Absorbable Suture Indication

Synthetic absorbable sutures
Aesculap. All it takes to operate.
Closure Technologies
Synthetic absorbable sutures
Safil

Monosy
n
Safil
Quick
MonoPlu
s
B. Braun absorbable suture

range
Indikasi umum
General and Gastrointestinal surgery

Laparotomy
Cholecystectomy
Appendectomy
Bowel anastomosis
Gastrectomy
Pyloroplasty
The gastrointestinal tract

Lambung dan intestine kaya akan
asupan darah dengan resiko edema
Potensi terjadinya kebocoran yang
dapat memicu peritonitis
Ikatan yang terlalu kuat dapat merobek
jaringan dan menyebabkan kebocoran
Kebocoran anastomosis tidak hanya
doble
terjadi pada single layer tapi juga
layer closure
mouth
pharynx
oesophagus
stomach
intesine
Upper alimentary tract procedures

Oral cavity: penyembuhan yang relatif cepat, USP<<
(little tension), absorbable
Non absorbable monofilament mengurangi resiko reaksi
jaringan, (suture removal?)
Esophagus: tidak ada lapisan serosa, proses
penyembuhan relatif lama, lapisan muscular yang tebal
The stomach
Relatif lembut dan lentur
Tebal dengan banyak pembuluh darah
3 lapis muscular
Penyembuhan yang cepat, maks 14-21 hari
Rekomendasikan: Safil, beberapa user menyukai
Premilene
Pliable suture: prevent cutting and allow smooth passage
Needles: HR
Stomach Surgical ProceduresGastrectomy

Gastrectomy: pengambilan sebagian atau keseluruhan jaringan pada
organ lambung
Patologi:
Pengambilan tumor atau penanganan perdarahan ulcer hebat
10

Surgery:
Attachment of the remaining portion of the stomach to the small intestine
In the case of cancer, it is almost always performed by traditional open surgery
Gastrectomy with anastomosis
Interrupted sutures
through all layers of
the stomach
Safil / Monosyn
2/0-3/0 HR22-HR26
Billroth I
(end to end)
Gastroduodenosto
my
Billroth II
(end to side)
Gastrojejunostomy
11

Surgery:
1- Abdominal incision
Ligation of subcutaneous blood vessels
2- Clamp and ligation of major stomach vessels
Safil 4/0-0
3-Clamp and cutting of the diseased part of the
stomach
4-Stomach approximation and anastomosis to the
duodenum
Safil 2/0-3/0 HR26
Monosyn 2/0-3/0 HR26
5-Closure (peritoneum, fascia, subcut., cut.)
12
13
Stomach Surgical ProceduresPyloroplasty

Pyroloplasty: reparation of pylorus
stenosis
Pathology:
Pylorus narrowing
Prevents stomag evacuation to
small intestine
(up
Primarly occurs in small babies
to 6 months)
2-3 cases every 1.000 infants
Treatment for high-risk patients for
gastric ulcer disease
14
Stomach Surgical ProceduresPyloroplasty

Pyroloplasty: reparation of
pylorus stenosis
Surgery:
The pylorus is cut and resutured to
relax the muscle and widen the
opening into the intestine
(duodenum)
Therefore, the stomach empties
more quickly
Safil 2/0 HR26-HR30
Silkam 2/0
15
The small intestine

Similar considerations than the stomach
Primarily bile or pancreatic juices may cause a severe
chemical peritonitis
Absorbable sutures are preferred cause they will not
permanently limit the lumen diameter
Monofilament sutures are recommended. Lack of capillarity
resists intestinal bacteria. Smoothness minimises tissue drag
Needles: HR
A non-abs. suture may be used in serosal layer for added
assurance
Rapid healing, reaching maximal strength in approx. 14 days
16
Intestine Surgical Procedures

Resection with anastomosis
17
Bowel anatomy
The submucosa is the layer that provides strength in the
gastrointestinal tract
1. Mucosa
2. Submucos
a
3. Muscle
layers
(musculari
s)
4. Serosa
18
Surgical procedures- Bowel

anastomosis
The gold standard: Resection with anastomosis- serosubmucosal single layer anastomosis
Surgery:
1-Abdominal incision
2-Determine the extent of
resection; ligation of mesenteric
vessels
Safil/Monosyn 4/0-0 precuts/reel, HR13-HR30
19

anastomosis
3-Bowel is cut and removed; large
vessel ligated
4-Bowel side approximation;
interrupted suturing
20

anastomosis
5a- Placement of interrupted sero-submucosal sutures on anterior

layer
Safil/Monosyn/Dafilon/Premilene 3/0 (4/0-2/0) HR17,
HR22, HR26, HR30, DR

6- Abdominal closure
21

anastomosis
5b- Wound approximation with
sutures
5b- Muscle suturing with interruptes stitches
Safil/Monosyn/Premilene 4/0-2/0 HR17HR22, DR
5b- Serosa suturing
Safil/Monosyn/Premilene 4/0-2/0
HR17-HR22, DR
22
The colon
High microbial content: absorbable sutures leave no channel for
microbial migration once absorbed
Leakeage could lead to serious concerns
Strong organ, it heals to a similar rate that
stomach and small intestine
Absorbable sutures (non abs might be used as well)

Placement of sutures in the submucosa,
avoiding penetration of the mucosa,
will help prevent complications
23
The rectum
Very slow healing
It has no serosa
A large bit of muscle should be included in the
anastomosis
Monofilament sutures reduce the risk of bacterial
proliferation in the rectum
http://www.healthcentral.com/animation/408/37/Colon_Cancer.html
24
Surgical procedures - Colorectal

resection
Right hemicolectomy
Left hemicolectomy
Sigmoid Colectomy
Low anterior resection
Abdominal perineal
resection
25
Surgical procedures- Colorectal anastomosis by

control release sutures
Safil/MonoPlus
/Silkam 4/0-2/0
HR17-HR22
26
Surgical procedures- Appendectomy

Surgical removal of the appendix
1- About 7-8cm
abdominal incision
2-Subcutaneous
/mesentery vessel
ligation Safil 4/0-0
3-Appendix is dettached
from the cecum and
removed. Ligation
Monosyn, Safil 2/0
27
Surgical procedures- Appendectomy

4- Cecum is closed. Purse string
suture Monosyn, Safil 4/0
HR17 HR22
Silkam
5-The appendix stump is inverted

into the cecum and the purse
string is closed
28
The biliary tract

Rapid healing
The presence of a foreign body may lead to stones
formation, since the organ is prone to crystal formation
Absorbable suture in the finest size possible that leaves
the least surface exposed
Multifilaments are not recommended
http://www.uclan.ac.uk/facs/health/nursing/sonic/scenarios/livjmanim/biliary_tract.html
29
Surgical procedures - Cholecystectomy

Surgical removal of the gallbladder
30
Cholecystectomy
31
Surgical procedures - Cholecystectomy

Surgery:
1-Subcutaneous blood vessel
ligation
Safil 4/0-0 pre-cuts/reel
2-Gallbladder isolation with
ligatures
3- Cystic artery and cystic duct

ligation
4-Gallbladder removal. The
undersurface of the liver is closed
with interrupted stitches
Safil/Monosyn 2/0-3/0 HR26
32
Parenchymatous organs
Organs composed of cells with little connective tissue for
support
Little tension is placed on the suture line
Small size sutures, they do not need to be placed close
together or deeply into the organ
Rapid healing
New fibrous tissue will form within 7-10 days
Large vessel ligatures: Safil
Surface repair: Safil Parenchyma or Mesh
33
Peritoneum
Thin membrane, quick healing
Some surgeons think it does not require suturing, other
disagree
Continuous suturing with absorbable suture (Safil,
MonoPlus) (Interrupted suturing could be also used)
Skin
Subcuticular
tissue
Subcutaneous
fat
Anterior fascia
Muscle
Posterior fascia
Peritoneum
34
Layered closure
Peritoneum (continued/interrupt)
Subcutaneous
Safil 3/0-2 HR26-HR37s
Safil 4/0-0 HR26-HR43
Monosyn 2/0-0 HR26s, HR30, HR37, HR40s, HR48
Intradermal
MonoPlus 3/0-1 HR22s-HR37s
Premilene/Dafilon 4/0-2/0 DSMP19Fascia
DSMP24
Monosyn 3/0-4/0 DSMP13-DSMP24
Safil 2/0-2 HR37s-HR48-HRT37
Skin (continuous)
Muscle
Safil Quick
Safil 0 HR37s
Premilene/ Dafilon 4/0-2/0 DSMP19Loop
DSMP24
MonoPlus 0-1 HR40s, HR76, HRT40s, HRT48
Synthofil 4/0-3/0 DS19-DS24
35
Urological surgery
Nephrectomy
Vasectomy
36
Urological surgery
Urologists are particularly concerned with suture
strength and ease of handling, since they work in confined
areas
Predictable absorption are specially important in the GU
tract becase: 1)the delicate passageways are subject to
blockage and calculi and 2) infection is often present
Because calculi can come from nonabsorb. sutures,
urologists prefer absorbable
sutures
Main surgeries: stone removal (bladder procedure),
kidney surgery (malformation, tumours), prostate
(cancer), urethra surgery, external genitalia
37
Urinary tract surgery

Prevent leakage
No use of non-abs sutures cause they can lead to calculi
formation
Absorbable sutures: Monosyn, Safil,
Rapid healing
The bladder wall regains 100% tensile strength within 14 days
Ureter: narrow tube with vulnerable blood supply. Easy to
manipulate and penetrate, unless fibrous or hardened. Normal
healing in 7 days
38
Surgical procedures- Nephrectomy

Removal of the kidney due
to infection, cancer, trauma
Surgery:
1-Dissection and clamp of
renal artery and vein.
Ligatures
Safil, Monosyn 3/02/0
2-Ureter is clamped and
ligated
3-Kidney removal
4-Wound closure
(peritoneum, muscle,)
Renal vein
Renal
artery
39
Surgical procedures- Vasectomy

Procedure for male sterilization,
but is commonly performed prior
to prostatic surgery to prevent
spread of infection
Surgery:
1-1 cm incision in the scrotum to
completely access the vas. Small
vessel ligatures
2-Clamp, cutting and tying the ends of
the tube (cauterization/clips)
Safil/Safil Quick 7/0-5/0 DR10,
DR12, HR13
3.1-Fascial interposition to create a

natural barrier between the two cut
ends (diag.3)
Aesculap.
All it takes to operate.
3.2-Open vasectomy
(diag.4)
40
Obstetrical & Gynaecological surgery

Hysterectomy
Cesarian section
Episiorrhaphy
41
Female genital tract

Potentially contaminated area
Limited surgery field to work
Handling properties of sutures for internal use are
very important
Safil /Safil Quick USP 0 for muscular, highly
vascular tissues of pelvis and vagina
Safil Quick for episiotomy

repair
The uterus is very vascular, tough and muscular.
Complete healing achieved in 5 days
Vagina: very thick, tough and vascular. Heals in 10
days
Fast healing tissue require short/mid term support:
Safil Quick, Monosyn, Safil
42
Surgical procedures- Hysterectomy

Surgical removal of the uterus
Vaginal hysterectomy or abdominal hysterectomy (50%50%)
The cervix might be also removed (total) and the vagina
(radical)
43
Surgical procedures-Hysterectomy
Surgery (abdominal hysterectomy):
1-Subcut. vessel ligatures
2-Clamping and cutting of pedicles
supporting the uterus
Safil/Monosyn 2/0-1 HR26s,
HR37s, HR37ss
3-Uterus and cervix removal
44
Surgical procedures-Hysterectomy
4-Closing of the vaginal cuff with interrupted or
continuous sutures
Safil/Monosyn/Safil Quick 3/0-0 HR26s,
HR37s, HR37ss
5-Abdominal closure
45
Surgical procedures- Cesarian section

(C-section)
Surgery
1-Subcut vessel ligatures
2-Rectus muscles and uterus incision
3-Baby delivery
4-Uterus closure with continuous suturing
Safil/Monosyn 2/0-1 HR37s, HR37ss, HR48

5-Layered closure
B1049000 Cesarian set 2
(Safil 1 HR37+Safil 2/0
HR37+Safil 1 HS37s)
G1048999 Cesarian set 1
(Safil 0 HR40s+ Safil 2/0 HR37s+

Safil 2/0 HR37+ Dafilon 4/0 DS24)
46
Surgical procedures -Episiorrhaphy

Surgery
1-Vagina/muscle closure with continuous suturing: Safil
Quick/Safil USP 0 HR37, HR37s, HR40s, HR48, HRT37,
HRT43
2- Skin closure: Safil Quick USP 2/0 DS24, DS30, DSMP24
Episio Set
B0046916
EPIST SQU2X0 90HRT37S,2/0
70DSMP24(M)DDP
B0046911
EPIST SQU.2/0 70 DS24,2X0 90 HRT43(M)DDP
C0046910
EPIST S.Q.U.2/0 70 DS24,0 90 HRT43(M)DDP
47
Common combinations in
Gynaecology/Urology
Mucous membrane
Monosyn 4/0-3/0-2/0 HR17-HR30
Ligatures
Monosyn 5/0 HR17
Urethra/Bladder
Monosyn 4/0-2/0 HR17-HR30
48
Paediatric Surgery
Circumcision: to enable foreskin to be pulled back
Superficial veins ligation Safil Quick 4/0-3/0
Approximation of distal/proximal edges of the foreskin with
interrupted Safil Quick 5/0-4/0 (children) 4/0-3/0 (adults)
HR22-HR26
49
Oral surgery
The oral cavity promotes rapid healing and inhibits
infection
Fast absorbable sutures are recommended to
minimize discomfort
Mucosa
Safil Quick/Monosyn
HR17, HR26s, DSMP11DSMP19
Subcutaneous
Safil Quick/Monosyn/Safil HR17-HR26
Skin
Dafilon/Premilene DS19-DS24, DSMP19DSMP24
50
Ophthalmic surgery
Safil Quick 6/0-8/0 DLm6s, VLM10 for conjuctiva
Safil 5/0-10/0 DLm6, HLm6, VLM8 for muscles, sclera,
conjuctiva
(i.e. Strabismus, Glaucoma (facilitate aqueous outflow to
reduce eye pressure))
51
Orthopaedic Surgery
Capsule repair:
repair of the fibrous tissues that enclose a joint (fingers, toes,
elbow, ankle)
Joint replacement: replacement of an entire joint with a prosthetic device

Total (THA) or partial (endoprosthesis) hip replacement
(arthroplasty, hemiarthroplasty): replacement of the femoral head and of the acetabulum
with prostheses
Shoulder surgery
Spinal surgery
Open reduction of fractures:
reposition and immobilize fractured
bones in their anatomical position
Ligament repair
Knee repair: repair/replace of the soft tissue structures of the knee joint
52
Knee joint
http://www.medterms.com/script/main/art.asp?articlekey=8845
53
Skin
Safil Quick / Non-absorbable sutures
Interrupted technique is usually preferred, absorbable
suture
If a non-abs suture is used, it is removed 3-10 days
postop, but it must be considered they are exposed to the
external environment being a serious contamination
threat. If chosen, Premilene or Dafilon
Key success is early suture
removal before
epithelialization of the suture tract occurs and before
contamination is converted into infection
54
Plastic surgery
Monofilaments
Facelift
http://www.healthcentral.com/animation/408/41/Facelift.html
Breast reduction
http://www.healthcentral.com/animation/408/39/Breast_Reduction.html
55
Monofilaments: Ideal for plastic

surgery
Product
Dafilon
/Premilene/
Monosyn
Monosyn
Monosyn
Dafilon
/Premilene/
Suture
Advantage
Property
Smooth surface
Absorbable
Absorbable
Non-absorbable
Surgeon's/patient
's benefit
Less trauma/
sawing effect
Better cosmetic
result
Less risk of postop reactivity
No suture
removal
Time and cost

saving
Less disconfort
for patient
Suture removal
needed
No suture
material
remaining
56
Product/Surgical Specialities overview

Safil
Safil Quick
Mid-term wound support (18-21 days

50%)
Particularly recommended:
Gastrointestinal surgery
Gynaecology and obstetrics
surgery
Urology
Subcutaneous
Ligatures
Ophthalmology
Microsurgery
Monosyn
Short-term wound support (7 days

50%)
Gynaecology
Paediatrics
Subcutaneous
Small vessel ligatures
Soft tissue approximations (14 days

50%)
Gastrointestinal surgery
Gynaecology and obstetrics

surgery
Urology
Plastic and reconstructive surgery
MonoPlu
s
Long-term wound support (28-35 days
50%)
Abdominal closure
Neurosurgery
Paediatrics
57

Absorbable Suture Indication

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Absorbable Suture Indication

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Droits d'auteur :

Formats disponibles

Synthetic absorbable sutures

Aesculap. All it takes to operate.

Synthetic absorbable sutures

Aesculap. All it takes to operate.

B. Braun absorbable suture

Aesculap. All it takes to operate.

Aesculap. All it takes to operate.

General and Gastrointestinal surgery

Aesculap. All it takes to operate.

The gastrointestinal tract

Aesculap. All it takes to operate.

Upper alimentary tract procedures

Aesculap. All it takes to operate.

Pliable suture: prevent cutting and allow smooth passage

Aesculap. All it takes to operate.

Stomach Surgical ProceduresGastrectomy

Aesculap. All it takes to operate.

Stomach Surgical ProceduresGastrectomy

Aesculap. All it takes to operate.

Stomach Surgical ProceduresGastrectomy

Stomach Surgical ProceduresGastrectomy

Stomach Surgical ProceduresGastrectomy

Aesculap. All it takes to operate.

Stomach Surgical ProceduresPyloroplasty

Aesculap. All it takes to operate.

Stomach Surgical ProceduresPyloroplasty

Aesculap. All it takes to operate.

The small intestine

Aesculap. All it takes to operate.

Intestine Surgical Procedures

Aesculap. All it takes to operate.

Surgical procedures- Bowel

Safil/Monosyn 4/0-0 precuts/reel, HR13-HR30

Aesculap. All it takes to operate.

Surgical procedures- Bowel

Aesculap. All it takes to operate.

Surgical procedures- Bowel

5a- Placement of interrupted sero-submucosal sutures on anterior

HR22, HR26, HR30, DR

Surgical procedures- Bowel

5b- Muscle suturing with interruptes stitches

Safil/Monosyn/Premilene 4/0-2/0 HR17HR22, DR

5b- Serosa suturing

Absorbable sutures (non abs might be used as well)

Aesculap. All it takes to operate.

Surgical procedures - Colorectal

Aesculap. All it takes to operate.

Low anterior resection

Surgical procedures- Colorectal anastomosis by

Aesculap. All it takes to operate.

Surgical procedures- Appendectomy

Aesculap. All it takes to operate.

Surgical procedures- Appendectomy

5-The appendix stump is inverted

Aesculap. All it takes to operate.

The biliary tract

Aesculap. All it takes to operate.

Surgical procedures - Cholecystectomy

Aesculap. All it takes to operate.

Aesculap. All it takes to operate.

Surgical procedures - Cholecystectomy

3- Cystic artery and cystic duct

Aesculap. All it takes to operate.

Aesculap. All it takes to operate.