Suture types & comparison training ppt.

TrainingTraining Manual

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STERICAT PLANT at Manesar

Company Presentati

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Mission and Vision of STERICAT Sutures

Mission: Leading suture Manufacturing and Marketing

company of India.

Vision: Offering high quality surgical products, developed in

close relationship with our customers and thus close to the market, for a reasonable price in order to help the hospitals save money.

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30 years of Suture Manufacturing experience

Training ManualTraining

Stericat is governed by International Quality Management System an ISO 13485: 2003/CMD CAS,

ISO 9001: 2008, CE along with CE as per MDD 93/42/EEC as amended WHO GMP certified Company

Way to Entrance Reception

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Admn. Office Changing Room

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Changing Room

At our state of the art CLASS 100,000 facility, we operate with a quality assurance system, based on written procedures, exhaustive in process controls and a meticulous quality plan. An ever attentive technical team along with employee participation monitors manufacturing of sutures from raw material to finished product stage ,enabling us to guarantee product reliability and Customer Satisfaction. At Stericat, we have a full in house testing facility to conduct all Chemical, Instrumental and Microbiological Tests.

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Pouch Opening Dry Division

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Production Control Room Wet Division

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Winding Needle Attachment

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Polishing Room Inspection Room

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World Class Testing Laboratory

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Filament Uniformity Testing

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Filament Attachment by Pneumatic Needle Crimping

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Microbiology Tests & Packaging

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Sealing Sterilisation

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STERICAT Sutures, MESH & Speciality Products are available:

•Human use•Veterinary use•Third parties ( US and European Companies)•Global Export

Product varieties like:•Sutures•Pro-Set (Customized Suture Sets)•Special Suture Sets


STERICAT FAMILY

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Marketing Office at South Delhi

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Presence in all Reputed Hospitals

TAMIL NADU GOVT ANDHRA GOVT DELHI GOVT ARMY HOSPITALS RAILWAY HOSPITALS GUJRAT GOVT MAHARASTHRA GOVT RAJASTHAN GOVT BIHAR GOVT. ORISSA GOVT MP GOVT PUNJAB GOVT HP GOVT HARYANA GOVT & ALL OTHER MAJOR HOSPITALS OF REPUTE

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Presentation Contents

HistoryHistory

Suture classification and selectionSuture classification and selection

NeedlesNeedles

Suture labelSuture label

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Workshop Contents

Suture presentation Suture presentation

Basic Suture Techniques VideoBasic Suture Techniques Video

Knot tying & suture exercisesKnot tying & suture exercises

Evaluation.Evaluation.

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HISTORY

The origins of surgery can be traced back many centuries. Through the ages, practitioners have used a wide range of materials and techniques for closing tissue……..

1650 BC – 2000’s AD

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In the tenth century BC, the ant was held over the wound until it seized the wound edges in its

jaws. It was then decapitated and the ant's death grip kept the wound closed.

AntsAnts

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Thorns

The thorn, used by African tribes to close tissue, was passed through the skin on either side of the wound.

A strip of vegetable fibre was then wound around the edge in a figure eight.

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Sterilised Catgut

The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading

through the eye of the needle before use.

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Swaged On Needles

Post World War II brought the swaged-on needle. The thread fits into the hollow end of the needle, allowing it to pass through tissue without the double loop of thread that exists with a conventional needle, reducing

tissue trauma.

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Raw Material

Biological: Linen Silk Collagen

•

Metallic: Stainless Steel

Synthetic: Polypropylene

Polyester

Polyamide

Polyglycolic acid

Polyglactin

Poliglecaprone 25

Polydioxanone

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Since 1970’s

From 1950’s

Criteria of suture material choice

• Calibre

• Lineal tensile strength

• Knot tensile strength

• Knot security

• Thread surface

• Flexibility

• Elongation / Elasticity

• Capillarity

• Period of useful tensile strength

• Period of absorption

• Tissue reaction

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Gut/Chromic GutMade of submucosa of small

intestines

Multifilament

Breaks down by Phagocytosis: Inflammatory reaction.

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Suture Classification and SelectionSuture Classification and Selection

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Suture ClassificationSuture Classification

NaturalNatural or or SyntheticSynthetic (man made) (man made)

MonofilamentMonofilament or or MultifilamentMultifilament (braided) (braided)

Absorbable Absorbable or or Non-AbsorbableNon-Absorbable

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The Ideal Suture

Minimal tissue reaction

Smoothness - minimum tissue drag

Low Capillarity

Max tensile strength

Ease of handling - Minimum memory

Knot security

Consistency of performance

Predictable performance

Cost effectiveness

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Suture Size

5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0

Thick

Thin

USP (United States Pharmacopoeia)

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Multifilament (braided)Multifilament (braided)

Suture ClassificationSuture Classification

MonofilamentMonofilament

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Braided v Monofilament

� Has capillary action� Increased infection risk� Less smooth passage� Less tensile strength� Better handling� Better knot security

� No capillary action� Less infection risk� Smooth tissue passage� Higher tensile strength� Has memory� More throws required

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These are absorbed within the living tissueThese are absorbed within the living tissue

Two main characteristics are:Two main characteristics are:

Tensile strength retention Tensile strength retention

Absorption rateAbsorption rate

Absorbable SuturesAbsorbable Sutures

I-COLI-COL :Day 21: 50% Absorption: 60-75 days:Day 21: 50% Absorption: 60-75 days

I-COL FastI-COL Fast :Day 06: 50% Absorption: 40-45 days:Day 06: 50% Absorption: 40-45 days

MonoColMonoCol:Day 28:50% Absorption: 180-210days.:Day 28:50% Absorption: 180-210days.

StericrylStericryl ::Day 21: 50% Absorption: 90-120daysDay 21: 50% Absorption: 90-120days..

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Absorbable Sutures

I-COL I-COL Fast MONOCOL STERICRYL

MATERIAL100%

Polyglycolic Acid.

100% Polyglycolic Acid. Polydioxanone Polyglecaprone 25

STRUCTUREBraided

( Coated )Braided

( Coated )Mono-filament Mono-filament

COATINGPolycaprolactone + Calcium Stearate

Polycaprolactone + Calcium Stearate NA NA

50% TENSILE STRENGTH 18-20Days 6-7 days 28 Days 18-21 Days

ABSORPTION PROFILE 60-75Days 40-45 Days 180-210 Days 90 - 120 Days

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Characteristics of Non-Absorbable Sutures

PermanentOnly used when long term support is requiredRemoved when used for skin.Tissue reaction generally low (except silk)However silk, linen and even nylon will lose tensile strength over a

period of timeTrue non-absorbable sutures include polyester, polyethylene,

polybutester, polypropylene and steel

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Suture Handling

1. Package Memory:Grasp strand close to needle and at end of strand and gently stretch

2. Opening Suture Foil:Tear in direction indicated to gain best needle exposure.

3. Arming needleArm needles 2/3rds distance between tip and swage

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Options to Close a Wound

Traditional sutures

Mechanical sutures

Tissue adhesives

Adhesive suture strips

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Surgical Sutures Presentations• Single Armed (One Needle)

• Double Armed (Two Needle)

• Loop Suture

• Pre-Cuts (Ligatures)

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Knot Tying & SuturingKnot Tying & Suturing

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Principles of Surgical Sutures• Wound edges approximation and ensure strength according to tissue

properties• Suture degradation profile according to wound healing process• Handling properties according to surgeon’s expectations ( flexibility,

smoothness, knot holding,…) Strong tissue with slow healing Fascia

Tendons

Weak tissue with quick healing

Muscles Intestines

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STERICAT Surgical Sutures

• Suture knots

Approximate tissues & hold wound edges

• Ligatures

• Identification of structures (Vessel loops)

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Most common knots in surgery• Square knot Surgeon's knot

• Most common techniques in surgeryContinuous suture (over and over)

Simple knots

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Training54

Weakest point in the suture

• Every surgeon has his own knotting technique.• USP / EP standards determine minimum values.

Knot pull Tensile Strength

Classification of Surgical Sutures

Surgical sutures can be classified according to

• Raw Material

• Structure

• Absorption profile

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Suture from STERICAT according to structure

Multifilament: braided or twisted

Monofilament

Pseudo-monofilament


Absorbable Suture Characteristics

• Degradation profileEnzimatic (Biological sutures) : CatgutHydrolysis (Synthetic sutures) : Abs. Syn.

• 50% tensile strength retention periodShort term : 7 days : I-COL FASTMid term : 14-21 days : I-COL ,

POLYCOL & STERICRYL

Long term : 28-40 days : MONOCOL

• Mass absorption timeShort term : 42 days : I-COL FASTMid term : 60-90 days : I-COL , POLYCOL &

STERICRYLLong term : 6 months : MONOCOL

0

20

40

60

80

100

0 3 6 9 12 15 18 21 24 28

Vicryl Rapide Safil Quick Catgut Plain

Catgut Chromic Safil Monosyn

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STERICAT suture, according absorption profile

• Absorbable suturesDegradation 50% tensile strength retention periodMass absorption time

• Non absorbable suturesRemain in the body forever

• “Pseudo-non absorbable sutures”Absorbed in a 2-3 years period

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I-COL® , POLYCOL ®I-COL ® FASTSTERICRYL ®MONOCOL ®CATGUT Plain / Chrom

STERILENE®STERIPOL®/STERIBON ®STERISTEEL®

STERILON ®STERISIL ®

TRAINNING

Calibre - Diameter• USP: United States Pharmacopoeia-4-0 is 0000 smaller than 3-0-Different systems for organic and synthetic materials.

3/0

• EP: European Pharmacopoeia (Metric system)0.01mm diameter = EP 0.1 (Minimum thread diameter x 10)0.35mm diameter = EP 3.5

2

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Calibre - Diameter

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Lineal Tensile StrengthMaximum linear load depends on• Thread material• Calibre• Structure

STRENGTH = SECURITY

Least material possible for secure hold.

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Training62

Knot-pull tensile strength according to the material (Kg)

5.4

4.5

3.75

3.75

3.75

3.75

3.5

3.25

3.25

2.45

8.5

0 1 2 3 4 5 6 7 8 9

Steel monofilament

Polyglycolic acid

Glyconate

Polypropylene

Polyamide monofilament

Silk

Supramid

Polyester monofilament

Polyester braided and coated

Polyester braided

Catgut

Strength Changes with the Material

Knot SecurityRelated to:• Flexibility.• Elasticity.• Suture Surface.• Knotting technique.• Surgeon’s experience. • Silk, linen, catgut.• Braided polyester,braided

absorbables.• Monofilar absorbable and

non absorbable.• Stainless steel.

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2 = 1

Closed knot = Security

Thread surface

Friction between thread and tissue• Tissue drag.• Knot repositioning.

Surface smoothness depends on:• Material. • Structure. • Coating.

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Flexibility

Flexibility depends on:• Material • Structure • Calibre

Flexibility eases:• Handling• Adaptation of wounds • Knot security

Flexibility = easy handling65

•Silk, synthetic absorbable braided

•Linen, braided polyesters

•Catgut

•Monofilaments

•Stainless steel

Elongation / ElasticityElongation: stretching of thread

-If elastic: comes back to original length- if not: deformation occurs (thinner- longer)

Skin closure: Elasticity = Less scar

Vascular anastomosis: No elongation to keep anastomosis closed.

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Elasticity

From less to most elastic:

• Stainless steel• Linen,Silk,Braided Synthetic absorbables,Braided polyester• Catgut• Absorbable monofilaments• Polypropylene• Polyester monofilament• Nylon

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Capillarity

Capillarity means the action by which the surface of a liquid where it is in contact with a solid

(as in a capillary tube) is elevated or depressed depending on the relative attraction of the molecules of the liquid for each other and for those of the solid.

This attraction of molecules means for sutures that liquid like blood or even bacteria may by elevated / transported through a suture thread.

Capillarity encourages infection causing suture sinuses and abscesses.

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Capillarity and Suture material No capillarity:• Stainless steel• Monofilaments (Synth. Absor., Polyester, Polypropylene and Polyamide)

Not likely to have capillarity:• PGA• Coated polyester• Catgut• Coated silk

Capillarity:• Linen• Braided polyester

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Period of useful tensile strength = 50%

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days0

50

100

%Wound healing process

Tensile strength retention loss absorbable suture

Suture useful

x

Period of useful tensile strength Suture material 50 % Period useful tensile strenght Polyglycolic acid 18-21 days Poliglecaprone 14 days Polydioxanone 28-35 days

0102030405060708090

100

0 8 16 25 30

days

% w

ou

nd

healin

g

SkinColonStomachAponeurosisUrinary Bladder

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Period of mass absorption

Polyglycolic Acid I-COL 60-75 days

Polyglactin 910 POLYCOL 60-75 days

Polyglycolic acid I-COL FAST 40–45 days

POLIGLECAPRONE 25 STRICRYL 90-120 days

CATGUT PLAIN /CHROMIC STERICAT 90 days

Polydioxanone MonoCOL 180 – 210 days

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Actual absorbable suture range

Term Short Mid Long

Monofilament STERICRYL® MonoCOL®

Polyfilament I-COL® FAST I-COL / POLYCOL®

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Absorbable: Until when useful? Tensile strength

ABSORBABLES SUTURES

I-COL VIOLET

I-COL FAST

POLYCOL

STERICRYL

MONOCOL

CATGUT.

Training 74Company Presentation

PGA and SterilizationAs PGA is susceptible to degradation from moisture

and gamma rays:Low humidity ethylene oxide gas sterilization procedures are used and moisture-proof packaging.

Acceleration of in vivo degradation due to gamma irradiation has been exploited to create devices where early fragmentation is desired.

This is how we create I-COL FAST where we accelerate the degradation profile of the suture, by breaking down the molecules.

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Tissue Reaction

Related to:• Material• Amount of suture

Calibre Knot type

• Structure / Capillarity

Low Tissue Reaction = Security

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I-COL VIOLET

Training 77

Mid-term braided and coated synthetic absorbable suture,

made of pure polyglycolic acid (violet or undyed).

High tensile strength

Secure holding of first throw

Excellent knotting ability

Smooth passage through tissue

Easy handling

Sizes available:USP 2 to 10/0

Surgical Specialties

Gastrointestinal Surgery.Gynaecology / Obstetrics.Ophthalmic surgery.Orthopaedics.Urology.Skin closure. (intra, sub, skin)Neurosurgery.

Company Presentation

I-COL® FAST

Training 78

Short-term synthetic absorbable braided and coated suture(POLYCAPROLACTONE+CALCIUM CITRATE),

made of low molecular weight polyglycolic acid.

High initial tensile strength

Predictable and constant degradation rate

Good knot security

Excellent handling properties

Quick mass absorption

Sizes available-USP8/0 to2

Used in Specialties

Gynaecology / Obstetrics. (e.g. episiotomies)Ophthalmic surgery. (e.g. conjunctiva suturing)Oral surgery. (e.g. oral mucosa)Paediatric surgery.Skin closure. (Intra, sub, skin)Ligatures.


STERICRYL.

Training 79

Mid-term

absorbable synthetic undyed monofilament

Suture made of poliglecaprone 25

Superior initial knot tensile strength

Ideal degradation profile for soft tissues

Smooth tissue passage

Excellent knot security

Quick mass absorption

Sizes available:6/0 to 1

Used in SpecialtiesGastrointestinal surgery.Gynaecology / obstetrics.Urology.Plastic and reconstructive surgery.Skin closure. (Intra, sub, skin)Ligatures.


MONOCOL

Training 80

Synthetic long-term

absorbable monofilament suture

made of polydioxanone,dyed violet.

High knot tensile strength

Outstanding strength retention for extended wound support

Very flexible, Pliable and easy to knot

Conveniently eligible


Sizes available :7/0 to 2Also available in Loop 150cm, size 1, 40mm heavy

Used in specialties.

Abdominal wall closure.Orthopaedics.Paediatric cardiovascular surgery


NON-ABSORBABLE SUTURES

STERILENE

STERIPOL

STERILON

STERISIL

STERISTEEL


Training 82

Cardio-vascular range of sutures

Sterilene

Steripol

Steristeel


STERILENE

Training 83

Synthetic non-absorbable monofilament suture

made of Polypropylene,

Blue colour - enhanced visibility.


Excellent knot run down and security

Optimal elasticity and elongation properties


Used in specialties.Vascular surgery,Cardiac surgery,Plastic and reconstructive surgery,Skin closure. (intra, sub, skin)Neurosurgery.Microsurgery.Gastrointestinal surgery.


STERILON® Synthetic

non-absorbable monofilament suture

made of polymers Polyamide 6/6.6 (dyed blue),

Polyamide 6.6 (dyed black) or Polyamide 6 (undyed).

Flexible, easy to handle and tie


Excellent histocompatibility

Sizes available: 11/0 to 1

Training

Used in specialties

Skin closure. (intra, sub, skin)Plastic and reconstructive surgery.Microsurgery.Ophthalmic surgery.Neurosurgery.


STERIPOL/STERIBON

Training 85

Silicone coated,

Multifilament braided Polyester fibers.

Unique PTFE oval pledget design improving adaptability to underlying anatomical structures

Improved passage through tissue

Excellent knot run-down properties

Minimised tissue drag and sawing

Optimal knot security

Available in single packs (1, 2 sutures) or Multipacks (4, 8 sutures) either green or white.

Pledget sizes:3x3 & 6x3,oval & rectangular.Sizes available:6/0 to 5(green & white)

Used in Specialties

Cardiac surgery (valve replacement)

Orthopaedics


STERISIL®

Training 86

non-absorbable,

braided and coated suture,

made of natural silk filaments

available in black.

Excellent handling properties

Good knot security


Used in Specialties

General surgery

Skin closure

Oral surgery

Ophthalmic surgery (Virgin silk)

NeurosurgeryLigatures


STERISTEEL®

Training 87

Non-absorbable twisted or

monofilament suture

made of corrosion-resistant steel

for orthopaedic and Cardiac surgery.

USP 5/0 (1 metric) to USP 7 (9 metric)

Exceptional tensile strength

Excellent tissue compatibility

Sizes available:USP 5/0 to 7

Steristeel® - Sternum Closure


Needles

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Basic components for the needleA. Points of needle: 1. Cutting points : it used to penetrate when tissue is

difficult to be penetrated as skin and tendon2. Reverse cutting3. Taper point : these needles are used in soft tissue such as

intestine and peritoneum, the sharp point at the tip of needle

4. Blunt point : these are using for suturing friable tissue such as liver and kidney

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Basic components for the needleB. Body of needle :

1.Straight 2.Curved

C. Eyed of needle: The eye is the segment of needle where the suture strand is attached

1.Eyed needle :Like of any household sewing needle

2. French eye needle : It has a slit from the inside if the eye to the end of the needle through which the suture is drawn

3.Eyeless needle : The suture strand the needle are one unit

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Cutting vs Reverse Cutting

Cutting

Reverse cutting

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Points of Needles

CuttingCutting edge on

inside of circleSkinTraumatic

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Points of Needles

Reverse CuttingCutting edge on

outside of circleSkinLess traumatic than

cutting

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Points of Needle

Taper point

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Shapes of Needles

3/8 circle

1/2 circle

Straight

Specialty1Training

Needle CurvatureNeedle Curvature

Corporate presentatio

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Taper Blunt

Conventional TAPERCUT Reverse cutting

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Needle point Geometry

Taper-Point•Suited to soft tissue•Dilates rather than cuts

Reverse cutting

•Very sharp•Ideal for skin•Cuts rather than dilates

Conventional Cutting

•Very sharp•Cuts rather than dilates•Creates weakness allowing suture tearout

Taper-cutting

•Ideal in tough or calcified tissues•Mainly used in Cardiac & Vascular procedures.

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Medical Grade Class Steel Types

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Summary of Needles

1. Needles are made of steel alloy (Medical Grade).STERICAT we use controlled hardness of VPN 525 to 625 with a coating so they stay sharp for multiple passes through tissue.

2. Different needle points for different tissues .

3. Choose the needle that will cause the least trauma.

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Suture Label

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The Suture Packaging

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STRAND SIZE

MATERIALSTRAND LENGTH

COLOUR

NEEDLE CIRCLE

POINT TYPE

NEEDLE LENGTH

PRODUCT CODE

Training

Outer Pack Label

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SPECIALITY PRODUCTS

HERNIA REPAIR – STERILENE MESH, STERIFLEX MESH, STERILENE MESH KIT

C-SECTION KIT

STERISLING-Transobturator Sling System

107Training

SPECIALITY PRODUCTS

HERNIA REPAIR – STERILENE MESH, STERIFLEX MESH, STERILENE MESH KIT

C-SECTION KIT

STERISLING-Transobturator Sling System


STERILENE® Mesh

Training 109

STERILENE ® Mesh

is made from monofilament polypropylene,

Rapid healing and tissue penetration

Closed, rounded edges

Thin mesh structure

Excellent transparency

Good handling

Well tolerated

Good stability

Used in SpecialtiesHernia repair.Reconstruction of the chest wall.Reinforcement of fascial tissue, when non-absorbablereinforcement material is requiredFor conventional and minimally invasive techniques.


STERILENE MESH® ULTRA LIGHT

Training 110

Lightweight polypropylene mesh

Improved bicompatibilitySoft and pliable

Thinner,

more conformable

Flexible,

strong and secure

Full transparency

Easy placement.

Used in Specialties.Inguinal hernia.Incisional hernia.Reconstruction of chest wall.For conventional and minimally invasive techniques.


STERISLING


STERISLING Trans-Obturator Needle System

The Transobturator Needle System consists of Two Curved Medical Grade Stainless Steel reusable passers.

They are used to place Sling for Female patients of Stress Urinary Incontinence (SUI) with minimal blind passage.

Making it very safe, It never enters the Reptropubic space & Abdominal wall.

Decreased risk of: Bowel, Bladder Injury & Major Bleeding.

Training Company Presentation


Hernia is a sac lined by peritoneum that protrudes through a defect in the layers of the abdominal wall.

Generally, a hernia mass is composed of a peritoneal sac, into which organs or other abdominal tissues can slip.

Most hernias occur in the abdominal cavity.

Although a hernia can develop on any part of the abdominal wall.

The areas near the natural openings in the groin areas (inguinal hernias), below the groin (femoral hernias), through the naval (umbilical hernias) through old surgical incisions (incisional hernias) are the most common.

Trend – Mesh Materials

Training115

Standard

Super-LightLightUniversal-lightTraditional Mesh

1997 2002 20052004

Light, Large porous

Heavy, Small porous

Lightweight Meshes are the new Standard.


TYPES OF HERNIA

Inguinal Hernias-

Indirect Inguinal HerniasThis occurs due to a weakness in the abdominal wall present at birth.

In men, this weakness is caused by a space that is created as the testes and spermatic cord descend by way of the inguinal canal (a / ½ inch canal)

Direct Inguinal HerniaThey are most common in men and usually later in life, most often

after 40, Direct inguinal hernias are due to an acquired wear and tear in the abdominal wall.

Training 117

Training 118

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Congenital Diaphragmatic Hernia is a birth defect in which abdominal organs protrude up into the chest cavity.

Femoral Hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the upper thigh area.

Hiatal Hernia is the protrusion of a portion of the stomach through an opening in the diaphragm called the hiatus. Hiatal hernia is also called a hiatus hernia.

Incisional Hernia is a hernia that develops through a previous surgical incision. This can occur anywhere on the abdomen or back.

Inguinal Hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the groin area (also called the inguinal canal). Inguinal hernia is the most common type of hernia.

Umbilical Hernia is the protrusion of part of the intestines or abdominal lining through the abdominal wall around the belly button. It most often occurs in infants ages six months and younger.

ENDOSCOPIC HERNIA REPAIR (Minimally invasive surgery )

There are two forms of Endoscopic Hernia repairs:-

Trans-Abdominal Pre-Peritoneal (TAPP), this repair involves entry into the abdominal cavity with peritoneal incision and dissection, Hernia reduction,

Mesh placement, and Closing Peritoneum.

In Totally Extra-Peritoneal (TEP) Hernia repair the abdominal cavity is not entered. The working space is created by pre-peritoneal dissection.

Mesh is placed without peritoneal incision.

Training 120

Advantages of large-pore sized, lightweight, monofilament Polypropylene Meshes : Improved biocompatibility Diminished foreign body sensation Less postoperative pain Lower rate of seroma formation Faster recovery Optimal incorporation into the surrounding tissue Better elasticity while maintaining the dymanics of the abdominal

wall Better handling characteristics Easy modeling to the body tissue

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ENDOSCOPIC HERNIA REPAIR (Minimally invasive surgery )


a) Midline

b) Right or Left Paramedian

c) McBurnny

d) Oblique inguinal

e)Sub-costal (Kocher’s)


a. Midline The most commonly used incision, made longitudinally in the center of the abdomen along the linea alba nad between the muscles. Can provide access to all quadrants,. i.e: Gastrectomy.

b Right or Left Paramedian

Vertical incision, lateral and parallel to the midline. Used for specific surgical procedures, e.g. Splenectomy.

c McBurnny The incision generally used for an Appendectomy.

d Oblique Inguinal Incision made in area of groin for Herniorrhaphy

e Sub-costal (Kocher’s)

Incision made below the ribs generally for Gallbladder procedures.


Skin Protective covering

Sub-cutaneous tissue Fatty layer under the skin. (Thickness will vary considerably according to individual’s weight.

Fascia (Anterior and Posterior) – a layer of firm connective tissue that covers muscles.

Muscle Fibrous tissue formed into sheaths

Peritoneum Thin membranous lining of abdominal cavity beneath the posterior fascia

Training 125


SKIN

SUBCUTANEOUS FAT

Anterior Fascia

Muscle

Posterior Fascia

Peritoneum

TISSUE LAYERS OF THE ABDOMEN

Skin Protective covering, The final layer closed.

Sub-cutaneous tissue Closing the subcutaneous tissue eliminates the possibility of dead spaces where accumulation of tissue fluids can delay healing processes and cause infection. Sub-cutaneous layer is thinFatty layer under the skin. (Thickness will vary considerably according to individual’s weight.

Fascia (anterior & posterior)Layer of firm connective tissue that covers muscles.

Muscle Fibrous tissue formed into sheaths

Peritoneum Thin membranous lining of abdominal cavity beneath the posterior fascia.

Training 127


Posterior Fascia

(fascia on the posterior side of the muscle sheath) where it does exist, is included in this layer.Note: Where extreme obesity or stress is encountered, surgeon will place retention sutures through all layers of the abdomen for extra security. Most often, retention sutures are put in prior to closure of the peritoneum.

Muscle Is frequently reflected rather than cut, and therefore does not require closure. If muscles have been transected they may be closed separately or together with the anterior fascia.

Fascia (anterior)

Is relied upon to re-establish postoperative abdominal wall strength. Therefore, anterior fascia closures are of extreme importance. Care must be taken in approximating the fascia to insure that there is sufficient distance from the incision line to the closure bite, otherwise the fascia may tear before it is healed from sudden stress such as a cough.

Training Manual

Peritoneum 2-0 or 3-0Muscles 1-0 or 1Linea Albas 1Sheath 1-0 or 1Subcutaneous Fat 3-0Esophagus 3-0 SilkStomach 2-0Anastomosis 2-0 or 3-0Kidney 1-0Urinary Bladder 2-0Gynaec. Operations 1-0 and 1Ovarian Surgery 2-0Tuboplasty 10-0 or 8-0Vasovasostomy 10-0 and 1Tendons 4-0 Polyester or 5-0 Stainless Steel

Training Training

S. No. NEEDLE DESCRIPTION Length SIZE CODE LAYER

I-COL-FAST (P.G.A.) Polyglycolic Acid

1 3/8 CIRCLE REVERSE CUTTING (P.POINT) 26mm, 70cm. . .3/0 SFN2732 SKIN

2 1/2 CIRCLE REVERSE CUTTING 30mm, 90cm. .1/0 SFN2761 EPISIOTOMY REPAIR

3 1/2 CIRCLE CUT TAPER 35mm, 90cm. .2/0 SFN2762(H) AS ABOVE

4 1/2 CRB & 1/2 C REVERSE CUTTING, (Double Armed) 36mm, 140cm .2/0 SFN2777 AS ABOVE

MONOCOL ( P.D.) Polydioxanon

5 1/2 CRB 40mm, 90cm. .1/0 SFN9371(H) MUSCLE

6 1/2 CRB 40mm, 90cm. 1 SFN9347 MUSCLE

7 1/2 CIRCLE RB, HEAVY LOOP 40mm, 150cm. 1 SFN9261 LOOP, SINGLE LAYER

POLYCOL ( Polyglactin 910 )

8 1/2 CIRCLE R.B. (Double Armed) 40mm, 90cm & 140cm 0,1/0 SPL2346 FASIA,MUSCLE

9 ½ CRB 30mm, 90cm. .2/0 SPL2317 BOWLE ANASTOMOMIS

10 ½ CRB 30mm, 90cm. .1/0 SPL2338 FASIA MUSCLE

11 1/2 CIRCLE REVERSE CUTTING (ORTHO) 36mm. 90cm. .1/0 SPL2534X FASIA MUSCLE(ORTHO)

12 ½ CRB 40mm, 115cm. 1 SPP2347LS FASIA MUSLE

13 ½ CRB 20mm, 70cm. .3/0 SPP2437 FASIA MUSLE

14 ½ CRB 30mm, 90cm. .2/0 SPP2317 BOWLE ANASTOMISIS

15 ½ CRB 30mm, 90cm. .1/0 SPP2338 BOWLE ANASTOMISIS

16 ½ C REVERSE CUTTING (ORTHO) 36mm, 90cm. .1/0 2534X FASIA MUSLE(ORTHO)

17 ½ CRB 40mm, 90cm. .1/0 SPP2346 FASIA MUSLE

18 ½ CRB 40mm, 90cm. .2/0 SPP2345 PERITONEOM

19 ½ CRB 40mm, 90cm. 1 SPP2347 FASIA MUSLE

20 1/2 C.REVERSE CUTTING 40mm, 90cm. .2/0 SPP2382 SKIN ,TOUGH ISSUE

21 1/2C. REVERSE CUTTING (ORTHO) 40mm, 90cm. 1 SPP2421X FASIA MUSLE(ORTHO)

CATGUT CHROMIC

22 ½ CRB 20mm, 76cm. .3/0 SFN4237 BOWEL ANASTOMISIS



25 ½ CRB (HEAVY) 40mm, 76cm. 1 SFN4259 GYNEC. 'c' -SECTION

26 ½ CRB (HEAVY) 45mm, 100cm. 2 SFN4228 GYNEC.HYSTRECTOMY

27 3/8 CRB 16mm, 76cm. .4/0 SFN5048 URO

28 3/8 CIRCLE CUTTING 16mm, 76cm. .4/0 SFN4280 PLASTIC Training Training Manual

STERISIL ( Baided Silk )

29 3/8 C.SPATULATED (P.POINT) 6mm, 38cm. .6/0 SFS-5043 OPTHAL

30 ½ CRB 20mm, 76cm. .3/0 SFS-5087 BOWL ANASTOMISIS

31 ½ CRB 25mm, 76cm. .3/0 SFS-5070 BOWL ANASTOMISIS

32 3/8 C.REVERSE CUTTING 26mm, 76cm. .3/0 SFS-5028 SUBCUTICULAR,SKIN

33 ½ CRB 30mm,76cm. .2/0 SFS-5333 INTESTINAL ANASTOMOSIS

34 ½ CRB 30mm, 76cm. .1/0 SFS-5334 INTESTINAL ANASTOMOSIS

35 3/8 C.REVERSE CUTTING 45mm, 76cm. .2/0 SFS-5036 SUBCUTICULAR,SKIN

36 3/8 C.REVERSE CUTTING 45mm, 76cm. .1/0 SFS-5037 (SKIN) SUBCUTICULAR,SKIN

37 3/8C. REVERSE CUTTING 60mm, 76cm. 1 SFS-5062A TOUGH SKIN

STERICRYL ( Poliglecaprone 25 )

38 3/8 C.REVERSE CUTTING 16mm, 70cm. .4/0 STR1205 SUBCUTICULAR,SKIN

39 3/8C.CUTTING(P.POINT) 25mm, 70cm. .3/0 STR1326 SUBCUTICULAR,SKIN

STERILON ( Monofilament Polyamide) NYLON

40 3/8 CIRCLE SPATULATED (P.POINT) 6mm, 38cm. .10/0 SFN3718 OPTHAL

41 3/8 CIRCLE SPATULATED (P.POINT) 6mm, 38cm. .9/0 SFN-3715 OPTHAL

42 3/8 CIRCLE SPATULATED, (P.POINT) 6mm, 38cm. .8/0 SFN-3322 OPTHAL

43 3/8 CIRCLE SPATULATED (P.POINT), (D. Armed) 6mm, 38cm. .10/0 SFN-3719 OPTHAL

44 3/8 CIRCLE R.CUTTING 10mm, 38cm. .4/0 SFN-3326 PLASTIC



47 3/8 CIRCLE R.CUTTING(P.PONT) 12mm, 70cm. .5/0 SFN-3317 PLASTIC

48 3/8 CIRCLE R.CUTTING(P.PONT) 12mm, 70cm. SFN-3318 PLASTIC

49 3/8 CIRCLE R.CUTTING 26mm, 70cm. .3/0 SFN-3328 SKIN

50 1/2 CRB 40mm, 150cm. .1/0 SFN-3340 LOOP

51 1/2 CRB (HEAVY) 40mm, 100cm. .1/0 SFN-3346 RECTUS/MUCLSE

52 1/2 CRB (HEAVY) 40mm, 100cm. 1 SFN-3347 RECTUS/MUCLSE

53 3/8 CIRCLE REVERSE CUTTING 45mm, 70cm. .2/0 SFN-3336 SKIN

54 1/2 CRB (HEAVY) 50mm, 150cm. 1 SFN-3348 LOOPTraining 132

Suture SelectionBowel: 2/0 - 3/0

Fascia: 1 - 0

Ligatures: 0 - 3/0

Pedicles: 2 - 0

Skin: 2/0 - 5/0

Arteries: 2/0 - 8/0

Micro surgery 9/0 - 10/0

Corneal closure: 9/0 - 10/0133Training

STERICAT FAMILY

134Corporate PresentationTraining

Date post:	16-Jul-2015
Category:	Health & Medicine
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Suture types & comparison training ppt.

Health & Medicine