Transcript SURGICAL INSTRUMENTS

SURGICAL INSTRUMENTS
Forceps- (L-a pair of tongs) Pincers for holding, seizing or extracting
A.Hemostatic forceps (artery forceps/haemostat/clamp) - holds a blood vessel, crushes its wall
causes min damage to surrounding tissues
The blades are generally ½ the size of the handle and the inner surface of the blades is serrated and
the handles are provided with catches for better apposition of the blades
Types
a) By size- long, medium, short ( “mosquito”)
b) By curvature- straight or curved
c) According to the teeth at the tip- Kocher to hold retracting blood vessels in a fibrous background
eg scalp
B Tissue Forceps-are used to hold tissues for traction or apposition
Types
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Babcock- very light instrument, with curved blades which are fenestrated and have a transverse
bar which is again transversally serrated
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Allis- light instrument with straight blades and curved tips provided with interlocking teeth
C Dissecting Forceps – these hold tissues and steadies it for dissection or suturing etc. The handles
have spring like action. The outer surface has a few ridges to give abettor grip. The blades are
serrated transversely on the inner aspect so that a better grip on tissues can be obtained
•
Types- toothed and non toothed for hold friable and soft structures
SURGICAL INSTRUMENTS
NEEDLE HOLDERS
The needle holder have blades that are much smaller than hemostats- the
fulcrum is closer to the tip so that greater force can be applied on the needle
to prevent it from slipping. The inner surface of the blades are serrated in a
criss-cross pattern and may have a groove for better accommodation and
grip of the shaft of the needle There are catches on the handles
SCISSORS
TYPES- ACCORDING TO CURVATURE- straight, curved or angled
“
“ USE
- Dressing, stitch removal, tissue
“ “ the Tip
- sharp or blunt
KNIVES
Interchangeable handles and blades
No 3 handle for # 15 blade – for small incisions
And
#11 blade – i& d of abscesses
N04 handle for #24 etc for larger incisions
RETRACTORS
SUTURES
Sutures bind tissues together
Ligatures or Ties obliterate the lumen of ductular tissues
•
Sutures are used to hold skin, internal organs, blood vessels and all other tissues
together, after they have been severed by injury or surgery.
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Sutures are designed to help the healing of the body by closely opposing the two
sides of a wound to minimize scar formation or to prevent leaking blood, like in
vessels. They have to comply with several requirements to be effective. They must
be strong (so they do not break), non-toxic and hypoallergenic (to avoid adverse
reactions in the body), and flexible (so they can be tied and knotted easily). In
addition, they must lack the so called "wick effect", which means that sutures must
not allow fluids to penetrate the body through them from outside, which could
easily cause infections
TYPES
A Based on origin
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animal- catgut,,silk
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vegetable- cotton, linen
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synthetic - nylon,
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metal- stainless steel
B Whether the material is absorbable or not
Absorbable or Nonabsorbabl
ABSORBABLE SUTURES
Absorbable sutures are made of materials which are broken down in tissue
after a given period of time, which depending on the suture can be from ten
days to four weeks. They are used therefore in many of the inner tissues of
the body. In most cases, three weeks is sufficient for the wound to close
firmly. The suture is not needed any more, and the fact that it disappears is
an advantage, as there is no foreign material left inside the body and no
need for the patient to have the sutures removed.
Absorbable sutures were originally made of the intestines of sheep, the so
called catgut. The manufacturing process was similar to that of natural
musical strings for violins and guitars, and also of natural strings for tennis
racquets. The inventor, a 10th century surgeon named al-Zahrawi reportedly
discovered the dissolving nature of catgut when his lute's strings were eaten
by a monkey. Today, gut sutures are made of specially prepared beef and
sheep intestine, and may be untreated (plain gut), tanned with chromium
salts to increase their persistence in the body (chromic gut). However, the
major part of the absorbable sutures used are now made of synthetic
polymer fibers, which may be braided or monofilament; these offer
numerous advantages over gut sutures, notably ease of handling, low cost,
low tissue reaction, consistent performance and guaranteed non-toxicity. (In
Europe and Japan, gut sutures have been banned due to concerns over
bovine spongiform encephalopathy, although the herds from which gut is
harvested are certified BSE-free.) Each major suture manufacturer has its
own proprietary formulations for its brands of synthetic absorbable sutures;
various blends of poly
NONABSORBABLE SUTURES
Nonabsorbable sutures are made of materials which 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. This is the case, for example, in the heart and in blood
vessels, whose rhythmic movement requires a suture which stays
longer than three weeks, to give the wound enough time to close. or
tendons which take a long time to heal because of its poor blood
supply.
There are several materials used for nonabsorbable sutures. The
most common is a natural fiber, silk, which undergoes a special
manufacturing process to make it adequate for its use in surgery.
Other nonabsorbable sutures are made of artificial fibers, like
polypropylene, polyester or nylon; these may or may not have
coatings to enhance their performance characteristics. Finally,
stainless steel wires are used in orthopedic surgery and for sternal
closure in cardiac surgery.
Absorbable Sutures
Name
Plain Catgut --Chromic Catgut
--Poliglecaprone 25
Polyglactin 910
Polyglycolic acid
Polydioxanone
Brand Name
Monocryl
Vicryl
Dexon
PDS II
NONABSORBABLE SUTURES
Name
Silk
Braided Polyester
Stainless Steel Wire
Polypropylene
Nylon---
Brand Name
Ethibond, Tevdek
--Prolene
Ethibond
SUTURING A LACERATION
NEEDLES
Traumatic and atraumatic needles with sutures
Traumatic needles with sutures are those which are supplied to the hospital plain,
i.e., the manufacturer supplies the suture thread and the eyed needle to use the
suture as separate items. The suture must be threaded as it is done when sewing at
home.
Atraumatic needles with sutures include an eyeless needle attached to a specific
length of suture thread. The suture manufacturer swages the suture thread to the
eyeless atraumatic needle at the factory. There are several advantages to having the
needle pre-mounted on the sutre. The doctor or the nurse do not have to spend time
threading the suture on the needle. More importantly, the suture thread which is
swaged using a hole at the end of the needle is smaller in size than the needle body.
In traumatic needle with suture, the thread comes out of the needle's hole or eye on
both sides. When passing through the tissues, this type of suture rips the tissue to a
certain extent. With the atraumatic needle with suture this does not happen. They
produce no trauma to the tissue, hence the name "atraumatic". Because of these
advantages, nearly all modern sutures feature swaged atraumatic needles.
There are several shapes of atraumatic needles, including straight, half circle, fiveeighths and one-quarter. Needles may also be classified 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), and "trocar point" or "tapercut" (needle body is
round and tapered, but ends in a small triangular cutting point)..
Finally, atraumatic needles may be permanently swaged to the suture or may be
designed to come off the suture with a sharp straight tug. These "pop-offs" are
commonly used for interrupted sutures, where each suture is only passed once and
then tied.
Tissue adhesives
In recent years, topical cyanoacrylate adhesives ("liquid stitches") have
been used in combination with, or as an alternative to, sutures in
wound closure. The adhesive remains liquid until exposed to water
or water-containing substances/tissue, after which it cures
(polymerizes) and forms a flexible film that bonds to the underlying
surface. The tissue adhesive has been shown to act as a barrier to
microbial penetration as long as the adhesive film remains intact.
Antimicrobial sutures
Another recent development in wound closure involves the use of
sutures coated with antimicrobial substances to reduce the chances
of wound infection. While long-term studies are not yet available,
preliminary results indicate that these sutures are effective at
keeping bacteria out of wounds.
Sizes of Sutures