ST230 Concorde Career College 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 non-absorbable 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 Absorbable Monofilament Synthetic Nonabsorbable 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 Open Closed Swaged Swaged (CV)

Needle Sizes & Types

Needle Sizes & Types

Microsurgical suture with needle 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 is removed from the package placing tension on the swage Suture Handling Suture is removed from the package placing tension on the swage

Needle holder correctly armed Suture Handling Needle holder correctly armed

Passing the armed needle holder Suture Handling Passing the armed needle holder

Rapid (control) Release Suture Handling Rapid (control) Release Step 1

Rapid (control) Release 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

(Connell’s Technique) Suturing Techniques Tendon Suture (Connell’s Technique)

Tie Terms Free-tie Stick-tie Tie on a pass Ligate 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

Meckel’s Diverticulectomy Surgical Staplers Linear Cutter Meckel’s Diverticulectomy

Surgical Staplers Linear Cutter Duodenal Division

Side-to-Side Anastomosis 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

Preparation for attachment of stapler segments 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

Polypropylene Mesh Configurations Meshes/Fabrics Polypropylene Mesh Configurations (Knitted)

Ventral Herniorrhaphy with Polypropylene Mesh Implant

Tissue Adhesives

Tissue Adhesives Tissue Adhesive (Skin)

Tissue Adhesives Liquid Bandage