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RLE 103SKILLS LABORATORY
KESTER GRANT COLLEGE, PHILIPPINES
JUNE 21-22, 27-29, 2011
Presented to:
Ms. May San DiegoPresented by:
Arcalas, JoyceBarazon, JonathanCatalua, Valerie JoyDel Rosario, Margot
Magbanua, ChristinePonseca, VanessaSan Luis, Luigie Miguel
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SUTURE [Medical Information]
Today, more and more people are aware that anoperating room could not solely operatewithout the necessary materials. Consequently,one of the most important materials needed inthe operating room are the sutures. Generally,
sutures are surgical guts, or silk, cotton or metalthread, 18 or more inches long, threaded on aneedle. It is used mainly for sewing or suturingtogether the edges and the surfaces of tissue, for
checking the flow of blood, fastening drainagetubes in position, etc. Sutures are eitherinterrupted, each stitch tied separately; orcontinuous, the thread running in a series ofstitches, only the first and last of which are
tied.
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TYPES
OFSUTURES
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I. Length and Kinds
The length of sutures naturally variesconsiderably. Each suture depends on thecharacter of the work and the nature of theoperation. For instance, deep work in the pelvisrequires a much longer suture than would be
necessary in suturing an area closer to thesurface of a wound. Experience and judgment,along with the desire of the surgeon, must bethe determining factors in details of sutures.Alternatively, there are different kinds ofsutures. Each classification is unique and has itsown respective function.
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II.Absorbable Sutures1.) Surgical Gut
also known as a catgut and is made from thesubmucous layer of a sheep's intestine. Once cleaned,dried and twisted into threads of various sizes theyare prepared for use by special processes, that includeinnumerable inspections of gauze and tensile strengthand scrupulous sterilization. The length of time forcomplete absorption of surgical gut in a wound variesaccording 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 therepair of hernias. It is not a true absorbable suture, butbecomes part of the tissue after the wound has
healed.
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III. Non -Absorbable Sutures
1.) SilkThis is prepared from the thread
spun by the silkworm larva in making itscocoon. It may be twisted or braided,
and it comes in sizes comparable withsurgical gut.
High Tensile StrengthRelatively Inexpensive
Less Tissue Reaction
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III. Non -Absorbable Sutures
2.) Cotton This is made from cotton fibers. The
strands are twisted and used for both internaland external suture. It should always be used
wet for maximal strength.
3.) Nylon
Monofilament
Multifilament
Braided
The chief disadvantage is that a tripleknot must be tied
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III. Non -Absorbable Sutures4.) Wire
This material has maximal flexibility andtensile strength, yet causes little or no local reactionin the tissue in which it is placed.
5.) Dacron
This is a synthetic polyester fiber that hasgreater tensile strength, minimal tissue reaction,maximal visibility, non-absorbent and non-frayingqualities.
6.) Linen
This is made of twisted line thread; it hassufficient tensile strength but is rarely used as suturematerial.
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III. Non -Absorbable Sutures7.) Silver Wire Clips
Many styles of clips are available for the purposeof holding the edges of the tissue in approximation. Theytend to produce some scarring when used in the skin, butmay be used when the wound is infected.
8.) Silkworm Gut
This is made from the fluid secreted by thesilkworm when they are ready to form their cocoons. Thedisadvantage is that they must be soaked in normal salinefor 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.
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III. Non -Absorbable Sutures
10.) Tantalum
This is a bluish bray metal that is
non-irritating to the body tissues. It isused because of its high tensile strengthand its inert reaction to tissues.
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DIFFERENT
SUTURE
TECHNIQUES
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Interrupted Stitch
Each stitch is tiedseparately. May beused in skin or
underlying tissuelayers. More exactapproximation ofwound edges can be
achieved with thistechnique than withthe running stitch.
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Mattress Stitch
A double stitch that ismade parallel (horizontalmattress) or perpendicular
(vertical mattress) to thewound edge. Chiefadvantage of this techniqueis strength of closure; eachstitch penetrates each side
of the wound twice, and isinserted deep into thetissue.
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Purse Stitch
A continuous stitchparalleling the edgesof a circular wound.The wound edges areinverted when tied.Commonly used to
close circularwounds, such as ahernia or anappendiceal stump.
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Smead-Jones / Far-and-NearStitch
A double looptechnique
alternating nearand far stitches.Commonly used
for approximatingfascial edges.
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Continuous Locking, or Blanket Stitch
A self-locking
running stitchused primarily forapproximating
skin edges.
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I. Local Anesthesia
An anesthetic drug (which can be given as a shot,spray, or ointment) numbs only a small, specific areaof the body (for example, a foot, hand, or patch ofskin). With local anesthesia, a person is awake orsedated, depending on what is needed. Local
anesthesia lasts for a short period of time and is oftenused for minor outpatient procedures (when patientscome in for surgery and can go home that same day).For someone having outpatient surgery in a clinic ordoctor's office (such as the dentist or dermatologist),
this is probably the type of anesthetic used. Themedicine used can numb the area during theprocedure and for a short time afterwards to helpcontrol post-surgery discomfort.
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II. Rgional Anesthesia
An anesthetic drug is injected near acluster of nerves, numbing a larger areaof the body (such as below the waist, like
epidurals given to women in labor).Regional anesthesia is generally used tomake a person more comfortable duringand after the surgical procedure.
Regional and general anesthesia areoften combined.
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III. General Anesthesia
The goal is to make and keep a personcompletely unconscious (or "asleep")during the operation, with no sensations,
pain, awareness, or memory of thesurgery. General anesthesia can be giventhrough an IV (which requires sticking aneedle into a vein, usually in the arm) or
by inhaling gases or vapors by breathinginto a mask or tube.