Wound Closure Manual (PDF) - Penn Medicine

CHAPTER 4 63
PREPARATION OF CONTINUOUS TIES
ON A LIGAPAK DISPENSING REEL
FIGURE
5
1. Open the packet containing
the appropriate
material on a reel. Transfer
the inner contents of the
primary packet to the
sterile field using aseptic
technique.
2. Extend the strand end
slightly for easy grasping.
Place reel conviently
on the Mayo tray.
3. Hand reel to surgeon as
needed, being certain that
the end of the ligating
material is free to grasp.
4. Surgeon holds reel in
palm, feeds strand
beween fingers, and
places around tip of
hemostat.
FIGURE
6
PEPARATION
OF PRE-CUT
SUTURES
FOR TIES OR
LIGATURE
SUTURES
1. Remove one pre-cut length from nonabsorbable
suture at a time from the labrinth packet as it is
needed by the surgeon.
2. Extract pre-cut strands of SUTUPAK* sterile
absorbable or nonabsorbable suture. Straighten
surgical gut with a gentle pull. Place strands in
the suture book or under Mayo tray.
advance should be avoided. For
example, if the surgeon opens the
peritoneum (the lining of the
abdominal cavity) and discovers
disease or a condition that alters
plans for the surgical procedure
and anticipated use of sutures,
opened packets would be wasted.
At closure following abdominal
surgery, remembering the letters
PFS (peritoneum, fascia, skin) will
be helpful for organizing sutures.
By watching the progress of the
procedure closely, listening to
comments between the surgeon
and assistants, and evaluating
the situation; suture needs can
be anticipated. Free moments can
be used to prepare sufficient suture
material to stay one step ahead of
the surgeon. The goal should be to
have no unused strands at the end
of the procedure.
Ligature material which remains
toward the end of the procedure
may be the same material and size
specified by the surgeon for sutures
in the subcutaneous layer of wound
closure. In this case, the remaining
ligating material should be used
rather than opening an additional
suture packet.
If the surgeon requires "only
one more suture," and strands of
suitable material remain which
are shorter than those prepared
originally, do not be reluctant to
ask the surgeon if one of the
strands will serve the purpose
before opening a new packet.
Most surgeons are cooperative in
efforts to conserve valuable supplies.
SUTURE HANDLING
TECHNIQUE
During the first postoperative week,
the patient's wound has little or no
strength. The sutures or mechanical
devices must bear the responsibility
of holding the tissues together
during this period. They can only
perform this function reliably if the
quality and integrity of the wound
* Trademark