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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.