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Sutures & Drainage

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Information about Sutures & Drainage

Published on May 16, 2008

Author: blackempress

Source: slideshare.net

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Sutures & Drainage

Sutures Suture material is a foreign body implanted into human tissues During wound closure, a sterile field and meticulous aseptic technique are critical to minimize the risk of wound infection.

Suture material is a foreign body implanted into human tissues

During wound closure, a sterile field and meticulous aseptic technique are critical to minimize the risk of wound infection.

Ideal suture characteristics Sterile All-purpose (composed of material that can be used in any surgical procedure) Causes minimal tissue injury or tissue reaction Holds securely when knotted High tensile strength Favorable absorption profile Resistant to infection

Sterile

All-purpose (composed of material that can be used in any surgical procedure)

Causes minimal tissue injury or tissue reaction

Holds securely when knotted

High tensile strength

Favorable absorption profile

Resistant to infection

TYPES of sutures The type of suture used varies on the operation, depending on the location and environment. Absorbable-broken down in tissue depending on the material can be from ten days to eight weeks Non-absorbable-are not metabolized by the body, and are used therefore either on skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in which absorbable sutures are not adequate

The type of suture used varies on the operation, depending on the location and environment.

Absorbable-broken down in tissue depending on the material can be from ten days to eight weeks

Non-absorbable-are not metabolized by the body, and are used therefore either on skin wound closure, where the sutures can be removed after a few weeks, or in some inner tissues in which absorbable sutures are not adequate

Absorbable sutures Natural- Prepared from beef and sheep intestine Collagen Surgical gut, plain Surgical gut, fast-absorbing Surgical gut, chromic

Natural- Prepared from beef and sheep intestine

Collagen

Surgical gut, plain

Surgical gut, fast-absorbing

Surgical gut, chromic

Absorbable sutures Synthetic- Chemical polymers are absorbed by hydrolysis and cause a lesser degree of tissue reaction. Polyglactin 910 (Vicryl): Poliglecaprone 25 (Monocryl): Polydioxanone (PDS II):

Synthetic- Chemical polymers are absorbed by hydrolysis and cause a lesser degree of tissue reaction.

Polyglactin 910 (Vicryl):

Poliglecaprone 25 (Monocryl):

Polydioxanone (PDS II):

Absorbable sutures Their uses are as follows. Tying off small arteries and veins near the skin. Stitches in the ureter, urinary tract, or biliary tract (where permanent sutures term a focus for stone formation). Closing off tissue spaces, e.g. subcutaneous space. Occasionally for closing the skin in children, where it is an advantage not to have to remove the stitches. In small bowel anastomosis or stomach mucosal anastomosis

Their uses are as follows.

Tying off small arteries and veins near the skin.

Stitches in the ureter, urinary tract, or biliary tract (where permanent sutures term a focus for stone formation).

Closing off tissue spaces, e.g. subcutaneous space.

Occasionally for closing the skin in children, where it is an advantage not to have to remove the stitches.

In small bowel anastomosis or stomach mucosal anastomosis

Non-absorbable sutures Natural Surgical silk- Used for (1) repairing rapidly healing tissues that require minimal support, (2) ligating superficial blood vessels, and (3) suturing subcutaneous fatty tissue. Surgical cotton- Same as silk Surgical steel- Surgical steel suture is used primarily in orthopedic, neurosurgical, and thoracic applications.

Natural

Surgical silk- Used for (1) repairing rapidly healing tissues that require minimal support, (2) ligating superficial blood vessels, and (3) suturing subcutaneous fatty tissue.

Surgical cotton- Same as silk

Surgical steel- Surgical steel suture is used primarily in orthopedic, neurosurgical, and thoracic applications.

Non-absorbable sutures Synthetic Nylon - Stitching the skin, 2 Closure of the abdominal muscles, 3-Ophthalmology and microsurgery Polybutester (Novofil)- Surface closure, permitting adequate tissue approximation while allowing for tissue edema and detumescence. Polyester fiber (Dacron ):1-vessel anastomosis 2-placement of prosthetic materials. Polypropylene (Prolene ): 1-Closure of the skin, particularly for subcuticular sutures.2-Arterial surgery 3-large bowel anastomosis and bile-duct surgery

Synthetic

Nylon - Stitching the skin, 2 Closure of the abdominal muscles, 3-Ophthalmology and microsurgery

Polybutester (Novofil)- Surface closure, permitting adequate tissue approximation while allowing for tissue edema and detumescence.

Polyester fiber (Dacron ):1-vessel anastomosis 2-placement of prosthetic materials.

Polypropylene (Prolene ): 1-Closure of the skin, particularly for subcuticular sutures.2-Arterial surgery 3-large bowel anastomosis and bile-duct surgery

Sizes of sutures Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics). Atraumatic needles are manufactured in all shapes for most sizes.

Modern sutures range from #5 (heavy braided suture for orthopedics) to #11-0 (fine monofilament suture for ophthalmics).

Atraumatic needles are manufactured in all shapes for most sizes.

Suture techniques Common suture stitching techniques include: Simple Interrupted Stitch Running Stitch Mattress Horizontal mattress Vertical mattress Continuous locking Subcuticular

Common suture stitching techniques include:

Simple Interrupted Stitch

Running Stitch

Mattress

Horizontal mattress

Vertical mattress

Continuous locking

Subcuticular

Surgical techniques Continuous Running stitch

Continuous

Running stitch

Surgical techniques Simple interrupted Subcuticular

Simple interrupted

Subcuticular

Surgical techniques Mattress

Mattress

Surgical needles Traumatic needles are needles with holes or eyes which are separate from their suture thread. Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread.

Traumatic needles are needles with holes or eyes which are separate from their suture thread.

Atraumatic needles with sutures comprise an eyeless needle attached to a specific length of suture thread.

Surgical needles There are several shapes of surgical needles, including: straight half curved or ski 1/4 circle 3/8 circle 1/2 circle 5/8 circle compound curve

There are several shapes of surgical needles, including:

straight

half curved or ski

1/4 circle

3/8 circle

1/2 circle

5/8 circle

compound curve

Surgical needles By their point geometry; examples include: taper (needle body is round and tapers smoothly to a point) cutting (needle body is triangular and has a sharpened cutting edge on the inside) reverse cutting (cutting edge on the outside) trocar point or tapercut (needle body is round and tapered, but ends in a sma blunt points for sewing friable tissues side cutting or spatula points

By their point geometry; examples include:

taper (needle body is round and tapers smoothly to a point)

cutting (needle body is triangular and has a sharpened cutting edge on the inside)

reverse cutting (cutting edge on the outside)

trocar point or tapercut (needle body is round and tapered, but ends in a sma

blunt points for sewing friable tissues

side cutting or spatula points

Needles

Other methods Tissue adhesives Topical cyanoacrylate adhesives ("liquid stitches") have been used in combination with, or as an alternative to, sutures in wound closure. Surgical staples Specialized surgery staples, which prove to be faster, consistent & accurate. Staple lines are less likely to leak blood, air or bowel contents.

Tissue adhesives

Topical cyanoacrylate adhesives ("liquid stitches") have been used in combination with, or as an alternative to, sutures in wound closure.

Surgical staples

Specialized surgery staples, which prove to be faster, consistent & accurate. Staple lines are less likely to leak blood, air or bowel contents.

Staples

Drainage A surgical drain is a tube used to remove pus, blood or other fluids from a wound. Drains may be hooked to wall suction, a portable suction device, or they may be left to drain by gravity. Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding.

A surgical drain is a tube used to remove pus, blood or other fluids from a wound.

Drains may be hooked to wall suction, a portable suction device, or they may be left to drain by gravity.

Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding.

Types of drains Jackson-Pratt drain Penrose drain Wound Vac System - Involves the use of enclosed foam and a suction device attached; often used for large surgical/trauma/non-healing wounds. Redivac drain Pigtail drain - has an exterior screw to release the internal "pigtail" before it can be removed Davol Chest tube

Jackson-Pratt drain

Penrose drain

Wound Vac System - Involves the use of enclosed foam and a suction device attached; often used for large surgical/trauma/non-healing wounds.

Redivac drain

Pigtail drain - has an exterior screw to release the internal "pigtail" before it can be removed

Davol

Chest tube

Complications of drainage Infection Anastomotic leakage Fistula formation Bleeding Erosion of adjacent tissue/vessels.

Infection

Anastomotic leakage

Fistula formation

Bleeding

Erosion of adjacent tissue/vessels.

The End

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