Carefully selecting a surgical suture needle is a critical component in achieving excellent wound closure outcomes. The ideal surgical needle should be. Ethicon Covidien B. Braun. 3/8 Circle. M-2 Reverse Cutting Needle with Precision Point. Lancet Needle with Micropoint. Needle Comparison Chart. Aesculap. Needle type and needle shape are shown in this subhead. sizes, shapes and chord lengths. Surgeons . ETHICON needles offers the surgeon a choice of.
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There are many circumstances in which sutures are used to repair tissue and facilitate healing. The techniques that you use, the suture material you use, and the specific type of needle you use will vary depending on whether you are closing a simple etbicon on the foot, a complex laceration on the face, a gastrointestinal anastomosis, a vascular anastomosis, or closing a median sternotomy.
Illustration from the Ethicon Wound Closure Manual. With vascular disruption there is ethicoj vasoconstriction, followed by vasodilatation and increased capillary permeability. Contact of platelets with collagen and ground substance causes activation and aggregation of platelets. The intrinsic and extrinsic coagulation cascades are triggered, and chemotaxis attracts inflammatory cells. Neutrophilswhich are the first nucleated cells to come into play, initiate phagocytosis and antimicrobial defense, but by the 3 rd or 4 th day macrophages have replaced the neutrophils as the dominant cell type.
Macrophages play a central role in wound healing. They remove microbes and cellular debris through phagocytosis and enzymatic breakdown of the extracellular connective tissue matrix, and they elaborate cytokines which stimulate angiogenesis and fibroplasia. The inflammatory response abates as the inflammatory stimuli are removed, and the fibroplastic phase is usually well established by the 5 th day. There is fibroblast migration and proliferation that is mediated by a variety of chemotactic factors and growth factors e.
As fibroblasts populate the wound, neede begin to synthesize and secrete proteoglycans, collagen, and elastin. There is then a gradual decrease in the size of the wound as a result of wound contraction. In response to angiogenic stimuli, new capillaries invade the wound and enlarge. At the same time, epithelial cells behind the wound edge proliferate and there is migration of the epithelial cells across the collagen and ground substance at the surface of the wound.
The maturation phase involves remodeling of the wound as a result of an interplay between matrix synthesis and degradation. Cross-linking of collagen also occurs, and over time there is a progressive increase in tensile strength. Engraving of a barber-surgeon cauterizing a leg wound with a hot iron.
Such treatments were common years ethkcon. These goals are facilitated by handling tissues gently. One of the most important concepts he introduced was that wounds should be treated gently to reduce inflammation and promote healing. He abandoned the traditional treatment of cauterizing wound after his experience in the battle of Turin inwhen the French fought the Italians.
Consequently, he dressed the remaining wounds with a salve that he made with egg yolks, oil of roses, and turpentine. I will tell the truth, I was not very expert at that time in matters of surgery; neither was I used to dressing these wounds made by gunshot. Now I had read in John de Vigo that wounds made by gunshot were poisoned … xhart for their cure, it was expedient to burn or cauterize them with scalding hot oil, with a little Treacle [theriac] mixed in.
Therefore I rose early in the morning, I visited my patients, and beyond expectation, I found such as I had dressed with [the salve] only … to have had a good rest, and that their wounds were not inflamed, or tumified; but on the contrary the others that were burnt with the scalding oil were feverish, tormented eticon much pain, and the parts about their wounds were swollen.
When I had many times tried this in diverse others …I thought that neither I nor any other should ever cauterize any wounded with gunshot.
As a result, Pare became a champion of treating wounds gently. Most sutures come as a single piece, with the suture material swaged onto the base of the needle. Grasping further back at the swaged end tends to weaken the needle and its attachment to the suture, and you are likely to bend the needle.
Taper needles do just what their name implies: Taper needles are used for tissue that is easy to penetrate, such as bowel or blood vessels. In contrast, the tip of cutting needles is triangular in shape, and the apex forms a cutting surface, which facilitates penetration of tough tissue, such as skin.
Cutting needles make it much easier to penetrate tough tissue. Penetrating skin with a taper needle is very difficult and causes excess trauma to the skin because of difficulty in penetration and the need to grasp the skin edge very tightly with forceps. Consequently, you should never use taper needles to suture skin. The reverse cutting needle is similar to a conventional cutting needle, except that the cutting edge faces down instead of up. This may decrease the likelihood of sutures pulling through tissue in some cases.
There are naturally occurring non-absorbable materials e. In some cases they are left in place indefinitely e. Absorbable suture materials are those that are broken down.
Plain gut is broken down enzymatically after about 7 days. Chromic gut is collagen treated with chromium salts to delay break down. Chromic gut typically loses its strength after weeks is completely digested after about 3 months. Now there are many synthetic absorbable materials made from polymers e.
These materials are broken down non-enzymatically by hydrolysis; water penetrates the suture ethicoj and causes breakdown of the polymer chain. As etbicon result, synthetic absorbables tend to evoke less tissue reaction than plain or chromic gut. It should also be neeedle that some of these suture materials consist of a single smooth strand monofilament and others consists of multiple fibers woven together multifilament.
Characteristically, multifilament suture material e. On the other hand, monofilament materials e. Despite the greater number of knots required, monofilament materials such as nylon are generally preferred for skin closure because they stimulate less tissue reaction, are less traumatic, may have less likelihood of infection, and provide a better cosmetic result. Among the absorbable suture materials, Vicryl is a multifilament material, but there is also a coated Vicryl that provides decreased drag through tissue.
For this reason, coated Vicryl is ethicno by some surgeons for the interior layer of bowel anastomoses. Monocryl is an absorbable monofilament material, but has excellent pliability and provides easy handling and good knot security.
GORE-TEX® Suture | Gore Medical
The most commonly used scalpel blades are the 10 and the 15 blade. The 10 blade is better for long, straight incisions, and is held with the shaft ethion the scalpel in the palm of the hand with the index finger chsrt top of the blade. The smaller 15 blade is well suited for short, tortuous incisions; for this type of chaart holding the scalpel as if it were a pencil may facilitate control. For skin closure use a fine-toothed forceps, such as an Adson forceps.
The forceps should be held so one arm is an extension of thumb and the other is an extension of your index finger. The base of the forceps should rest on the dorsal surface of the web space between the thumb and index finger. Use only forceps with teeth. Use the arm with a single tooth to gently elevate the skin edge.
Avoid crushing the skin edges with the forceps. This further traumatizes the wound edge and impedes healing. The forceps allow you to create counter traction and control the position of the skin edge to facilitate passage of the needle perpendicularly through the skin. The forceps should also be used to grasp the needle when repositioning it in the needle holder. You should never touch the needle with your fingers.
Instead of using forceps, the skin edges can also be controlled using skin hooks, which have the advantage that they do not crush the skin edge. There are several techniques for holding the ethicno holder.
Suturing Basics » Surgery | Boston University
This allows you to pronate and supinate and to open and close the jaws of the needle holder. Avoid inserting your fingers far into the rings of the instrument, since this will tie up your fingers and impede your mobility.
Some surgeons do not put their fingers into the rings at all and simply grasp the rings and body of the needle holder in the palm of their hand. The ideal skin suture should form a rectangle, penetrating the epidermis and dermis perpendicular to the skin surface, then turning at a right angle to traverse the depth of the wound parallel to the skin surface, and then turning again to emerge from the opposite skin edge perpendicular to the skin surface.
The distance between the skin edge and the emerging suture should be the same on both sides of the wound. When tied, a suture placed in this fashion will form a rectangle and will provide optimal approximation of the wound edges.
Getting the suture path to follow the rectangular course described above may seem counterintuitive, since the needle is curved. Think of the skin as the tangent to the arc formed by the needle; in this case, the tangent is stationary and the arc rotates. Efficient and atraumatic placement of sutures which follow the rectangular path described above requires coordinated use of the forceps and needle holder.
One can best take advantage of the natural curvature of the needle by alternately pronating and supinating the hand with the needle holder. The needle holder and needle should be roughly perpendicular. The tip of the needle should penetrate the skin perpendicularly about mm from the wound edge, and the needle should be rotated all the way through the epidermis and dermis by supinating the right hand to rotate the needle through its arc.
The tip of the needle should now be seen protruding into the wound from the subcutaneous tissue.
At this point, it is important to maintain the position of the skin edge using the forceps. A common error here is to release the forceps from the skin edge, but this allows the skin to retract, and the needle may move and retract beneath the skin edge.
The key is to maintain the position of the skin edge while releasing the needle from the needle holder. This will maintain the position of the needle tip. After the needle is released from the needle holder, the right hand should be fully pronated before regrasping the needle.
The needle should emerge about mm from the wound edge equidistant on both sides of the wound. Scissors are generally held with the thumb slightly in one ring and the ring finger in the other. The index finger stabilizes the instrument by resting on the shaft. When cutting sutures, some recommend sliding the tips of the scissors down the strands to the point where they will be cut, but it probably makes more sense to simply move the tips of the scissors directed to the point where the eyhicon will be made.
Many patients are very apprehensive about suture removal, so the first step is to reassure the patient that the procedure is not painful.
The skin should be cleansed. Hydrogen peroxide is a good choice for gently removing dried blood and exudate. This should be nredle close to the skin edge in order to minimize the amount of contaminated suture that will be dragged through the stitch path.
The suture is then gently removed by pulling with the forceps. It is frequently a good idea to reinforce the wound with Proxi-Strips. These are narrow adhesive strips that are placed perpendicularly across the wound at intervals.