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RLE 103

SKILLS LABORATORY
KESTER GRANT COLLEGE, PHILIPPINES JUNE 21-22, 27-29, 2011

Presented to: Ms. May San Diego Presented by: Arcalas, Joyce Barazon, Jonathan Catalua, Valerie Joy Del Rosario, Margot Magbanua, Christine Ponseca, Vanessa San Luis, Luigie Miguel

SUTURE [Medical Information]


Today, more and more people are aware that an operating room could not solely operate without the necessary materials. Consequently, one of the most important materials needed in the operating room are the sutures. Generally, sutures are surgical guts, or silk, cotton or metal thread, 18 or more inches long, threaded on a needle. It is used mainly for sewing or suturing together the edges and the surfaces of tissue, for checking the flow of blood, fastening drainage tubes in position, etc. Sutures are either interrupted, each stitch tied separately; or continuous, the thread running in a series of stitches, only the first and last of which are tied.

TYPES OF SUTURES

I. Length and Kinds


The length of sutures naturally varies considerably. Each suture depends on the character of the work and the nature of the operation. For instance, deep work in the pelvis requires a much longer suture than would be necessary in suturing an area closer to the surface of a wound. Experience and judgment, along with the desire of the surgeon, must be the determining factors in details of sutures. Alternatively, there are different kinds of sutures. Each classification is unique and has its own respective function.

II.Absorbable Sutures
1.) Surgical Gut also known as a catgut and is made from the submucous layer of a sheep's intestine. Once cleaned, dried and twisted into threads of various sizes they are prepared for use by special processes, that include innumerable inspections of gauze and tensile strength and scrupulous sterilization. The length of time for complete absorption of surgical gut in a wound varies according to the action of certain hardening agents. 2.) Fascia Lata This muscle connective tissue of beef has been used in reconstructive orthopedic surgery and for the repair of hernias. It is not a true absorbable suture, but becomes part of the tissue after the wound has healed.

III. Non -Absorbable Sutures


1.) Silk This is prepared from the thread spun by the silkworm larva in making its cocoon. It may be twisted or braided, and it comes in sizes comparable with surgical gut. High Tensile Strength Relatively Inexpensive Less Tissue Reaction

III. Non -Absorbable Sutures


2.) Cotton This is made from cotton fibers. The strands are twisted and used for both internal and external suture. It should always be used wet for maximal strength. 3.) Nylon Monofilament Multifilament Braided The chief disadvantage is that a triple knot must be tied

III. Non -Absorbable Sutures


4.) Wire This material has maximal flexibility and tensile strength, yet causes little or no local reaction in the tissue in which it is placed. 5.) Dacron This is a synthetic polyester fiber that has greater tensile strength, minimal tissue reaction, maximal visibility, non-absorbent and non-fraying qualities. 6.) Linen This is made of twisted line thread; it has sufficient tensile strength but is rarely used as suture material.

III. Non -Absorbable Sutures


7.) Silver Wire Clips Many styles of clips are available for the purpose of holding the edges of the tissue in approximation. They tend to produce some scarring when used in the skin, but may be used when the wound is infected. 8.) Silkworm Gut This is made from the fluid secreted by the silkworm when they are ready to form their cocoons. The disadvantage is that they must be soaked in normal saline for about 10 minutes before use to make them pliable. 9.) Mesh This type of suture is made of stainless steel, usually used for hernia repairs and large defects. It is rarely used.

III. Non -Absorbable Sutures


10.) Tantalum This is a bluish bray metal that is non-irritating to the body tissues. It is used because of its high tensile strength and its inert reaction to tissues.

DIFFERENT SUTURE TECHNIQUES

Running Stitch
It is made with one continuous length of suture material. Used to close tissue layers which require close approximation, such as the peritoneum. May also be used in skin or blood vessels. The advantages of the running stitch are speed of execution, and accommodation of edema during the wound healing process. However, there is a greater potential for malapproximation of wound edges than with the interrupted stitch.

Interrupted Stitch
Each stitch is tied separately. May be used in skin or underlying tissue layers. More exact approximation of wound edges can be achieved with this technique than with the running stitch.

Mattress Stitch
A double stitch that is made parallel (horizontal mattress) or perpendicular (vertical mattress) to the wound edge. Chief advantage of this technique is strength of closure; each stitch penetrates each side of the wound twice, and is inserted deep into the tissue.

Purse Stitch
A continuous stitch paralleling the edges of a circular wound. The wound edges are inverted when tied. Commonly used to close circular wounds, such as a hernia or an appendiceal stump.

Smead-Jones / Far-and-NearStitch
A double loop technique alternating near and far stitches. Commonly used for approximating fascial edges.

Continuous Locking, or Blanket Stitch


A self-locking running stitch used primarily for approximating skin edges.

TYPES OF
ANESTHESIA

I. Local Anesthesia
An anesthetic drug (which can be given as a shot, spray, or ointment) numbs only a small, specific area of the body (for example, a foot, hand, or patch of skin). With local anesthesia, a person is awake or sedated, depending on what is needed. Local anesthesia lasts for a short period of time and is often used for minor outpatient procedures (when patients come in for surgery and can go home that same day). For someone having outpatient surgery in a clinic or doctor's office (such as the dentist or dermatologist), this is probably the type of anesthetic used. The medicine used can numb the area during the procedure and for a short time afterwards to help control post-surgery discomfort.

II. Rgional Anesthesia An anesthetic drug is injected near a cluster of nerves, numbing a larger area of the body (such as below the waist, like epidurals given to women in labor). Regional anesthesia is generally used to make a person more comfortable during and after the surgical procedure. Regional and general anesthesia are often combined.

III. General Anesthesia The goal is to make and keep a person completely unconscious (or "asleep") during the operation, with no sensations, pain, awareness, or memory of the surgery. General anesthesia can be given through an IV (which requires sticking a needle into a vein, usually in the arm) or by inhaling gases or vapors by breathing into a mask or tube.

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