Surgical sutures and needles - PowerPoint Presentation

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Surgical sutures and needles

Presented By :

Dr.

Behzad

Nemati

Honar

MD. MISF.

Imam Hossein Hospital

Shahid

Beheshti

University Of Medical Sciences

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Special Thanks to ETHICON Company for Providing Educational Material of this Presentation

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Why Sutures ?!

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Can we use any sutures in any tissues?

Heart

Kidneys

Stomach

Skin

Lungs

Small Intestine

Colon

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CLASSIFICATION

Sutures

Biological

Synthetic

Non-absorbable

Absorbable

Multifilament

Monofilament

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ADVANTAGES

Smooth surface

Low friction (Less drag & tissue trauma)

No Bacterial harbours

No capillarity

.

DISADVANTAGES

Handling & Knotting

Ends/knot burial

Stretch

Monofilament

Multifilament

ADVANTAGES

Strength

Soft & pliableGood HandlingGood knotting DISADVANTAGESBacterial harboursCapillary actionTissue trauma (Drag & cutting) CLASSIFICATION

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CLASSIFICATION

ADVANTAGES

Broken down by body

No foreign body left

DISADVANTAGES

Time of wound support

Absorbable

Non-Absorbable

ADVANTAGES

Permanent Wound Support

.

DISADVANTAGES

Foreign body left

Suture sinus Suture extrusion

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CLASSIFICATION

Biological

ADVANTAGES

Handling & Knotting

Economy

.

DISADVANTAGES

Absorption by enzymatic action

Tissue reactions

Unpredictable absorption

.

Synthetic

ADVANTAGES

Non-

absorbables are inertAbsorbables resemble natural substancesAbsorption by hydrolysisPredictable absorptionStrengthDISADVANTAGESMonofilament handling.

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Current Situation

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Absorbable

Sutures

VICRYL*

rapide

MONOCRYL*

Coated VICRYL*

Coated VICRYL*

Plus

Antibacterial Suture

PDS* II

Skin

Perineum

Oral

LacerationsTraumatologyLigamentsFasciaVessel anastomosis10 daysBy 42 daysWound SupportMass AbsorptionTypical Uses30 days60 days

20 days30 days 56 - 70 days90 - 120 days56 - 70 days180 - 210 daysLigature GeneralBowelOrthopaedicsLigature GeneralBowelOphthalmicLigatureMucosaObstetricsBowelSkin

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Coated VICRYL

Rapide

(

Polyglactin

910)

 90%

glycolide

and 10% L-

lactide

.

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VICRYL

rapide

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VICRYL rapide

6

to

14

days

By

42

days

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MONOCRYL

(POLIGLECAPRONE 25)

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MONOCRYL

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MONOCRYL

21

days

90 - 121

days

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MONOCRYL

The integrity of

MONOCRYL

consistent performance

Chromic catgut

suture frays after multiple passes, which may lead to increased tissue drag and weaker sutures

MONOCRYL

suture integrity

maintained after multiple passes

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MONOCRYL

MONOCRYL ABSORPTION

Chromic Catgut at 14 days.

Extensive tissue reaction .

Monocryl

at 14 days.

Minimal tissue reaction.

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Coated VICRYL

(

Polyglactin

910)

VICRYL coating

is composed of

:

50%

Polyglactin

370 - (35%

Glycolide

- 65%

Lactide

)

50% Calcium Stearate

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VICRYL

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VICRYL

56 to 70 days

28 days

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PDS * II

(

Polydeoxanone

)

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PDS * II

For smooth passage through tissue.

For minimal tissue reaction.

By hydrolysis.

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PDS * II

Wound support

Mass absorption

56

days

180

days

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Loop sutures for fast effective and secure fascia closure

PDS * II

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Plus Sutures

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Bacterial Contamination

Healthcare professionals take numerous steps to control bacterial contamination in the surgical setting:

Pre-operative antibiotic prophylaxis

Scrubbing, gowning, gloving

Antimicrobial skin prep

Maintenance of sterile field

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Bacterial Contamination

All of these measures are employed

before

the procedure and

external

to the patient.

Doesn’t it make sense to try to control bacterial wound contamination

during

the procedure, and

inside

the patient?

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Plus

Sutures

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In vitro evidence

Zone of inhibition studies show that

IRGACARE® MP

(

Triclosan

)

inhibits colonization of VICRYL* Plus Antibacterial Sutures by

:

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In vitro evidence

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NON

ABSORBABLE SUTURES

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PROLENE*

POLYPROPYLENE

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PROLENE*

Synthetic

Non-absorbable

Monofilament

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PROLENE*

MINIMAL TISSUE REACTION

Enlarged photomicrograph

PROLENE* suture

Implanted

6

months

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ETHIBOND EXCEL*

Polybutylate

Coated Braided Polyester Suture

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ETHIBOND EXCEL*

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ETHIBOND EXCEL*

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ETHIBOND* EXCEL Cardiac Valve Kit

Multistrand

valve kit presentation – Save time and easy to use

Green and white strands – for easy identification

Wide range of suture and pack sizes

Each suture comes threaded with a

pledget

Each

pledget

is self-centering for ease of use

Effective buffering protects valve and surrounding tissues

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STAINLESS STEEL WIRE

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STAINLESS STEEL WIRE

Special packaging to

minimise kinks

Where extra strength is required

>>>

Sternum closure

Rotating

needle for sternum sutures

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STAINLESS STEEL WIRE

D9805

This product has been designed for the

Bunnell

technique

for

tendon

repair

.

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Suture Size

Volume % Reduction With Decreasing Size

2/0

3/0

4/0

5/0

6/0

7/0

8/0

51%

40%

49%

54%

50%

44%

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SURGICAL NEEDLES

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ETHALLOY

INTELLIGENT

GEOMETRY

ADVANCED

NEEDLE COATING

Selection & Use

of Surgical Needles

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Selection & Use

of Surgical Needles

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Needle Radius

Needle Length

Chord Length

Swage

Needle Point

Flatted Area

Diameter

EYELESS NEEDLE

ANATOMY OF A SURGICAL NEEDLE

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Selection of the needle

shape

is dependent on the

:

Needle Shape

Size

and

Depth

of the area to be sutured

.

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Needle Shape

¼ Circle

½ Circle

3/8 Circle

5/8 Circle

Eye

Microsurgery

Dura

Eye

Fascia

Nerve

Muscle

Eye

Skin

PeritoneumCardiovascularOralPelvisUrogenital tract

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Needle Shape

J Shape

Compound Curve

Straight

½ Curved

Nasal cavity

Nerve

Skin

Tendon

Laparoscopy

Eye (Anterior

segment)

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Needle Alloy

ETHALLOY

+40%

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Needle Alloy

ETHALLOY

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Round Bodied

Cutting

Ophthalmic

Text

Penetrate tissue by

separating

the

fibres

It does not cut the tissue.

Forming a

leak-proof

suture line.

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TAPERCUT

1

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CC NEEDLE

2

C

ALCIFIED

C

ORONARY

Unique point design

Improved penetration.

to be used on tough tissues without increasing tissue trauma.

Square body - strength & stability

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CC

TaperCut

POINT DESIGN

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VISI - BLACK Needle

3

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Blunt Point

Blunt

4

It is used for suturing

friable

,

highly vascularised

tissue such as

liver

or

kidney

.

It is also used as a

ligature carrier

for the

Shirodka

suture

for the incompetent cervix.

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GUARD

5

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Round Bodied

Cutting

Ophthalmic

Text

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CONVENTIONAL CUTTING

1

This needle has a

triangular

cross section with the apex of the triangle on the

inside

of the needle curvature.

Conventional cutting needles are ideal needles for

skin

.

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REVERSE CUTTING

2

The body of this needle is triangular in cross section, having the apex cutting edge on the

outside

of the needle curvature.

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P

Needle

3

sharper

stronger

more secure in the needle holder.

The

square body geometry

and the use of a

premium alloy

P Needles are available in

:

Conventional

Reverse

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PRIME

4

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TROCAR Point

5

Strong cutting head

exceeds diameter of body

Powerful penetration

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Round Bodied

Cutting

Ophthalmic

Text

They are designed for

:

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Spatulated

1

Sharp points with side cutting edges.

Penetration between layers.

Strabismus

&

Retinal

surgery.

340 & 440 micron wire diameter.

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MICRO POINT

2

Thin

,

flat

profile

allows the needle to penetrate between the layers of

scleral

or

corneal

tissue .

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ADVANCED MICRO-POINT(AMP)

3

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CS ULTIMA

4

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INTELLIGENT

GEOMETRY

A Unique Needle Range

ETHIGUARD Blunt

Point Needles

Taper Point

Needles

BV needles

Improving

safety

Gentle separation

of fibrous tissue

Consistency pass

after pass

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INTELLIGENT

GEOMETRY

A Unique Needle Range

VISI-BLACK

Needles

CC

Needles

HEMO-SEAL

Needle Sutures

Visibility is their

strength

Easy penetration of

calcified coronary

tissues

A fitting choice for

vascular surgery

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INTELLIGENT

GEOMETRY

A Unique Needle Range

MULTICURVE

Needles

TAPERCUT

Needles

PRIME

Needles

For confined access

procedures

Easy penetration of

dense tough tissue

Excellence in skin

closure

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Multipass

Needle

ADVANCED

NEEDLE COATING

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Multipass

Needle

ADVANCED

NEEDLE COATING