SUMMARY OF INSTRUMENTS - YARN AND NEEDLES INTRODUCTION The use of surgical instruments is planned according to the type of surgery

and surgical time. Surgical procedures are carried out in four stages: • • • • Diaeresis (opening) itself Hemostasis Surgery (resection) Summary (sutur e) The surgical instruments are grouped according to surgical time and for didactic purposes, classified into seven groups, but this work will emphasize only the g roup III with regard to synthesis tools. HISTORY Throughout the history of manki nd, are episodes that depict surgical attitudes to the maintenance of life. Init ially, the surgeries were directed deferrals for correction and control traumati c bleeding. Pain control intra-and postoperative anesthesia and the initial step s of the control of surgical infection also transformed the history of surgery, contributing to its development. In principle, the surgery was aimed at cripplin g and extipar part of the patient or the organ affected. After the discovery of narcosis and asepsis in the nineteenth century, the surgeries began to be restor ative and conservative. From there then, there is an accelerated advance in deve lopment, both scientific and surgical techniques more specific, less mutilating and more cures. It is noteworthy that the relief of pain, cotrol bleeding and in fection are aspects that remain focused as indicators of surgical success. Anoth er point to be considered in the evolution of surgery was the challenge of trans forming the surgery on a scientific activity and a safe therapeutic choice. Alli es surgical outcome, many instruments were developed and used by surgeons in all periods of history. Over time many of these instruments, especially the synthes is tools have been reworked, adapted, removed or replaced by more practical and specific to a particular procedure. Surgical instruments are essential for the d evelopment of the sequence that makes up the surgical times. 3 SURGICAL TIME The term surgical times characterizes the sequence of procedures used in handlin g of tissues and organs during surgery, and identified four basic tenses. Dieres is: consists of separating tissues, or anatomical planes, to reach a region or o rgan. The diaeresis can be accomplished by several methods: mechanical, thermal, cryotherapy and laser, and the most used is the mechanic, using sharps, such as electric scalpels, scissors, knife, saw burr, needles and others. Hemostasis: I t is to determine or prevent bleeding. It can be done by clamping and ligation o f vessels, electrocoagulation and compression. These methods can be used simulta neously or individually. Surgery itself or Excision: This is the moment when the surgeon reaches the desired point and performs the surgery in order to diagnose , control or resolution of the events, reconstructing the area and leaving it as physiological as possible. Synthesis or Suture: It is the union of the tissues, the synthesis can be classified as: bloody: suture is permanent or removable un bloody: suture through plaster, adhesive bandage or Immediate: after incision me dia: some time after the incision track: in the entire length of the incision in complete: it maintained a small opening for the placement of drains. In summary of the plans must be respected hierarchy tissue, its stratification, making the constitution for the synthesis of tissue identical to each other. The conditions necessary for a good summary are: antisepsis local vascularization perfect the edges of incision. Sharp edges, perfect hemostasis, ie, no bruises or other coll ections, because the success of organic synthesis depends on hemostasis correct coaptation without compression of tissues, absence of foreign bodies and necroti c tissue, appropriate choice of yarn for each tissue, implementation with correc t technique. Surgical Instruments The surgical instruments are grouped according to surgical time, as previously d escribed, this paper will give emphasis to group III, ie, instruments used in th e synthesis. But it is extremely important we discuss other tools used during su

rgery and how they are grouped. For teaching purposes the surgical instruments a re divided as follows: 4 Group I: Diaeresis of Group II: Group III of Hemostasis: Overview of Group IV: S pecial Group V: Support Group VI Group VII Field: Afastadores or exposure Group I: This group is composed almost sharp instruments such as scalpels and sc issors in various sizes and types,€and others like knife, saw, drill bit needles . Group II: This group consists of instruments for the clamping of bleeding vess els, and these hemostatic forceps, straight or curved, with or without tooth, va rious types and sizes. In general they are called by the name of its creator. Gr oup III: This group is composed of instruments of suture needles as straight or curved, triangular or traumatic or atraumatic round-bottom fixed or false. This group has the needle holder and suture materials. This group will be detailed in the sequel, to be the main theme of this work. Group IV: This group consists of instruments whose appointment is determined by the type of surgery. These instr uments are only used in surgery itself, so take the place apart economies at the table of instruments. It read like the clamps exmeplo: Duval, Satinsky and Alli s. Group V: It is composed of auxiliary instruments hold. As its name indicates, is intended to assist in using other instruments. Basically this group makes up the tweezers and tooth anatomy of the rat. Group IV: This group consists of cla mps designed to fix the barren fields for defining the operative field. Basicall y part of this group calipers Backhaus. Group VII: This group consists of instru ments that allow exposure to better visualize the operative cavity .. 5 SUMMARY OF MANUAL INSTRUMENTS WITH YARN AND NEEDLES The manual suture, popularly known as "points" and performed using the following instruments, yarn, needles, forceps and needle holder. The manual synthesis Wir ed and needles is the most used in surgical procedures, then we detail the main instruments. Needles are used to in order to transfix the tissues, serving as a guide for the suture. Material: are usually produced in stainless steel division : the needle is divided into three parts: • Tip: It is part of the suture needle that facilitates penetration of the tissue, causing as little trauma as possibl e. • Body: This is the central portion of the needle, which enables adequate fix ation to portaagulha. With that provides easy maneuvering of release and redempt ion of the needle into the tissue during the surgical process of synthesis. • Ba ckground: This is the point of a union of the needle with the suture. There are needles and fixed false floor. The needles are classified as: Shape: Can be straight and curved. The curves can be 90 °, 135, 180 and 225 º circle. Diameter can be thin or thick Length in inc hes: the curved needles varies from 3mm to 9 cm and straight 5-6 cm. Type or tip section: it can be cylindrical, triangular, diamond, tool or blunt. The sharps are called traumatic and non-cutting to atraumatic. The cylindrical geometry of the needles and allows for a minimum of trauma when their penetration into the f abric, place a better seal between the fabric and yarn. The cutting needles are designed to sever the fibers of the tissue pierced by them, through one or more sharp edges. No background: No background - the wire is inserted into the needle - this type is called atraumatic. When there is needle at both ends of the wire is called a double. 6 Background, and false: Background regular, elongated, square Fund, Fund rounded, Benjamin Fund, Fund French, fork or false - when the wire can be inserted under pressure without being stuffed. Parts of a needle forms needles

7 Type of traumatic and atraumatic ends 8 Funds Needle Indications: The suture needle, cylindrical in shape, is indicated for sutures i n the intestine, peritoneum, vessels and other tissues of easy penetration. The triangular, for suturing skin and aponeurosis, because the cutting tip enables p enetration into tissues more resistant. The diamond tip of traumatized unless cy lindrical, and its power of penetration is higher than the triangular needle. Th e spatula, by the power of penetration is indicated for ophthalmic surgery. The blunt shape to organ suturing friable, such as liver, kidney and others. 9 Suture From about 2000 BC There are references indicating the use of strings and tendon s of animals for suturing. Through the centuries, a variety of materials have be en used in the manufacture of wire for surgical procedures, such as silk, linen, cotton, horsehair, tendons and intestines of animals. However, some of these ar e still used today. The development of suture materials brought us to a point of refinement that includes the development of sutures and specialty yarns for spe cific types of procedures. Therefore, to eliminate some of the difficulties enco untered in the past by surgeons, and also€decreased substantially the potential for postoperative infection. The suture thread concept is a flexible structure w ith circular shape and has a reduced diameter. Can be of synthetic material of v egetable fiber or organic material. Despite being a simple structure is a major element in the surgery because it is an essential part of surgical sutures and k nots. Sutures are already within the medical practice since the ancient Greeks a nd egípsios being used and known by men long before the surgery as we know it to day. Always important to remember that all the sutures are seen as foreign in ou r bodies, so they will produce a type of local reaction. But there are peculiari ties of each wire and thus cause a greater reaction and some other minor reactio n. The sutures are composed of many different types and classified as: • absorpt ion • Origin • • Number of filament diameter. As for absorption: Absorbable x no nabsorbable Absorbable: Are you, some time after the suture, are absorbed by org anic action, may be of animal origin or synthetic. Catgut simple: it is of anima l origin, received that name originated from the English translation which is "c at gut." During the manufacturing process does not undergo any specific treatmen t to change their time of absorption when in contact with body tissues. The simp le catgut is indicated for the following surgeries: 10 • • • • • • Closing General: peritoneum, subcutaneous and bandages. Ob-Gin: anastomoses, epi siorrafias. Gastrointestinal: anastomoses, omentum. Urology: bladder, prostate c apsule, ureter, links arteries vesicles, urethra. Ophthalmology: Conjunctival. E NT: tonsillectomy. Serous natural intestinal submucosa and bovine intestine of s heep 70-10 days 70 days By cobalt 60 6-0 1 Type of material composition tensile strength of absorption Sterilization Time P resentation Catgut chrome: This type of wire is the same source as simple catgut, but was im pregnated with chromium salts or tannic, to give it more time tensile strength a nd therefore increasing the absorption time to sue. The simple chrome catgut wir

es are kept in isopropyl alcohol, to maintain their properties. Material type Se rous natural composition of bovine intestine and intestinal submucosa of sheep t ensile strength 21 to 28 days 90 days time to absorb Sterilization For cobalt-60 Presentation to a 5-0 catgut The chrome is indicated for the following surgerie s: • • • • • • Closing General: peritoneum, subcutaneous and bandages. Ob-Gin: a nastomoses, episiorrafias. Gastrointestinal: anastomoses, omentum. Urology: blad der, prostate capsule, ureter, links arteries vesicles, urethra. Ophthalmology: Conjunctival. ENT: tonsillectomy. Caprofyl. Type of material composition tensile strength Time Synthetic absorptio n Poliglecaprone 25 (copolymer glycol and caprolactone) 21 91 a 119 days 11 Sterilization Presentation Ethylene oxide to 1 5-0 The caprofyl is indicated for the following surgeries: • • • • Closing General: peritoneum, subcutaneous tissue. Gastrointestinal: anastomoses, omentum. Ob-Gin: tubal ligation, vaginal vault, uterus, vaginal wall. Urology: bladder, ureter, artery ligation vesicular, urethra. Monocryl type composition material tensile strength of absorption Sterilization Presentation Time Synthetic Poliglecaprone 25 (copolymer glycol and caprolactone ) 21 91 a 119 days of ethylene oxide 5-0 to 3-0 The monocryl is indicated for: • Plastic (skin) Vicryl type composition material tensile strength of absorption Sterilization Presentation Time Synthetic Polygl actin 910, covered with Polyglactin 370 + stearate calcium. 28 56 to 70 days of ethylene oxide to 2 10-0 The vicryl is indicated for: • • • • • • • Closing General: peritoneum, aponeuro sis, serosa, submucosa and skin. Neurology: dura, fascia and aponeurotic muscle. Ophthalmology: sclera, conjunctiva. Gastrointestinal: anastomoses, omentum. ObGin: bandages, vaginal vault, uterus, bladder, vaginal wall. Orthopedics: synovi al membrane and knee cap. Urology: bladder, ureter and urethra. 12 Vicryl Rapid type composition material tensile strength of absorption Sterilizat ion Presentation Time Synthetic Polyglactin 910, 370 + Polyglactin covered with calcium stearate. 10 to 14 days 42 days 60 6-0 1 Cobalt The rapid vicryl is indicated for: • • • Closure of skin and mucous Plastic Surg ery Episiorrafias 13 Vicryl absorbable suture Vicryl Plus Plus has the same composition, characterist ics and construction confident that the Vicryl suture. The difference between th em is that the Vicryl Plus contains IRGACARE MP€the purest form of triclosan, a broad-spectrum antibacterial agent at a concentration of 0.003 mg / kg. The IRGA CARE MP is an antiseptic. It is not an antibiotic, and is not toxic at the conce ntration used. The IRGACARE MP is effective against most common pathogens associ ated with surgical site infections: Staphylococcus Aureos and Staphylococcus epi dermidis, both methicillin resistant. This feature promotes protection against b acterial colonization around the suture line, minimizing the risk of infection Pds II type composition material tensile strength of absorption Sterilization Pr

esentation Time Synthetic polydioxanone 42 days 180 days EO 7-0 2 The wire PDs II is indicated for: • Closing General: peritoneum and aponeurosis. • Transplantation: kidney and liver. • Gastrointestinal: serosa, submucosa. 14 • • • Ob-Gin: bandages, vaginal vault, uterus, bladder, vaginal wall. Orthopedics: syn ovial membrane and knee cap. Cardiopediatric: coarctation of the aorta. Nonabsorbable: are those that are permanently in the body, even suffering the ac tion of exculpatory evidence organic is not disposed, are involved for some time by fibrous tissue. May be animal, vegetable, mineral, synthetic and blended. Mo nonylon type composition material tensile strength Sterilization Uses frequent P resentation: • • • • Closing General: aponeurosis. Microsurgery: anastomoses. Pl astic: skin. Ophthalmology: cataract extraction, penetrating queroplastia, detac hed retina, cornea, sclera. Synthetic Fibres of flax Loss of 20% per annum of et hylene oxide at 0 11-0 Polycot type composition material tensile strength Sterilization Uses frequent P resentation: • Closing General: bandages and skin. Synthetic Filament Polyester (70%) and cotton fibers (30%). Permanent Cobalt 60 4-0 0 15 • Flax Gastrointestinal: mucosa, submucosa. Type of material composition tensile strength Sterilization Uses frequent Presen tation: Silk • • Type of material composition tensile strength Sterilization Use s frequent Presentation: • • • • • Natural linen fibers Undetermined (loses most of the tensile strength in less th an a year) Cobalt 60 3-0 1 General: bandages Gastrointestinal: mucosa, submucosa. Natural cocoon silkworm silk (70% Protein + 30% gum) - fibroin (Protein Organic) 1 year 60 8-0 1 Cobalt Closing General: bandages. Gastrointestinal: mucosa, submucosa. Neurology: dura, fascia aponeurotic muscle. Ophthalmology: Cataract extraction, queroplastia per manent strabismus (sclera), retinal detachment. Plastic: skin. Prolene type composition material tensile strength Presentation Synthetic polypr opylene permanent sterilization ethylene oxide 10-0 to 2 16 Uses frequent: • Closing Overall: aponeurosis. • Gastrointestinal: anastomosis • Plastic: skin. • Cardiovascular: bypass graft coronary artery, proximal and dis tal anastomoses, aortomia, aorto-abdominal aneurysm (AAA). • Ophthalmology: Scle ral fixation. Mersilene type composition material tensile strength Sterilization Presentation Frequent Use: • • Ophthalmology: Strabismus, Corneal Transplantati on. Closing General: bandages. Synthetic Polyester (8 careers). permanent 10-0 e thylene oxide at 0 Ethibond type composition material tensile strength Sterilization Uses frequent Presentation: • • • Gastrointestinal: laparoscopy. Orthopedics: synovial membran

es. Cardiovascular catheterization, sternal closure, fixation of prostheses, rep lacement of the valve. Synthetic Polyester (16 rows). Permanent ethylene oxide 5 -0 5 17 Aciflex type composition material tensile strength Sterilization Uses frequent P resentation: • • • Cardiovascular: Closure of the sternum. Oral and Maxillofacia l: Fixation of the mandible. Orthopedics: bone fixation. Synthetic Stainless Ste el 316L (low carbon) permanent ethylene oxide 2-0 to 6 Sternumband issues related to consolidation of the sternum is one of the most se rious complications in heart surgery. Treatment is complex and requires long hos pitalization resulting desgastefísico and emotional for the patient. " The atern umband aims to: • Make sternum closure after medial sternotomy in cardiac or tho racic surgeries. • Promote adequate stabilization of the sternum, favoring the f ixation. • Prevents the instability of the sternum postoperatively. Why Use Ster numband? Band width steel (six times that of steel wire) contributes to the forc e is evenly distributed through the bone, high stability and promoting rapid hea ling. The quantity of filaments: There is a monofilament X Multifilamentary subdivisio n of monofilament and multifilamentary wires.€A monofilament consists of just a "filament", and is less resistant but more delicate and suffers less resistance passing through the tissues. A multifilament yarn consists of multiple "strands of material woven or braided to form a single wire. These are tougher and have m ore comfortable handling. Other 18 features described for the suture as the tissue reaction, infection, resulting i n firm and we among others, are generally under the raw material for its product ion. How The Presentation Almost all types of suture materials are found with or without needles. The sutu res are presented by numbers that indicate their strength and thickness. The siz es range from 6 (thickest) to 12 zeros (thinner) and the number 6 the diameter o f a strand 12 and the number of zeros of a hair of a baby. The wires also have d ifferent lengths ranging from 0.13 to 2.50 m, each length indicated for certain surgeries. As Origin: Natural and Synthetic As the source wires are divided into natural and synthetic. The natural yarns are produced in nature (animal, vegeta ble and mineral.) As for the synthetic yarns are obtained by chemical processes. Packaging Description Of The wires should come in packaging grade surgical or a combination of plastic film Thermosealers properly according to NBR No. 12 496 of 06.30.1994 and repacked in boxes as the practice of the manufacturer in order to maintain the integrity and sterilization product during storage until ready to use and labeled according to law. The individual packages should indicate: Nu mber surgical Cord Length Type Type suture needle size needle Control Number Num ber Name of manufacturer of yarn (if multiple) 19 SAMPLE PACKAGING ETHICON 20 NEEDLE HOLDERS

The Mayo-water port Mayo-Hegar needle is similar to conventional hemostatic forc eps, is stuck to the fingers for the rings present in their rods and have to rac k lock, progressive pressure. But his part clamp is shorter, wider and its insid e the grooves form a lattice with a center slot in the longitudinal direction. A re devices to increase their efficiency in the immobilization of the needle duri ng suturing, preventing its rotation when the force is applied. If the branches clamps are coated hard metal (tungsten) will not show longitudinal split. Althou gh the ease or difficulty in closing and opening may be related to the temper an d quality of steel that are produced, theoretically its handling is smoother in the instruments that have longer stems. In this case the application of force is further from the pivot axis of the branches, making a move to leverage more eff icient, as we know from physics. 21st The Needle Mathieu Mathieu differ much from previous, in its way, has no rings o n the rods is the opening of the clamp part limited because there are a spring-s haped blade uniting their stems, which makes them automatically open, when not l ocked. They are used attached to the palm of his hand, which make them open, if it is inadvertently used excessive force during handling. Your best indication w ould be to suture structures that offer little resistance to the passage of the needle. A good indication of this is that they lack the longitudinal split which increases the support of the needle. 22 The Olsen-Hegar needle holder of Olsen-Hegar is characterized together in a sing le instrument, the functions of tweezers and scissors to cut the wires. Below th e portion that holds the needle for the blades that cut the wires. During fabric ation of the node instrumental, sometimes the wire can bring to the blades, bein g cut accidentally, which is why many people avoid their use. 23 The Gillies needle holder GILLIES has rings on the rods, which are asymmetric: t he longest to the shortest finger and the thumb, which gives it greater ergonomi cs. It has no rack to hang the rods, which indicates its use be more suitable fo r suture needles with small, soft fabrics. 24 CONCLUSION In this study, we observed that the principles used for choosing the ideal synth esis tools for each time of surgery, is extremely important to obtain a positive prognosis, free of any iatrogenic short and long term. Synthesis tools are used come in different brands and substances on the market today, so we must emphasi ze the importance of professional nursing in the choice of synthesis tools for y our unit, the success of all 25 a team depends on this work,€you should opt for a better quality product possibl e. REFERENCES Rebollo, Eliane Covre, Booklet Surgical Nursing, Limeira. São Paulo, 2003. Sharing service Scribd online texts, Class 6, Available at: m/doc/7262687/Aula-6-Suturas, accessed the 20/03/2009 16:30:30. 26