Suturing techniques and basics for maxillofacial surgery.pptx

suturing techniques and basics

1. Suturing

2. 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

3. 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. Ants

4. 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.

5. 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.

6. 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.

7. Suture Classification and Selection

8. Suture Classification Natural or Synthetic (man made) Monofilament or Multifilament (braided) Absorbable or Non-Absorbable

9. 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

10. Multifilament (braided) Suture Classification Monofilament

11. 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

12. 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) A+E General

13. Suture Selection Bowel: 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 - 10/0

14. Suture Handling Package Memory Grasp strand close to needle and at end of strand and gently stretch Opening suture foil Tear in direction indicated to gain best needle exposure 3. Arming needle Arm needles 2/3 rds distance between tip and swage

15. Needles

16. 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.

17. Needle Point Geometry Blunt Also known as “Protect Point” Mainly used to prevent needle stick injuries i.e. for abdominal wall closure. Premium point spatula Ophthalmic Surgery Spatula Ophthalmic Surgery DermaX* NEW: ½ The Penetration force ½ The Penetration force Superior Cosmetic Effect

18. Needle Curvature

19. Summary of Needles 1. Needles are made of steel alloy (Surgalloy) with a Nucoat 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

20. Suture Label

21. The Suture Packaging STRAND SIZE MATERIAL STRAND LENGTH PRODUCT CODE NEEDLE CODE WITH LIFE SIZE PICTURE OF NEEDLE NEEDLE LENGTH COLOUR POINT TYPE NEEDLE CIRCLE

22. Principles of Suturing

23. The needle holder should grasp the needle at approximately 1/3 of the distance from the end. The needle should enter the tissue perpendicular to the surface . If the needle pierces the tissue obliquely, a tear may develop Principles of Suturing

24. c. The needle should be passed through the tissue following the curve of the needle . d. The suture should be placed at an equal distance from the incision on both the sides and at an equal depth . e. The needle should pass from the free tissue to the fixed side. Principles of Suturing

25. f. If one tissue side is thinner than the other the needle should pass from the thinner tissue to the thicker one. g. If one tissue plane is deeper than the other, then the needle should pass from the deeper to the superficial side. h. The distance that the needle is passed into the tissue should be greater than the distance from the tissue edge. Principles of Suturing

26. Avoid excessive tissue bites with small needles, as it will be difficult to retrieve them . The tissues should not be closed under tension, since they will tear or necrosis around the suture. If tension is present the tissues should be undermined to relieve it . The suture should be tied so that the tissue is merely approximated and the edges are everted . Principles of Suturing

27. Principles of Suturing The knot should not be placed over the incision line. Sutures should be placed approximately 3-4mm apart. Closer spaced sutures are indicated in areas of tension