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11 Suturing21012015

The document discusses suturing in surgery. It describes factors that affect wound healing like age, nutrition status, and immune response. Surgical principles for wound closure include length and direction of incision, hemostasis, and choice of closure materials. There are different types of wounds and phases of wound healing. The document outlines various suture materials that are absorbable or non-absorbable. Suturing techniques include ligatures, knots, running locks, mattress stitches, interrupted stitches, and subcutaneous stitches. Needle anatomy, shapes, points, and proper needle holding are also covered.

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Putri Sari Septiriani
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223 views30 pages

11 Suturing21012015

The document discusses suturing in surgery. It describes factors that affect wound healing like age, nutrition status, and immune response. Surgical principles for wound closure include length and direction of incision, hemostasis, and choice of closure materials. There are different types of wounds and phases of wound healing. The document outlines various suture materials that are absorbable or non-absorbable. Suturing techniques include ligatures, knots, running locks, mattress stitches, interrupted stitches, and subcutaneous stitches. Needle anatomy, shapes, points, and proper needle holding are also covered.

Uploaded by

Putri Sari Septiriani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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SUTURING

Dr. Charles A Simanjuntak, dr, SpOT(K), MPd


PSPD, FKIK, Universitas Jambi
CharlesASjuntak 2015 2

Wound
CharlesASjuntak 2015 3

Measuring the Strength


• TENSILE STRENGTH--The load per cross-sectional area
unit at the point of rupture2 relating to the nature of the
material rather than its thickness.

• • BREAKING STRENGTH--The load required to break a


wound regardless of its dimension2, the more clinically
significant measurement.

• • BURST STRENGTH The amount of pressure needed to


rupture a viscus, or large interior organ
CharlesASjuntak 2015 4

Factors That Affect Wound Healing

• The patient’s age


• The patient’s weight
• The patient’s nutritional status
• Inadequate Blood supply to the wound site
• The patient’s immune response
• The presence of chronic disease
• Radiation therapy
CharlesASjuntak 2015 5

Surgical Principles

• THE LENGTH AND DIRECTION OF THE INCISION


• DISSECTION TECHNIQUE
• HEMOSTASIS
• REMOVAL OF NECROTIC TISSUE AND FOREIGN MATERIALS
• CHOICE OF CLOSURE MATERIALS
• CELLULAR RESPONSE TO CLOSURE MATERIALS-
• ELIMINATION OF DEAD SPACE IN THE WOUND
• CLOSING WITH SUFFICIENT TENSION
• STRESS PLACED UPON THE WOUND AFTER SURGERY
CharlesASjuntak 2015 6

Classifications of Wounds

• Clean
• Clean-contaminated wounds
• Contaminated wounds
• Dirty and infected wounds
CharlesASjuntak 2015 7

Types of Wound Healing

• PHASE I: INFLAMMATORY RESPONSE (DAY 1 TO DAY 5)


• PHASE II: MIGRATION/ PROLIFERATION (DAY 5 TO DAY 14)
• PHASE III: MATURATION/ REMODELING (DAY 14 THROUGH
COMPLETE HEALING)
CharlesASjuntak 2015 8

Sutures
CharlesASjuntak 2015 9

Absorbable Material:
• Surgical Gut
• Plane
• Chromic
• Polyglactin 910
• Uncoated
• Coated
• Polyglycolic Acid
• Poliglecaprone
• Polyglyconate
• Polydioxanone
• Poly (L-lactide/glycolide)6
CharlesASjuntak 2015 10

Nonabsorbable Materials
• Surgical Silk
• Stainless Steel Wire
• Nylon
• Polyester fiber
• Uncoated
• Coated
• Polypropylene
• Poly(hexafluoropropylene-VDF)
CharlesASjuntak 2015 11

Techniques
CharlesASjuntak 2015 12

Ligatures
• Free tie or freehand ligatures

• Stick tie, suture ligature, or transfixion suture


CharlesASjuntak 2015 13

Knot
CharlesASjuntak 2015 14

Coninuous Suturing Techniques


CharlesASjuntak 2015 15

Running locked
CharlesASjuntak 2015 16

Mattress
(Vertical, Pulley, Far-near, Horizontal)
CharlesASjuntak 2015 17

Tip stich
CharlesASjuntak 2015 18

Interrupted suturing techniques


CharlesASjuntak 2015 19

Interrupted
CharlesASjuntak 2015 20

Purse-string sutures (tabac sac)


CharlesASjuntak 2015 21

Subcutaneous sutures
CharlesASjuntak 2015 22
CharlesASjuntak 2015 23

Needles & needle-holder


CharlesASjuntak 2015 24

Anatomy of a needle
CharlesASjuntak 2015 25

The needle eye


CharlesASjuntak 2015 26

Needle shapes
CharlesASjuntak 2015 27

Needle points & body shapes


CharlesASjuntak 2015 28

Needle-holder jaws
CharlesASjuntak 2015 29

Holding needle holder


CharlesASjuntak 2015 30

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