Dr.

shraddha

Ants

In the tenth century BC, the ant was held over the wound until it seized the wound edges in its jaws. It was then decapitated and the ant's death grip kept the wound closed.

Thorns

The thorn, used by African tribes to close tissue, was passed through the skin on either side of the wound. A strip of vegetable fibre was then wound around the edge in a figure eight.

Sterilised Catgut

The serosa of sheep intestine was provided to the surgeon pre-sterilised and required threading through the eye of the needle before use.

Swaged On Needles

Post World War II brought the swaged-on needle. The thread fits into the hollow end of the needle, allowing it to pass through tissue without the double loop of thread that exists with a conventional needle, reducing tissue trauma.

Clean incised wounds Uncontaminated lacerated wound Surgical incisions

Small superficial cuts Severely contused or heavily contaminated wounds High velocity injuries (Gun shot injuries)

Scalpel set Needle holder Artery forceps Stitch scissors Toothed dissecting forceps Needle Suture material Local anaesthetics

Most important step for reducing the risk of wound infection. Remove all contaminants and devitalized tissue before wound closure.
IRRIGATE CUT OUT DEAD, FRAGMENTED TISSUE

If not, the risk of infection and of a cosmetically poor scar are greatly increased

Look for injury to underlying nerve, vessel, bone Rule out cavity penetration( peritoneum, thorax etc)

Primary closure - appropriate for uninfected and relatively uncontaminated wounds < 6 to 8 h old (< 12 to 24 h for face and scalp wounds). Healing by secondary intention- Secondary healing involves no formal wound closure; the wound closes spontaneously by contraction and reepithelialization.

Delayed primary closure- closed after several days, appropriate for wounds too old for primary closure, particularly if signs of infection have begun to appear, and for wounds of any age with

3 ways of classifying suture material:

Natural or Synthetic Absorbable or Non-Absorbable Monofilament or Braided/Twisted

Natural
Silk, linen, catgut

Polypropylene Polypropylene, polyester, polyamide

Polyester

Synthetic polymer

Absorbable
catgut, polydioxanone, polyglycolic acid Used for deep tissues, membranes, & subcuticular skin closure

Non-Absorbable
polyester, nylon, Used for skin (removed) & some deep structures (tendons, vessels, nerve repairs not removed)

Monofilament
Polypropylene Polydioxanone Nylon

Multifilament
Catgut (twisted) Polyester Silk (braided)

Smaller ------------------------------------- Larger - - -

Classified according to shape and type of point

Curved or straight (Keith needle) Taper point, cutting, or round body

Curved
Designed to be held with a needle holder Used for most suturing

Straight
Often hand held Used to secure percutaneously placed devices (e.g. central and arterial lines)

Closely approximating skin margins Everting wound edges Eliminating dead space Minimizing tension in the wound and of individual sutures

Basic suturing techniques:

Simple sutures Mattress sutures Subcuticular sutures

 Remember!!! Thumb & ring finger into needle (NOT your middle finger!)

The needle should always penetrate the skin at a 90 angle, which minimizes the size of the entry wound and promotes eversion of the skin edges. The needle should be inserted 1-3 mm from the wound edge, depending on skin thickness Clasp needle 1/2 to 2/3 back from tip

Grasp forceps between thumb & middle finger, while index finger is used for stabilization. If possible, use forceps to grasp dermis, rather than epidermis or skin surface itself. This helps prevent marking & injuring of skin at wound edge.

Simple interrupted stitch

Single stitches, individually knotted (keep all knots on one side of wound) Used for uncomplicated laceration repair and wound closure

Vertical mattress stitch

Affords precise approximation of skin edges with eversion Two-step stitch:
Simple stitch made relative to wound edge (large bite) Needle reversed and 2nd simple stitch made inside first

Suture spacing is also The sutures should be equidistant from wound edge as well as from each other

Usually a running stitch, but can be interrupted Intradermal horizontal bites Allow suture to remain for a longer period of time without development of crosshatch scarring

Rule of halves:
Matches wound edges better Vary from rule when too much tension across wound

Rule of halves

Rule of halves

With a braided material, such as silk, a 3rd throw (replicating the first) would be placed to secure the knot. If a slippery monofilament material, such as nylon were being used, one would place 5 or 6 throws of alternating construction in order to minimize knot slippage.

Tightly tied sutures can cause ischaemia & wound edge necrosis. Gentle but firm knots & minimal wound tension will minimize these factors. Remember, keep skin edges everted, NOT inverted!

Face: 3-4 days Scalp: 5 days Trunk: 7 days Arm or leg: 7-10 days Foot: 10-14 days

Sterile adhesive tapes Available in different widths Frequently used with subcuticular sutures Used following staple or suture removal Can be used for delayed closure

Rapid closure of wound Easy to apply Evert tissue when placed properly Can also be used for intestinal closure NOT to be used For?

Analgesics Antibiotics To report in case of oozing or pain