SURGICALSutures & Knots/Operation Theater

*Mansoor Khan

26 May, 2010

1650 BC – 2000’s AD

Through the ages,Practitioners have used a wide range of materials and techniques for closing tissue…

The origins of surgery can be traced back many centuries

In the 10th century BC, ANTS was held over the wound until it seized the wound edges in its jaws. It was then decapitated.

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 tied around the edge in a figure eight.

The tough membrane of sheep intestine was provided to the surgeon pre-sterilised and required threading

through the eye of the needle before use.

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.

Sutures

Absorbable Non-absorbable

Natural Synthetic Natural Synthetic

Mono-filament

Multi-filament

Mono-filament

Multi-filament

Mono-filament

Multi-filament

Mono-filament

Multi-filament

Multifilament (braided)Multifilament (braided)MonofilamentMonofilament

SterilitySterility

Low tissue reactivity

Low tissue reactivity

Easyhandling

Easyhandling

knot security

knot security

Tensile strength

Tensile strength

QUALITIESQUALITIES

ABSORBABLE!Usually lose their tensile strength within

60 days.ABSORBED by

Hydrolysis or enzymatic degradation

Derived from the small intestine of healthy sheep.

Loses 50% of tensile strength by 5-7 days.

Used on mucosal surfaces.

PLAIN

GUT

Treated with chromic acid to delay tissue absorption time.

50% tensile strength by 10-14 days.

Used in episiotomy repairs.

CHROMIC

GUT

Monofilament50% tensile strength = 30+ days

Sites = need for prolonged strength,

P

OLYDIOXANONE (P

DS ®)

Braided, synthetic polymer50% tensile strength for 30 days

Used: subcutaneous

Polyglycane 910 (vicyle ®)

NON-ABSORBABLE!Permanent, used for long term strength

Appears to be stronger then nylon and has better overall

wound security.

Polypropylene (Prolene®)

Braided Before the advent of synthetic fibers,

silk was the mainstay of wound closure.Easy handling, excellent knot security.

High reactivity and infection dueto the absorption of body fluids

by the braided fibers.

S

I

L

K

5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0

Thick Thin

Suture size

USP (United States Pharmacopoeia)

General

Bowel: 2/0 - 3/0Fascia: 1 - 0Ligatures: 0 - 3/0Pedicles: 2 - 0Skin: 2/0 - 5/0Arteries: 2/0 - 8/0Micro surgery 9/0 - 10/0Corneal closure: 9/0 - 10/0

SUTURE SELECTION

Operation TheatresOperation Theatres

“Place where life saving or life improving invasive procedures are performed on human

body under strict aseptic measures!!!!!!”

History of Hygiene

• Aristotle Greek Philosopher recommends

Boiling water to armies. Advises the Alexander.

Recommends hygiene for healthy living

HAND WASHING- Semmelweis

Practices, emphasizes the importance of washing hands with chlorinated water in Obstetrics to reduce maternal mortality

Florence Nightingale creates fundamentals in Nursing care

“The Very First Requirement in hospitals that should do the sick no harm”

Florence Nightingale 1860

• 1867 –Dr.Joseph Lister first identifies airborne bacteria and uses Carbolic acid spray in surgical areas

• 1880 – Johnson and Johnson introduce antiseptic surgical dressings.

Beginning of Safe Operation Theatre Practices

“Soap, Water and Common Sense Yet the best Antiseptic”

William Osler

Factors which influence Safety inHospital Environment

WET HANDS & APPLY SOAP

RIGHT PALM OVER LEFT, LEFT

OVER RIGHT

PALM TO PALM FINGER

INTERLACED

ROTATIONAL RUBBINGROTATIONAL

RUBBING OF RIGHT THUMB IN

LEFT PALM & VICE VERSA

BACK FINGERS TO OPPOSING

FINGERS INTERLOCKED

13

2

5

46

H

A

N

D

S

W

A

S

H

I

N

G

• Which suits the Circumstances.

• Availability of Resources.• Economical.• Safe to you.• Some chemical

containing compounds can cause sensitization and Allergic reactions.

BEST HAND WASH IS….

Good Hand Washing Practices Save many Lives

Cleaning more Important than Disinfection and Sterilization

Sterilization!

is absolute, removes microbes and spores too.To achieve Sterilization is Expensive, not

sustainable, many times not needed.

Disinfection!reduces the infections drastically.

• Paying great attention to Floors Using unnecessary, too many chemical not necessary

• Keep the floor Clean and Dry - Bacteria are reduced,

• Most Important component of Bacteria is water a dry areas causes natural death except spores

• Do not disturb unnecessarily,

• Do not use ceiling fans they cause aerosol spread

• Clean only when remodeling or accumulated ,good amount of dust.

Do not disturb the Roof

Who/What is Important in prevention of Infections

Remember we are More important than many

Operation Theatre Safety isResponsibility Of….????????

Everyone……..

THANKSQUESTIONS PLEASE