Wound Closure Manual (PDF) - Penn Medicine

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CONTRAINDICATIONS Being absorbable, should not be used where extended approximation of tissues under stress is required. Should not be used in patients with known sensitivities or allergies to collagen or chromium. Being absorbable, should not be used where extended approximation of tissues under stress is required. Should not be used in patients with known sensitivities or allergies to collagen or chromium. FREQUENT USES General soft tissue approximation and/or ligation, including use in ophthalmic procedures. Not for use in cardiovascular and neurological tissues. General soft tissue approximation and/or ligation, including use in ophthalmic procedures. Not for use in cardiovascular and neurological tissues. HOW SUPPLIED 7-0 thru 3 with and without needles, and on LIGAPAK dispensing reels 0 thru 1 with CONTROL RELEASE needles 7-0 thru 3 with and without needles, and on LIGAPAK dispensing reels 0 thru 1 with CONTROL RELEASE needles COLOR CODE OF PACKETS Yellow Beige TABLE 5 SUTURING OPTIONS: MATERIALS, CHARACTERISTICS, AND APPLICATIONS Should not be used where extended approximation of tissue under stress is required or where wound support beyond 7 days is required. Superficial soft tissue approximation of skin and mucosa only. Not for use in ligation, ophthalmic, cardiovascular or neurological procedures. 5-0 thru 1 with needles Red Being absorbable, should not be used where extended approximation of tissue under stress is required. Undyed not indicated for use in fascia. General soft tissue approximation and/or ligation. Not for use in cardiovascular and neurological tissues, microsurgery, or ophthalmic surgery. 6-0 thru 2 with and without needles 3-0 thru 1 with CONTROL RELEASE needles Coral Being absorbable, should not be used where extended approximation of tissue is required. General soft tissue approximation and/or ligation. Not for use in cardiovascular and neurological tissues. 5-0 thru 2 with and without needles Violet Being absorbable, should not be used where extended approximation of tissue is required. Being absorbable, should not be used where prolonged approximation of tissues under stress is required. Should not be used with prosthetic devices, such as heart valves or synthetic grafts. General soft tissue approximation and/or ligation, including use in ophthalmic procedures. Not for use in cardiovascular and neurological tissues. All types of soft tissue approximation, including pediatric cardiovascular and ophthalmic procedures. Not for use in adult cardiovascular tissue, microsurgery, and neural tissue. 8-0 thru 3 with and without needles, and on LIGAPAK dispensing reels 4-0 thru 2 with CONTROL RELEASE needles; 8-0 with attached beads for ophthalmic use 9-0 thru 2 with needles 4-0 thru 2 with CONTROL RELEASE needles 9-0 thru 7-0 with needles 7-0 thru 1 with needles Violet Silver Should not be used in patients with known sensitivities or allergies to silk. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 9-0 thru 5 with and without needles, and on LIGAPAK dispensing reels 4-0 thru 1 with CONTROL RELEASE needles Light Blue Should not be used in patients with known sensitivities or allergies to 316L stainless steel, or constituent metals such as chromium and nickel. Abdominal wound closure, hernia repair, sternal closure and orthoaedic procedures including cerclage and tendon repair. 10-0 thru 7 with and without needles Yellow-Ochre Should not be used where permanent retention of tensile strength is required. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 11-0 thru 2 with and without needles Mint Green Should not be used where permanent retention of tensile strength is required. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 6-0 thru 1 with and without needles 4-0 thru 1 with CONTROL RELEASE needles Mint Green None known. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 6-0 thru 5 with and without needles 10-0 and 11-0 for ophthalmic (green monofilament); 0 with CONTROL RELEASE needles Turquoise None known. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 7-0 thru 5 with and without needles 4-0 thru 1 with CONTROL RELEASE needles; various sizes attached to TFE polymer pledgets Orange None known. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 6-0 thru 2 (clear) with and without needles; 10-0 thru 8-0 and 6-0 thru 2 with and without needles; 0 thru 2 with CONTROL RELEASE needles; various sizes attached to TFE polymer pledgets Deep Blue None known. General soft tissue approximation and/or ligation, including cardiovascular, ophthalmic and neurological procedures. 6-0 through 5-0 with TAPERCUT* surgical needle 8-0 through 5-0 with taper point needle Royal Blue * Trademark
22 THE SUTURE tissue strangulation. Excessive tension and instrument damage should be avoided to prevent suture breakage which could disrupt the entire line of a continuous suture. Continuous suturing leaves less foreign body mass in the wound. In the presence of infection, it may be desirable to use a monofilament suture material because it has no interstices which can harbor microorganisms. This is especially critical as a continuous suture line can transmit infection along the entire length of the strand. A continuous one layer mass closure may be used on peritoneum and/or fascial layers of the abdominal wall to provide a temporary seal during the healing process. INTERRUPTED SUTURES Interrupted sutures use a number of strands to close the wound. Each strand is tied and cut after insertion. This provides a more secure closure, because if one suture breaks, the remaining sutures will hold the wound edges in approximation. Interrupted sutures may be used if a wound is infected, because microorganisms may be less likely to travel along a series of interrupted stitches. DEEP SUTURES Deep sutures are placed completely under the epidermal skin layer. They may be placed as continuous or interrupted sutures and are not removed postoperatively. BURIED SUTURES Buried sutures are placed so that the knot protrudes to the inside, under the layer to be closed. This technique is useful when using large diameter permanent sutures on deeper layers in thin patients who may be able to feel large knots that are not buried. PURSE-STRING SUTURES Purse-string sutures are continuous sutures placed around a lumen and tightened like a drawstring to invert the opening. They may be placed around the stump of the appendix, in the bowel to secure an intestinal stapling device, or in an FIGURE 4 FIGURE 5 DEEP SUTURES PURSE-STRING SUTURES organ prior to insertion of a tube (such as the aorta, to hold the cannulation tube in place during an open heart procedure). SUBCUTICULAR SUTURES Subcuticular sutures are continuous or interrupted sutures placed in the dermis, beneath the epithelial layer. Continuous subcuticular sutures are placed in a line parallel to the wound. This technique involves taking short, lateral stitches the full length of the wound. After the
Page 1 and 2: ✛✛✛✛✛✛✛✛✛✛✛
Page 3 and 4: CONTRIBUTING EDITOR David, L. Dunn,
Page 5 and 6: 4 PACKAGING An Integral Part of the
Page 7 and 8: 2 WOUND HEALING & MANAGEMENT THE WO
Page 9 and 10: 4 WOUND HEALING SURGICAL PRINCIPLES
Page 11 and 12: 6 WOUND HEALING contaminated wounds
Page 13 and 14: 8 WOUND HEALING occur, the wound is
Page 15 and 16: 10 THE SUTURE WHAT IS A SUTURE? The
Page 17 and 18: 12 THE SUTURE ABSORBABLE VS. NONABS
Page 19 and 20: 14 THE SUTURE gut being used, the t
Page 21 and 22: 16 THE SUTURE support for up to 6 w
Page 23 and 24: 18 THE SUTURE dyed green, polyester
Page 25: ABSORBABLE SUTURES SUTURE Surgical
Page 29 and 30: 24 THE SUTURE increases in intra-ab
Page 31 and 32: 26 THE SUTURE PDS* II (polydioxanon
Page 33 and 34: 28 THE SUTURE the biologic forces i
Page 35 and 36: 30 THE SUTURE Monofilament sutures
Page 37 and 38: 32 THE SUTURE and the anterior fasc
Page 39 and 40: 34 THE SUTURE straining, or distent
Page 41 and 42: 36 THE SUTURE preferred. Patients,
Page 43 and 44: 38 THE SUTURE anastomoses. Multifil
Page 45 and 46: 40 THE SUTURE VICRYL sutures may be
Page 47 and 48: 42 THE SURGICAL NEEDLE Necessary fo
Page 49 and 50: 44 THE SURGICAL NEEDLE curved needl
Page 51 and 52: 46 THE SURGICAL NEEDLE THE NEEDLE E
Page 53 and 54: 48 THE SURGICAL NEEDLE uniform bite
Page 55 and 56: 50 THE SURGICAL NEEDLE exclusive ET
Page 57 and 58: 52 THE SURGICAL NEEDLE penetration.
Page 59 and 60: 54 THE SURGICAL NEEDLE edges inside
Page 61 and 62: 56 PACKAGING AN INTEGRAL PART OF TH
Page 63 and 64: 58 PACKAGING ABSORBABLE SUTURE Surg
Page 65 and 66: 60 PACKAGING in an organizer sleeve
Page 67 and 68: 62 PACKAGING PREPARATION OF STANDAR
Page 69 and 70: 64 PACKAGING closure materials are
Page 71 and 72: 66 PACKAGING 1. Protect absorbable
Page 73 and 74: 68 TOPICAL SKIN ADHESIVES Low tensi
Page 75 and 76: 70 TOPICAL SKIN ADHESIVES HOW TO CA
Page 77 and 78:
OTHER SURGICAL PRODUCTS CHAPTER 6
Page 79 and 80:
CHAPTER 6 75 1. Using sterile techn
Page 81 and 82:
CHAPTER 6 77 the staplers are not r
Page 83 and 84:
PRODUCT TERMS AND TRADEMARKS CHAPTE
Page 85 and 86:
CUTICULAR SUTURES Sutures designed
Page 87 and 88:
MODULAR SUTURE STORAGE RACK Plastic
Page 89 and 90:
STERILE Free of living microorganis
Page 91 and 92:
PRODUCT INFORMATION CHAPTER 8
Page 93 and 94:
CHAPTER 8 93 ETHILON* NYLON SUTURE
Page 95 and 96:
CHAPTER 8 91
Page 97 and 98:
CHAPTER 8 93 ETHILON* NYLON SUTURE
Page 99 and 100:
CHAPTER 8 95 MERSILENE* POLYESTER F
Page 101 and 102:
CHAPTER 8 97 MONOCRYL* (Poliglecapr
Page 103 and 104:
CHAPTER 8 99 NUROLON* NYLON SUTURE
Page 105 and 106:
CHAPTER 8 101 PERMA-HAND* SILK SUTU
Page 107 and 108:
CHAPTER 8 103 PROLENE* (POLYPROPYLE
Page 109 and 110:
CHAPTER 8 105 PRONOVA* POLY (HEXAFL
Page 111 and 112:
CHAPTER 8 107 PROXIMATE ® SKIN STA
Page 113 and 114:
CHAPTER 8 109 SURGICAL GUT SUTURE A
Page 115 and 116:
CHAPTER 8 111 VICRYL* Knitted Mesh
Page 117 and 118:
INDEX CHAPTER 9
Page 119 and 120:
CHAPTER 9 115 K L M KNOT SECURITY,
Page 121 and 122:
CHAPTER 9 117 subcuticular techniqu
Page 123 and 124:
CHAPTER 9 119 V W VASCULAR SURGERY,
Page 125 and 126:
NOTES
Page 127:
W OUND H EALING S UTURES N EEDLES A
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