SUTURE AND SUTURING

นพ. จิรยุทธ โตเลิศมงคล
พบ. ม.สงขลานครินทร วว.ศัลยศาสตรทั่วไป ม.สงขลานครินทร วว.ศัลยศาสตรตกแตง คณะแพทยศาสตร ศิริ รร ิ าชพยาบาล

Wound
z Definition

: A bodily injury caused by physical means, with disruption of the normal continuity of structure
z z

Closed wound Open wound

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5 % z Clean contaminated wound : 10 % z Contaminated wound : 15 % z Dirty wound : 30 .40 % .Wound Classification z Clean wound : 1 .

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Factors that affect wound healing Age z Weight z Nutrition z Dehydration z Blood supply z Immune response z Chronic illness z Drugs and radiation therapy z Smoking z .

Basic principles in wound management .

1) Hemostasis z First priority z Bloodless field z Suture ligation z Seroma and hematoma can lead to infection or to a delay in wound healing .

2) Wound cleansing z Sterile technique z Anesthesia z Irrigation .

3) Wound Exploration .

4) Debridement .

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5) Wound closure z Handling of the tissue z Incision planning z Relaxed skin tension lines .

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z undermining .

z Choice of suture material with sufficient tension z Closing .

Tissue moisture z Dead spaces z z Postoperative wound stress .

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SUTURE TECHNIQUES .

Goal : approximate and evert the wound edge.Simple interrupted suture z The most commonly used suture techniques. z .

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z Second bite : reduced tension from wound edge. z Two bite technique z First bite : approximate. .Vertical mattress suture z Useful in inverted wound z Excellent eversion and precise skin edge approximation.

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Horizontal mattress suture z Two bite sticth technique z Good tissue evert z Fair approximate z Small simple interrupted z Sterile strip z Take tension off the wound edge .

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Horizontal half burries .

Running closure (baseball stitch) z Wound’s z Not edges easily evert and long straight wound used in wound significant risk of hematoma. z Safe suture material and time .

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Running – lock closure z z Significant more tissue eversion. . Reduces the skin tension more than the running closure.

Running intracuticular z Useful in keloid patients z Removal is quick and easy Æ children z If incision longer than 3 cm. Æ surface loop .

NON – SUTURING TECHNIQUE

STAPLES

STERILE .STRIPS z Used to close very low tension. z Wound edge approximate. .

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SUTURE MATERIAL Diameter z Tensile strength z Tissue reactivity z Ease of handling the suture material z Facility for typing and maintaining knots z The absorption of the sutures by the body z .

1 days 6 days .

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Surgical needle .

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CASE STUDY 1 .

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CASE STUDY 2 .

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CASE STUDY 3 .

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CASE STUDY 4 .

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CASE STUDY 5 .

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THANK YOU .

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