Surgical Care at the District Hospital
Control initial oozing of blood from the cut surfaces by pressure overgauze
Control individual bleeding vessels with cautery or suture ligationusing fine suture; when tying off bleeders, cut the ligature short
Avoid diathermy near the skin where it may cause damage and devitalizetissue
When tying off a large vessel, or to ensure that the suture will notcome off the end of a vessel, use a suture ligature. This involves passingthe needle through the vessel before securing the tie around the vessel(Figure 4.4). Place a second free tie below the suture ligature.
Suture is made of a variety of materials with a variety of properties
There are many types of sutureand a variety of materials; learnthe properties of each, becomeconfident using a few andregularly use those you aremost comfortable with
Suturing is the most versatile,least expensive and mostwidely used technique of securing tissue during anoperative procedure.
4.2 SUTURE AND SUTURE TECHNIQUE
Suture is made of a variety of materials with a variety of properties. It may besynthetic or biological, absorbable or non-absorbable and constructed with asingle or multiple filaments.Nylon is an example of a synthetic suture. Biological suture, such as gut,increases physiological response and is not good for use in the skin. Silk is abraided biological suture, which should not be used in dirty wounds. Themultiple filaments create space, allowing bacterial trapping, and silk is absorbedslowly.Choice among these materials depends on:
Individual preference in handling
Security of knots
Behaviour of the material in the presence of infection
Cost.If you want a suture to last, for example when closing the abdominal wall orligating a major vessel, use one made of non-absorbable material. Useabsorbable material in the urinary tract to avoid the encrustation and stoneformation associated with non-absorbable suture. All varieties of suture material may be used in the skin, but a reactive suturesuch as silk should be removed within a few days. In skin wounds, removesutures early to reduce visible markings.Because of the ease of tying, braided suture may be easier to use for interruptedstitches. Absorbable and non-absorbable monofilament suture is convenientfor continuous running stitches.