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PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Surgical SuturesSurgical Suturesand Needlesand Needles

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

SUTURESSUTURESSUTURESSUTURES

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

The Ideal SutureThe Ideal SutureMoynihan 1912Moynihan 1912

Monofilament Use for any procedure Easy to handle Minimal tissue reaction High breaking strength Hold knots securely Absorbable Predictable Absorption Sterile

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Classification of SuturesClassification of Sutures

CHARACTERISTIC Absorbable Nonabsorbable

STRUCTURE Monofilament Multifilament

MATERIAL Synthetic Biological

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

AdvantageAdvantage

ABSORBABLEBroken down by bodyNo foreign body left

NONABSORBABLEPermanent Wound

Support

NONABSORBABLEPermanent Wound

Support

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

DisadvantageDisadvantage

ABSORBABLETime of wound

support

ABSORBABLETime of wound

support

NONABSORBABLEForeign body leftSuture sinusSuture extrusion

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

AdvantageAdvantage

MONOFILAMENTSmooth surfaceLow friction

– Less drag– Less tissue trauma

No bacterial harboursNo capilarity

MONOFILAMENTSmooth surfaceLow friction

– Less drag– Less tissue trauma

No bacterial harboursNo capilarity

MULTIFILAMENTStrengthSoft & pliableGood handling

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

DisadvantageDisadvantage

MONOFILAMENTHandling & KnottingEnds/knot burialStrecth

MULTIFILAMENTBacterial harboursCapillary actionTissue trauma

– Drag– Cutting

MULTIFILAMENTBacterial harboursCapillary actionTissue trauma

– Drag– Cutting

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

AdvantageAdvantage

BIOLOGICALHandling & KnottingEconomical

SYNTHETICSResemble natural

substancesAbsorption by

hydrolysisPredictable

absorption Strong

SYNTHETICSResemble natural

substancesAbsorption by

hydrolysisPredictable

absorption Strong

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

DisadvantageDisadvantage

BIOLOGICALAbsorption by

enzymatic actionTissue reactionUnpredictable

absorption

BIOLOGICALAbsorption by

enzymatic actionTissue reactionUnpredictable

absorption

SYNTHETICSMonofilament

handling

SYNTHETICSMonofilament

handling

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

AbsorbableAbsorbableAbsorbableAbsorbable

BiologicalBiologicalBiologicalBiological

SyntheticSyntheticSyntheticSynthetic

Plain/F.A. Gut

Chromic Gut

VICRYL*

PDS II*

MONOCRYL*

VICRYL*Rapide

PANACRYL*

* Trademark

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Absorption TerminologyAbsorption TerminologyABSORBABLE SUTURESABSORBABLE SUTURES

Wound support No loss of suture

bulk Strength reduced

Wound support No loss of suture

bulk Strength reduced

Elimination of Suture Material removed

LOSS OFTENSILE STRENGTH

ABSORPTION OFMASS

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Suture HandlingSuture Handling

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Absorbable SuturesAbsorbable SuturesWOUND SUPPORT ABSORPTION OF

MASS

Catgut 7 – 10 60 – 90

VICRYL* Rapide 6 – 14 by 42

Chromic Catgut 17 – 21 90 – 110

MONOCRYL* 14 – 21 90 – 120

Coated VICRYL* 28 – 35 56 – 70

PDS* II up to 56 by 182

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Catgut AbsorptionCatgut Absorption

PLAIN CHROMIC

Wound Support 7-10 days 17 – 21 days

Mass absorption 60 – 90 days 90 – 110 days

Absorption affected by many factorsAbsorption affected by many factors

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Coated VICRYL*Coated VICRYL*AbsorptionAbsorption

Coated VICRYL* 2/0 at 14 daysMinimal Tissue Reaction

around suture

Chromic Catgut at 14 daysExtensive tissue reaction withacute inflammatory response

Synthetic Absorbable – HydrolysisPredictable absorptionMinimal tissue reactions

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Non AbsorbableNon AbsorbableNon AbsorbableNon Absorbable

BiologicalBiologicalBiologicalBiological

SyntheticSyntheticSyntheticSynthetic

PROLENE*

Silk

ETHIBOND*

MERSILENE*

Stainless Steel

ETHILON*

* Trademark

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

MERSILK*MERSILK*

DRAWBACKSTissue reactionsLoss of strengthUltimately fragmentsForeign body

implanted long term

DRAWBACKSTissue reactionsLoss of strengthUltimately fragmentsForeign body

implanted long termNUROLON* SILK

Greater reaction to biological material

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

PROLENE* PolypropylenePROLENE* Polypropylene

MINIMAL TISSUE REACTIONMINIMAL TISSUE REACTION

Enlarged photomicrographPROLENE* suture

Implanted 6 months

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

NEEDLESNEEDLES

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Needle SelectionNeedle Selection

Minimal trauma to tissue

SharpnessBend resistanceCorrosion resistanceSterilitySize, shape & design

Minimal trauma to tissue

SharpnessBend resistanceCorrosion resistanceSterilitySize, shape & design

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Use of Needle HoldersUse of Needle Holders

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Eyed NeedlesEyed Needles

Double suture strandThreading timeResterilisationPoint maintenanceRisk of corrosionRisk of unthreading

EyedEyed French / split eyeFrench / split eye

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Suture AttachmentSuture Attachment

ChannelDrilled

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Anatomy of a Surgical NeedleAnatomy of a Surgical Needle

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Needle ShapesNeedle Shapes¼ Circle¼ Circle 33//88 Circle Circle ½ Circle½ Circle 55//88 Circle Circle

½ Curved½ Curved

StraightStraight

CompoundCompound

CurveCurve

J ShapeJ Shape

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Needle Size RangeNeedle Size Range

MICROSUTURES 3.75mm – 8mm

OPHTHALMIC 5mm – 16mm

CARDIOVASCULAR 8mm – 40mm

SKIN RANGE 9mm – 60mm

G.I. RANGE 13mm – 40mm

CLOSURE 30mm – 110mm

HAND HELD 55mm – 110mm

110mm110mm 3mm3mm

45 needle sizes from 3mm to 110mm45 needle sizes from 3mm to 110mm

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Needle TypesNeedle Types

Round Bodied

Cutting

Ophthalmic

Round Bodied

Cutting

Ophthalmic

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Round Bodied NeedlesRound Bodied Needles

IntestinalJB NeedleVISIBLACK*BluntETHIGUARD*CC

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Cutting NeedlesCutting Needles

CONVENTIONALCONVENTIONALCUTTINGCUTTINGApex of edges on

inside curvature

CONVENTIONALCONVENTIONALCUTTINGCUTTINGApex of edges on

inside curvature

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Cutting NeedlesCutting Needles

REVERSEREVERSECUTTINGCUTTINGApex of edges on

outside curvature

REVERSEREVERSECUTTINGCUTTINGApex of edges on

outside curvature

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

PACKAGINGPACKAGING

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Packaging – Foil PackPackaging – Foil PackUSP GaugeUSP Gauge Metric

GaugeMetricGauge

Code numberCode number

Denotes EasyAccess packagingDenotes EasyAccess packaging

Sterilisation MethodSterilisation Method

Manufacture& Expiry dateManufacture& Expiry date

Product description& colourProduct description& colour

LengthLength

NeedledescriptionNeedledescription

IDENTIFICATION OF MARKINGSIDENTIFICATION OF MARKINGSIDENTIFICATION OF MARKINGSIDENTIFICATION OF MARKINGS

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Packaging – Foil PackPackaging – Foil Pack(Easy Access)(Easy Access)

Tear in direction of arrow

Foil & card open together revealing needle

Arm needle holderWithdraw suture

Tear in direction of arrow

Foil & card open together revealing needle

Arm needle holderWithdraw suture

PELATIHAN BEDAH DASARKOLEGIUM ILMU BEDAH INDONESIAKOLEGIUM ILMU BEDAH INDONESIA

Packaging – RELAY*Packaging – RELAY*

Single overwrapRemove trayPull down flap to

exposeArm needle holderWithdraw suture

Single overwrapRemove trayPull down flap to

exposeArm needle holderWithdraw suture

KINK FREE SUTURE DISPENSEDKINK FREE SUTURE DISPENSED

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