Objective and Management of OT V

Sutures

A suture can be simply defined as a length of material used to keep bodily tissues close together until a heating process has taken place. A surgical suture is a type of medical device used to keep bodily tissue together after an operation or damage. Typically, it consists stitching a needle and thread. Over time, a variety of thread types, sizes, and forms have been produced.

An ideal surgical suture should have the following characteristics:

• Sterile
• Universal (its material can be used in any surgical procedure )
• Easy to handle
• High tensile strength
• Holds securely when knotted
• Good absorption profile and
• Resistance to infection. However, at the moment, no single material possesses all the mentioned characteristics.

Suture Size

The diameter of the suture strand determines the surgical suture size. It represents the 0s. The diameter of the strand decreases as the number of zeros increases (for example, 1-0 or 0 is bigger than 2-0 or 00). The tensile strength of the strand decreases with decreasing suture size.

Types of Surgical Suture

The many types of surgical sutures used in the operation vary, with the location and environmental requirements, the surgeons' judgment and professional expertise serving as the primary determining factors.

Function of sutures

• to maintain the integrity of tissues or structures that have been split during a surgical procedure.
• using an implant to resemble (hold) a bodily tissue or other structure in order to maintain the implant's right position.
• To clearly differentiate and identify certain surgical structures in order to aid in the surgical process by serving as a marker
• to enable a specific structure to be gently pulled back during surgery in order to enhance the surgeon's visibility and access.

Classification of Sutures

• Absorbable
• Non-Absorbable

Absorbable

These are surgical sutures that are absorbable and will break down safely in the body over time without intervention. Utilized internally because it would require a re-opening if they were to be removed.

These types of sutures material are absorbed by the body at varying duration following surgery ranging from 7 days to 6 months. For example- plain catgut, chronic catgut, vicryl.

Absorbable materials: (Natural organic)

• Catgut: - Prepared from submucosa of the small intestine that government inspected of sheep and bovine intestine. (sterilized by gamma irradiation)
• Chronic catgut: - The terms chronic indicate that the ribbons have been treated with chromic salt, which increased material strength and reduces tissue irritation. This type of catgut is use in Peritoneum cavity, Muscles, facia, uterine tube.
• Collagen: - Like catgut, these are prepared as plain or chromic catgut.

Non –Absorbable

These types of suture remain within the body unless removed intentionally. They are therefore used in areas that have poor healing, or where natural healing can’t occur such as Prolene, Silk.

Non-Absorbable suture materials

• Silk: Silk can be used for skin suture, Ophthalmic, and oral surgery.
• Polyester: Use vascular, Orthopedic Surgery.
• Stainless steel: These materials used for tendon and for suturing of a chest, Orthopaedic.

Selection criteria of structure materials

• Natural and comfortable healing
• Tissue response is minimal.
• Preventing the development of a bacterial environment.
• Dependable knot growth
• Simple to use
• Both the surgical team's and the patient's safety.

There are two types of absorbency.

• Natural and artificial.
• Multifilament and monofilament.

Rate of absorption.

• Embroidery and typing.

A suture's purpose, along with each step.

• Healing potential.
• pace of healing.
• An approximation of tissue strength

Care and Storage of Sutures Materials:

• Keep the theater's seating area dry and clear of dust.
• easily observable
• Transferable to various operating rooms with ease.
• efficiently stocked in every operational theater.
• Period of expiration.
• Manufacturing firm.
• various materials.

Needles

There are several varieties, including cutting and round body. The latter kind has edges that are sharp and readily penetrate flesh.

Sewing soft tissues like blood vessels, muscles, etc. is done with the help of the round body. Their eyes are really tiny. Nowadays, atraumatic needles are utilized the majority of the time. It indicates that they don't cause tissue harm. These sutures are completely removed from the needle eyes and are secured there permanently.

The needles come in a variety of sizes with varying thicknesses and curves.

Also present are straight needles. A needle holder is used to hold the curved needles. Steel, either stainless or plated carbon, is used to make needles.

Needles are grouped according to their:

• Tip
• Hole
• structure

The hole in the skin is due to the tip of the needles and not due to length. The injury is caused due to the eye of the needle.

Common needles used in theater and its types:

• Round-bodies needles
• Cutting needles
• Reverse cutting needles
• Blunt needles

Needles shape

• Quarter-circle
• Three-eight circle
• Half-circle
• Five-eight-circle
• J-shaped
• Straight

Surgical Drains

For many years, different types of surgical drains have been used in a variety of operations with the best of intentions. The surgeon's preference or the needs of the patient are taken into consideration when selecting the drainage systems.

There are 3 types of drainage systems:

• The closed drainage system is a network of tubing or other equipment that is connected to the body to drain fluids in an airtight circuit, shielding the wound or region being drained from any form of environmental contamination.
• A tube or device that is introduced into the body and drains onto a dressing called the open drainage system.
• Last but not least, the suction drainage system uses a mechanical pump or device to assist in removing the extra fluid from the body.

Indications

Surgical drains are used in a wide variety of different types of surgery. Generally speaking, the intention is to decompress or drain either fluid or air from the area of surgery. Examples include:

• To stop fluid from accumulating (blood, pus, and infected fluids).
• To avoid the buildup of air (dead space).
• To describe fluid (for example, early identification of anastomotic leakage)

Specific examples of drains and operations where they are commonly used include:

• procedure involving myocutaneous flaps in plastic surgery.
• a breast operation (to prevent a collection of blood lymph).
• orthopedic techniques (associated with greater blood loss).
• chest dripping
• chest operation (with, for example, the associated risks of raised intrathoracic pressure and tamponade).
• bacterial cysts (to drain pus).
• surgery on the pancreas (to drain secretions).
• thyroid operation (concern over hematoma and hemorrhage around the airway).
• bladder catheters.
• nose-to-mouth tubes.

Types of Surgical Drain

Drain can be:

• Open or shut
• Fluid is drained from open drains, such as corrugated rubber or plastic sheets, onto a gauze pad or into a stoma bag. They probably make becoming sick more likely.
• Tubes emptying into a bottle or bag provide closed drains. Examples include drains for the chest, abdomen, and joints. Infection risk is generally decreased.
• both active and inactive
• Drains that are active are kept under suction (which may be low or high pressure).
• Passive drains operate based on the difference in pressure between body cavities and the outside because they lack a suction mechanism.
• styrene or rubber
• Silastic drains cause little tissue reaction and are comparatively inert.
• Red rubber drains may cause a strong tissue reaction and occasionally cause a tract to form.

General Guidance

• If the drain is running, a suction source can be connected to it (and set at a prescribed pressure).
• Make sure the drain is shut off (dislodgement is likely to occur when transferring patients after anesthesia). Dislodgement might raise the possibility of infection and skin irritation in the vicinity.
• Measure and record drainage output with accuracy.
• Keep an eye out for fluid character or volume changes.
• Utilize the measurement of fluid loss to help with IV fluid replacement.

Removal

• Inform the patient that the drain being removed may cause considerable discomfort.
• Prior to removal, take into account the necessity for pain relief.
• Cover the area where the drain was eliminated with a dry dressing.
• Until the wounds are healed, there will usually be some leakage from the area.
• When to remove: Drains that have been kept in one position for a long time could be challenging to get rid of.

Early removal could reduce some complications' risks, particularly infections.