Transcript Suture, Needles, Staplers, Wound Closure Techniques

Suture, Needles, Staplers,
Wound Closure Techniques, &
Wound Closure Devices
ST230
Concorde Career College
Objectives
• Define the term suture as a noun and as a
verb.
• List the specifications for suture material and
describe the importance of each.
• Describe the suture selection process.
Objectives
• List and describe the ideal characteristics for suture
material and surgical needles.
• Identify the types and sizes of suture material,
provide examples of each, and describe the type of
tissue usage appropriate for each type.
Objectives
• Identify the types and sizes of surgical needles,
provide examples of each, and describe the type of
tissue usage appropriate for each type.
• Describe suture packaging, list the information found
on the suture package, and explain its importance.
Objectives
• Identify types of stapling and ligating devices
and provide examples of when each may be
utilized.
Objectives
• Identify types of alternative wound closure
materials, tissue adhesives, and tissue repair
and replacement materials and provide
examples of when each may be utilized.
Definition
Suture
Noun
Definition
Suture
Verb
(It’s what you do…)
Brief Suture History
• 3000 BCE - Linen strips and animal sinew
(tendon) were used to close wounds with
needles made of bone
• 600 BCE - Cotton, leather, horsehair, and bark
fiber from trees was used to close wounds
Brief Suture History
• Lister (late 1800s) was the first to use a
bacteriocide (carbolic acid) on suture
• Suture manufacture and sterilization started in
the early 20th Century
• First synthetic absorbable suture was
produced in the 1960s
Brief Suture History
Sinew
(wolverine)
Brief Suture History
Suture Needle
(buffalo bone)
Specifications for Suture Material
• Must be sterile and sterile technique must be used
when handling
• Uniform tensile strength
• Uniform size
• Appropriate diameter for tissue type
• Provide knot security
• Cause minimal foreign body tissue reaction
Suture Selection
• Characteristics of the
suture material
• Age
• Weight
• Allergy status
• General tissue condition
•
•
•
•
•
•
Surgical site disease
Comorbid condition(s)
Surgeon preference
Suture availability
Cost
Mentor influence
Ideal Suture Characteristics
•
•
•
•
•
•
•
Pliable
Easy to tie secure knots
Tensile strength (will not fray or break)
Glide through tissue effortlessly
Inert
Nonallergenic
Inexpensive
Tensile Strength
Tensile strength of
absorbable and nonabsorbable sutures is
critical both during
and after surgical
procedures. Breaking
strength and
elongation can be
measured using
either a "straight
pull" test or a "knot
pull" test.
Types of Suture Material
• Natural
• Synthetic
• Absorbable
• Nonabsorbable
• Monofilament
• Multifilament
Types of Suture Material
Natural
Raw Silk
Magnified 1300 X
Types of Suture Material
Synthetic
Nylon
Types of Suture Material
Absorbable
Plain
Types of Suture Material
Nonabsorbable
Silk
Types of Suture Material
Monofilament
Types of Suture Material
Multifilament
Twisted
Types of Suture Material
Multifilament
Braided
Suture Packaging
Suture Sizes
Ideal Needle Characteristics
•
•
•
•
Stainless steel (corrosion resistant)
Slim without compromising strength
Stable in the needle holder
Carries suture through tissue with minimal tissue
trauma
• Sharp
• Sterile
• Inexpensive
Needle Eye Types
1.
2.
3.
4.
Open
Closed
Swaged
Swaged (CV)
Needle Sizes & Types
Needle Sizes & Types
Needle Sizes & Types
Microsurgical suture
with needle
Anatomy of a Needle
–
–
–
–
–
Eye
Point
Body
Shape
Chord Length
Needle Points
– Taper – most internal
tissues
– Cutting – Skin and
other tough tissues
– Reverse Cutting –
Tendon sheath, bone,
cornea, other tough
tissues
– Blunt – Liver and other
friable tissues
Commonly Used Needle Codes
(Ethicon)
•
•
•
•
•
•
•
•
CP
CT
CTX
CV
FS
FSL
FSLX
KS
•
•
•
•
•
•
•
•
MO
SH
TF
OS
UR
PS
RB
S
Suture Handling
Needle holder is
clamped onto the
needle approximately
1/3 the distance from
the swage to the point
Suture Handling
Suture is removed from
the package placing
tension on the swage
Suture Handling
Needle holder correctly
armed
Suture Handling
Passing the armed
needle holder
Suture Handling
Rapid (control) Release
Step 1
Suture Handling
Rapid (control) Release
Step 2
Simple Suture
• Interrupted
• Running (continuous)
Mattress Suture
• Vertical
• Horizontal
Suturing Techniques
Retention Suture
Suturing Techniques
Figure of Eight Suture
Suturing Techniques
Tendon Suture
(Connell’s Technique)
Tie Terms
• Free-tie
– Place a suture (no needle) into the surgeons
hands
• Stick-tie
– Suture on a needle (use a needle holder)
• Tie on a pass
– Place the suture (no needle) on an instrument
(tonsil/right angle)
• Ligate
– To tie
Stapling Devices
Skin Stapler
Surgical Skin Stapler
Skin Staples - Shape
Skin Stapler
Skin staples in place
Skin Stapler
Skin Staple Remover
Surgical Staplers
Linear Stapler
Surgical Staplers
Linear Cutter
Assorted Size Staples
Surgical Staplers
Linear Cutter
Meckel’s
Diverticulectomy
Surgical Staplers
Linear Cutter
Duodenal Division
Surgical Staplers
Linear Cutter
Side-to-Side
Anastomosis
Ligating Clip Applier
Ligating Clips
Ligating Clips
Clip Applier
• Automated Ligating Clip Applier
Surgical Staplers
Intraluminal Stapler
Surgical Staplers
Intraluminal Stapler
Schematic
Surgical Staplers
Intraluminal Stapler
Anvil in Position
Surgical Staplers
Intraluminal Stapler
Placement
Surgical Staplers
Intraluminal Stapler
Preparation for
attachment of stapler
segments
Meshes/Fabrics
Meshes/Fabrics
Stainless Steel Mesh
Fine Weave
Meshes/Fabrics
Stainless Steel Mesh
Loose Weave
Meshes/Fabrics
2” x 3” Mesh
$305.00
Meshes/Fabrics
Polypropylene Mesh
Configurations
(Knitted)
Ventral Herniorrhaphy
with Polypropylene
Mesh Implant
Tissue Adhesives
Tissue Adhesives
Tissue Adhesive
(Skin)
Tissue Adhesives
Liquid Bandage