Basic_Wound_Closure_Knot_Tying_Primer3

Basic_Wound_Closure_Knot_Tying_Primer3 - Basic Wound...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Basic Wound Closure & Knot Basic Wound Closure & Knot Tying Primer Vic Vernenkar, D.O. Dept. of Surgery St. Barnabas Hospital Objectives Objectives Provide basic information on commonly used suture materials Review general principles of wound closure Provide a general overview of basic surgical knot tying Suture Material Suture Material Generally categorized by three characteristics: Absorbable vs. non­absorbable Natural vs. synthetic Monofilament vs. multifilament Absorbable Suture Absorbable Suture Degraded and eventually eliminated in one of two ways: Via inflammatory reaction utilizing tissue enzymes Via hydrolysis Examples: “Catgut” Chromic Vicryl Monocryl PDS Non­absorbable Suture Non­absorbable Suture Not degraded, permanent Examples: Prolene Nylon Stainless steel Silk* (*not a truly permanent material; known to be broken down over a prolonged period of time—years) Natural Suture Natural Suture Biological origin Cause intense inflammatory reaction Examples: “Catgut” – purified collagen fibers from intestine of healthy sheep or cows Chromic – coated “catgut” Silk Synthetic Suture Synthetic Suture Synthetic polymers Do not cause intense inflammatory reaction Examples: Vicryl Monocryl PDS Prolene Nylon Monofilament Suture Monofilament Suture Grossly appears as single strand of suture material; all fibers run parallel Minimal tissue trauma Resists harboring microorganisms Ties smoothly Requires more knots than multifilament suture Possesses memory Examples: Monocryl, PDS, Prolene, Nylon Multifilament Suture Multifilament Suture Fibers are twisted or braided together Greater resistance in tissue Provides good handling and ease of tying Fewer knots required Examples: Vicryl (braided) Chromic (twisted) Silk (braided) Suture Degradation Suture Degradation Suture Material “Catgut” Method of Degradation Proteolytic enzymes Vicryl, Monocryl Hydrolysis PDS Hydrolysis Time to Degradation Days Weeks to months Months Suture Size Suture Size Sized according to diameter with “0” as reference size Numbers alone indicate progressively larger sutures (“1”, “2”, etc) Numbers followed by a “0” indicate progressively smaller sutures (“2­0”, “4­0”, etc) Smaller ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­Larger .....”3­0”...”2­0”...”1­0”...”0”...”1”...”2”...”3”..... Needles Needles Classified according to shape and type of point Curved or straight (Keith needle) Taper point, cutting, or reverse cutting Needles Needles Curved Designed to be held with a needle holder Used for most suturing Straight Often hand held Used to secure percutaneously placed devices (e.g. central and arterial lines) Needles Needles Taper­point needle Round body Used to suture soft tissue, excluding skin (e.g. GI tract, muscle, fascia, peritoneum) Needles Needles Cutting needle Triangular body Sharp edge toward inner circumference Used to suture skin or tough tissue Suture Packaging Suture Packaging Wound Closure Wound Closure Basic suturing techniques: Simple sutures Mattress sutures Subcuticular sutures Goal: “approximate, not strangulate” Simple Sutures 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 Mattress Sutures Mattress Sutures Horizontal mattress stitch Provides added strength in fascial closure; also used in calloused skin (e.g. palms and soles) Two­step stitch: Simple stitch made Needle reversed and 2nd simple stitch made adjacent to first (same size bite as first stitch) Mattress Sutures Mattress Sutures Vertical mattress stitch Affords precise approximation of skin edges with eversion Two­step stitch: Simple stitch made – “far, far” relative to wound edge (large bite) Needle reversed and 2nd simple stitch made inside first – “near, near” (small bite) Subcuticular Sutures 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 Steri­strips Steri­strips Sterile adhesive tapes Available in different widths Frequently used with subcuticular sutures Used following staple or suture removal Can be used for delayed closure Staples Staples Rapid closure of wound Easy to apply Evert tissue when placed properly Two­Hand Square Knot Two­Hand Square Knot Easiest and most reliable Used to tie most suture materials Instrument Tie Instrument Tie Useful when one or both ends of suture material are short Commonly used technique for laceration repair References References Encyclopedia of Knots provided by Ethicon; available at www.jnjgateway.com/public/USENG/5256ETHICON_Encyclopedia_of_Knots.pdf (More extensive overview of knot tying with photos for those interested in surgery) Blackbourne, LH, editor. Surgical Recall. 2nd ed. Baltimore: Lippincott Williams & Wilkins; 1998 Cameron, JL, editor. Current Surgical Therapy. 7th ed. St. Louis: Mosby; 2001 Edgerton, MT. The Art of Surgical Technique. Baltimore: Williams & Wilkins; 1988 (Excellent resource for technical details of surgery) Gomella, LG, Haist, SA. Clinician’s Pocket Reference. 9th ed. New York: McGraw­Hill Medical Publishing Division; 2002 (Useful book for anyone doing clinical rotations!) ...
View Full Document

  • Fall '11
  • Dr.Aslam
  • Monocryl, Ethicon Inc., Suture Absorbable Suture, Suture Multifilament Suture, Suture Degradation Suture

{[ snackBarMessage ]}

Ask a homework question - tutors are online