortality
Florence Nightingale creates fundamentals in Nursing care
“The Very First Requirement in hospitals that should do the sick no harm”
Florence Nightingale 1860
• 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
“Soap, Water and Common Sense Yet the best Antiseptic”
William Osler
Factors which influence Safety inHospital Environment
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
13
2
5
46
H
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• 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….
Good Hand Washing Practices Save many Lives
Cleaning more Important than Disinfection and Sterilization
Sterilization!
is absolute, removes microbes and spores too.To achieve Sterilization is Expensive, not
sustainable, many times not needed.
Disinfection!reduces the infections drastically.
• 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
• 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
Who/What is Important in prevention of Infections
Remember we are More important than many
Operation Theatre Safety isResponsibility Of….????????
Everyone……..
THANKSQUESTIONS PLEASE