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------=_NextPart_01C68EEE.0D19E7C0 Content-Location: file:///C:/59044EC2/BasicWoundClosureKnotTyingPrimer3b_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C68EEE.0D19E7C0 Content-Location: file:///C:/59044EC2/BasicWoundClosureKnotTyingPrimer3b_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Knot Tying & Suturing Primer
Basic Wound Closure & Knot Tying Primer
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file:///C:/59044EC2/BasicWoundClosureKnotTyingPrimer3b_files/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Knot Tying & Suturing Primer
Objectives
nProvide basic information on commonly used suture materials = nReview general principles of wound closure nProvi= de a general overview of basic surgical knot tying
n
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Suture Material
nGenerally categorized by three characteristics:
&= #8226;Absorbable vs. non-absorbable
&= #8226;Natural vs. synthetic
&= #8226;Monofilament vs. multifilament
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Absorbable Suture
nDegraded and eventually eliminated in one <= /span>= of two ways:
•<= /span>Via inflammatory reaction utilizing tissue = enzymes
•<= /span>Via hydrolysis
nExamples:
•<= /span>“Catgut”
•<= /span>Chromic
•<= /span>Vicryl
•<= /span>Monocryl
•<= /span>PDS
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Non-absorbable Suture
nNot degraded, permanent
nExamples:
•P= rolene
•N= ylon
•S= tainless steel
•S= ilk*
= 226;
•(*not a truly permanent material; known to be broken down over a prolonged period of time—years)
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Natural Suture
nBiological origin
nCause intense inflammatory reaction
nExamples:
•“Catgut” – purified collagen fibers from intestine of healthy sheep= or cows
&= #8226;Chromic – coated “catgut”
&= #8226;Silk
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Synthetic Suture
nSynthetic polymers
nDo not= cause intense inflammatory reactio= n
nExamples:
•V= icryl
•M= onocryl
•P= DS
•P= rolene
•N= ylon
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Monofilament Suture
nGrossly appears as single strand of suture = material; all fibers run parallel
nMinimal tissue trauma
nResists harboring microorganisms
nTies smoothly
nRequires more knots than multifilament = suture
nPossesses memory
nExamples:
•<= /span>Monocryl, PDS, Prolene, Nylon
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Multifilament Suture
nFibers are twisted = or braided together
nGreater resistance in tissue&= #13;
nProvides good handl= ing and ease of tying
nFewer knots required
nExamples:
•Vicryl (braided) <= /span>
•Chromic (twisted) =
•Silk (braided)<= /div>
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Suture Degradation
Months
Hydrolysis
PDS
Weeks to months
Hydrolysis
Vicryl, Monocryl
Days
Proteolytic enzymes
“Catgut”
Time to Degradation
Method of Degradation
= Suture Material
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Suture Size
nSized according to diameter with “0” as reference size <= /span>
nNumbers alone indicate progressively larger sutures (“1”, “2”, etc)= 3;
nNumbers followed by a “0” indicate progressively smaller sutures (“2-0”, “4-0”, etc)
= n
Smaller ß-------= -----------------------------= -àLarger=
  .....”3-0”...”2-0”...”1-0”...”0”...”1”...”2”...”3&= #8221;.....
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Needles
R= 26;Classified according to shape and type of point
nCurved or straight (Keith needle)
nTaper point, cutting, or reverse cutting
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Needles
nCurved
•Designed to be held with a needle holder
•Used for most suturing
nStraight
= •Often hand held
•Used to secure percutaneously placed devices (e.g. central and arterial lines)
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Needles
nTaper-point needle
= •Round body
•Used to suture soft tissue, excludin= g skin (e.g. GI tract, muscle, fascia, peritoneum)
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Needles
nCutting needle
= •Triangular body
•Sharp edge toward inner circumference
•Used to suture skin or tough tissue = ;
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Suture Packaging
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Wound Closure
nBasic suturing techniques:
&= #8226;Simple sutures
&= #8226;Mattress sutures
&= #8226;Subcuticular sutures
n
nGoal:  “approximate, not = strangulate”
n
------=_NextPart_01C68EEE.0D19E7C0 Content-Location: file:///C:/59044EC2/BasicWoundClosureKnotTyingPrimer3b_files/slide0015.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Knot Tying & Suturing Primer
Simple Sutures
nSimple interrupted stitch
•Single stitches, individually knotted (keep all knots on one side of wound)
•Used for uncomplicated laceration repair and wound closure
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Mattress Sutures
nHorizontal mattress stitch
•Provides added strength in fascial closure; also used in calloused skin (e.g. palms and soles)
•T= wo-step stitch:
nSimple stitch made
nNeedle reversed and 2nd simple stitch made adjacent to first (same size bite as first stitch)
n
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Mattress Sutures
nVertical mattress stitch
•Affords precise approximation of skin edges with eversion
•T= wo-step stitch:
nSimple stitch made – “far, far” relative to <= span style=3D'position:absolute;top:63.0%;left:18.53%;width:29.77%;height:4.25%= '>wound edge (large bite)
nNeedle reversed and 2nd simple stitch made inside first – “near, near” (small bite)
n
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Subcuticular Sutures
nUsually a running <= /span>stitch, but can be interrupted
nIntradermal = = horizontal bites
nAllow suture to r= emain for a longer period of time without development of crosshatch scarring
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