suture and suturing-2550
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SUTURE ANDSUTURE AND
SUTURINGSUTURING
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WoundWound
zzDefinitionDefinition : A bodily injury: A bodily injury causedcausedby physical means, with disruptionby physical means, with disruption
of the normal continuity ofof the normal continuity ofstructurestructure
zz Closed woundClosed wound
zz Open woundOpen wound
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Wound ClassificationWound Classification
zzClean wound : 1Clean wound : 1 -- 5 %5 %
zzClean contaminated wound : 10 %Clean contaminated wound : 10 %
zzContaminated wound : 15 %Contaminated wound : 15 %
zzDirty woundDirty wound : 30: 30 -- 40 %40 %
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Factors that affect wound healingFactors that affect wound healing
zz AgeAge
zz WeightWeight
zz NutritionNutrition
zz DehydrationDehydration
zz Blood supplyBlood supplyzz Immune responseImmune response
zz Chronic illnessChronic illness
zz Drugs and radiation therapyDrugs and radiation therapy
zz SmokingSmoking
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Basic principles in woundBasic principles in woundmanagementmanagement
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1)1) HemostasisHemostasiszzFirst priorityFirst priority
zzBloodless fieldBloodless field
zz
SutureSuture
ligationligation
zzSeromaSeroma andand hematomahematoma can leadcan lead
to infection or to a delay into infection or to a delay inwound healingwound healing
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2) Wound cleansing2) Wound cleansing
zzSterile techniqueSterile technique
zzAnesthesiaAnesthesia
zz IrrigationIrrigation
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3) Wound Exploration3) Wound Exploration
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4)4) DebridementDebridement
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5) Wound closure5) Wound closure
zzHandling of the tissueHandling of the tissuezz Incision planningIncision planning
zzRelaxed skin tension linesRelaxed skin tension lines
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zz underminingundermining
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zzChoice of suture materialChoice of suture material
zzClosing with sufficient tensionClosing with sufficient tension
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zz Tissue moistureTissue moisture
zz Dead spacesDead spaces
zz PostoperativePostoperativewound stresswound stress
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SUTURESUTURETECHNIQUESTECHNIQUES
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Simple interrupted sutureSimple interrupted suturezzThe mostThe most
commonly usedcommonly usedsuture techniques.suture techniques.
zz Goal : approximateGoal : approximate
andand evertevert thethe
wound edge.wound edge.
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Vertical mattress sutureVertical mattress suturezz Useful in inverted woundUseful in inverted wound
zz ExcellentExcellent eversioneversion and precise skinand precise skinedge approximation.edge approximation.
zzTwo bite techniqueTwo bite techniquezz First bite : approximate.First bite : approximate.
zz
Second bite : reduced tension fromSecond bite : reduced tension fromwound edge.wound edge.
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Horizontal mattress sutureHorizontal mattress suturezzTwo biteTwo bite sticthsticth techniquetechnique
zzGood tissueGood tissue evertevert
zz Fair approximateFair approximate
zzSmall simple interruptedSmall simple interrupted
zzSterile stripSterile strip
zzTake tension off the wound edgeTake tension off the wound edge
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Horizontal halfHorizontal halfburriesburries
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Running closure (baseballRunning closure (baseball stitch)stitch)
zzWoundWounds edges easilys edges easily evertevert and longand longstraight woundstraight wound
zz Not used in wound significant risk ofNot used in wound significant risk ofhematomahematoma..
zz
Safe suture material and timeSafe suture material and time
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RunningRunning lock closurelock closure
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RunningRunning lock closurelock closure
zz Significant more tissueSignificant more tissue eversioneversion..zz Reduces the skin tension more than theReduces the skin tension more than the
running closure.running closure.
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RunningRunning intracuticularintracuticular
zz Useful inUseful in keloidkeloid patientspatientszz Removal is quick and easyRemoval is quick and easy childrenchildren
zz If incision longer than 3 cm.If incision longer than 3 cm. surfacesurfacelooploop
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NONNON SUTURINGSUTURINGTECHNIQUETECHNIQUE
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STAPLESSTAPLES
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STERILESTERILE -- STRIPSSTRIPS
zzUsed to close very low tension.Used to close very low tension.zzWound edge approximate.Wound edge approximate.
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SUTURE MATERIALSUTURE MATERIALzz
DiameterDiameterzzTensile strengthTensile strength
zzTissue reactivityTissue reactivity
zz Ease of handling the suture materialEase of handling the suture material
zz Facility for typing and maintaining knotsFacility for typing and maintaining knots
zzThe absorption of the sutures by the bodyThe absorption of the sutures by the body
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6 days1 days
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S i l dlS i l dl
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Surgical needleSurgical needle
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CASE STUDY 1CASE STUDY 1
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CASE STUDY 2CASE STUDY 2
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CASE STUDY 3CASE STUDY 3
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CASE STUDY 4CASE STUDY 4
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CASE STUDY 5CASE STUDY 5
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THANK YOUTHANK YOU
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