Suture Workshop 2012 - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

Suture Workshop 2012

Description:

Suture Workshop 2012 An Introduction to Basic Suturing Mrs Esther Mitchell MBChB MRCS Ed Objectives To be able to demonstrate interrupted sutures To handle ... – PowerPoint PPT presentation

Number of Views:194
Avg rating:3.0/5.0
Slides: 27
Provided by: hald5
Category:

less

Transcript and Presenter's Notes

Title: Suture Workshop 2012


1
Suture Workshop 2012
  • An Introduction to Basic Suturing
  • Mrs Esther Mitchell
  • MBChB MRCS Ed

2
Objectives
  • To be able to demonstrate interrupted sutures
  • To handle instruments correctly
  • To know common suture materials advantages and
    disadvantages
  • Know how to achieve the best wound closure
    possible

3
(No Transcript)
4
Sterility
  • Open dressings packs / instruments
  • Open sutures
  • Open syringes needles
  • Understand Skin prep, drapes, gloves/gowns

5
Needle Holder
  • Thumb ring finger into needle holders rings
  • (NOT your middle finger)

6
Forceps
  • Grasp forceps between thumb middle finger,
    while index finger is used for stabilization.
  • Like holding a pen!

7
Surgical Scissors
8
Needles
  • Curved
  • Cutting usual for skin
  • Tapered
  • Straight
  • Hand held
  • Instrument held

9
Suture Sizes
  • 7 Thickest
  • 0 - Thick
  • 11/0 - Finest
  • Normal usage 1 to 5/0
  • Face 5/0-6/0
  • Scalp 3/0-4/0
  • Abdomen 3/0-4/0
  • Back 2/0-3/0
  • Limbs 3/0-4/0

10
Suture Material
  • Absorbable/Non-absorbable
  • Synthetic/Natural
  • Braided/Non Braided

11
Absorbable Vs Non Absorbable
  • Absorbable
  • Self dissolving
  • Avoids removal in children
  • Increased Scarring
  • Non Absorbable
  • Less scarring
  • Decreased infection

12
Synthetic vs Natural
  • Synthetic
  • Less tissue reaction
  • Mass produced
  • Developed for specific properties
  • Natural
  • Cheaper
  • Traditional
  • More tissue reactions

13
Braided Vs Non-Braided
  • Braided
  • Inc Tensile strength
  • gtFlexible
  • Handles well
  • Inc capillarity
  • Non- Braided
  • (monofilament)
  • Less resistance
  • Less infection
  • Weaker

14
Suture Materials
Absorbable Non-Absorbable
Vicryl Prolene
Monocryl Ethilon (Nylon)
PDS Ethibond
Catgut Silk
Steel
15
Main Sutures
  • Interrupted / Simple
  • Continuous
  • Mattress
  • Subcuticlar

16
Ligation - Tying of Sutures
  • Hand Ties
  • Longer learning curve
  • Delicate placement possible
  • Needs relatively long suture length
  • More accurate
  • Instrument Ties
  • Relatively simple to learn
  • Less delicate
  • Uses less suture material
  • Quick

17
Interrupted suturing technique
  • Sutures 3-4mm from wound edge
  • Sutures 5-10mm apart in distance
  • Start on side farthest to you
  • Evert skin edges
  • Grasp needle 2/3rd from tip
  • Grasping tip causes blunting
  • Grab subcutaneous tissue not skin

18
Practice Practice Practice!!
19
Local Anaesthetic
  • Lignocaine 3mg/kg (70Kg, 21mls 1)
  • Lignocaine Adrenaline 7mg/Kg (70Kg, 49mls 1)
  • Always aspirate before injecting
  • Check contra-indications
  • Know side effects

20
Adrenaline in LA
  • Used at 1200 000 strength
  • Never use more than 100mls
  • Increases duration of action
  • Reduces absorption, so more can be used without
    toxicity
  • Causes vasoconstriction, good and bad
  • Good stops bleeding, effects above
  • Bad causes ischemia of extremities (fingers,
    toes, ears noses etc)

21
Toxic effects of local anaesthetic
  • Feeling Inebriated and Lightheaded
  • Muscle twitching
  • Convulsions
  • Coma
  • Respiratory arrest
  • Arrhythmia
  • Cardiac arrest
  • MONITOR for 30mins post injection

22
Factors Affecting Wound Healing
  • LOCAL
  • Contamination
  • Foreign body
  • Poor haemostasis
  • Poor tissue handling
  • SYSTEMIC
  • Diabetes
  • Anaemia
  • Hypothyroidism
  • Drugs steroids, anti-cancer drugs
  • Immunosuppression
  • Nutritional Status

23
Alternatives to sutures
  • Staples
  • Adhesives eg wound glue
  • Steri-strips

24
Tidying up
  • Dress wound
  • Post op instructions to patient
  • Signs and symptoms of infection
  • Keep dry / change wet dressings
  • Suture removal
  • Other follow-up
  • Dispose of Sharps
  • Write Op note

25
Suture Removal
  • Face 3-5 days
  • Scalp 5 days
  • Limbs 7-10 days
  • Trunk 7-10 days
  • Foot 10-14 days

26
Summary
  • Suturing permits primary wound healing
  • Good surgical technique is required
  • Correct selection of suture and needle
  • Optimise factors to encourage good wound healing
  • Practice!!
Write a Comment
User Comments (0)
About PowerShow.com