BASIC SKILLS AND KNOWLEDGE OF SURGERY TECHNIQUE AND MATERIAL SUTURE
CHAPTER I
INTRODUCTION
Knowledge suturing is required in the science of surgical wounds due to scisum injuries and surgical sutures meant to reunite the severed tissue and improve the process of grafting and tissue healing and also prevent an open wound that will result in the entry of micro-organisms / infections.
Material suture quality is covering certain heavy-laden. The first is comfort to be used or to be held. Then the security alert on each appliance. Must always be sterile. Quite elastic. Made up from not reactive material. Enough power to wound healing. The ability for biodegradation of chemicals to prevent destruction of foreign materials.
CHAPTER II
MATERIAL sutures
The use of sewing tools and materials that are quality certain.The first is comfort to be used or to be held. Then the security alert on each appliance. Must always be sterile. Quite elastic. Not made of a reactive materials . Enough power to wound healing.The ability for biodegradation of chemicals to prevent destruction of foreign materials.
II .1. INSTRUMENT
A. Needle holder
Other names or Donald voeder needle holders. Types used vary, the type Crille wood (shaped like a clamp) and Mathew type Kusten (triangles). Use it on the sewing needle holder as the holder of a needle and thread bond.
Wood Crille Type
Needle Holder
2. Scissors
u Scissors Yarn
There are two kinds of thread scissors that cut the thread of a crooked and straight utility to cut the thread of the operation, smoothing the wound. Provision of each of the fruit.
u Cut out dissection
These scissors are of two types, namely straight and crooked. Edges are usually sharp. There are two frequently used, the type of the Mayo and Metzenbaum type. The usefulness of this scissors is to open the network, freeing a small tumor from the surrounding tissue, to esksplorasi and tidy wounds.
dissecting scissors
u Scissors bandage / dressing
Usability is to cut bandages and plaster.
3. Knife Surgery
Consists of two parts, namely the handle and blade (mess / bistouri / blade). In the old model of a scalpel, the blade and the handle together, so that when a blunt blade should be sharpened again. In the new model, the blades can be replaced. Blades usually only to be disposable.
There are two numbers that are often used knife, the handle of the number 4 (for large blade) and the handle number 3 (for small blades). Use of this knife is for cutting a variety of organ / body part. Adjusted the blade will cut the body.
4. clamp (Clamp)
u clamps Pean artery . There are two types, namely the straight and crooked. Its usefulness is for hemostasis, especially for thin and soft tissue.
u Kocher clamps . There are two types of clamps are straight and crooked. Not intended for hemostasis. Typical properties are having teeth on the edges (like the teeth on sirurgis tweezers).The point is to clamp the tissue, especially that the network does not slip from the clamp, and this is possible with the gear on the end of the clamp.
u clamps Mosquito . Similar to clamp the artery Pean, but the size, smaller. Dalah use for hemostasis, especially for thin and soft tissue.
u Allis clamps . Its use is to pinch the soft tissue tumor and a small pinch.
u Babcock clamps . Its use is to clamp the tumor rather large and fragile.
u Towel clamp (clamp Doek) . Its use is to clamp doek / fabric operation.
5. Retractors (Wound Hook)
u Retractors langenbeck. uses are injury unfold.
u double-ended retractor U.S. Army. Its use is to unfold the wound.
u Retractors Volkman. Its use is to unfold the wound. Adapted to the wide use of the wound retractor. There are has two teeth, 3 teeth, and four teeth. 2 teeth for minor cuts, 4 gear for big cuts. There is also a blunt-toothed retractor.
6. Needles
So many kinds. To sew the leather used for easy slicing triangle berpenampak skin (scherpe Donald). Muscles were used for tailoring the Berpenampang round (round Donald).There is a semicircular-shaped and some are a quarter of a circle.
Its use is to stitch the wound and sew pepul other damaged. Provision of customized needs.
7. Tweezers
Sirurgis tweezers . Its use is to clamp the tissue at the time of dissection and suturing wounds, member mark on the skin before the start of the incision.
Anatomical tweezers . Its use is to clamp the screen while pressing the wound, pinching the thin and soft tissue.
8. Yarn
u Seide / silk
Made of silk fibers, fibers made up of 70% protein and 30% additional material in the form of adhesive. Black and white. Silk is not as slick as usual because it was combined with an adhesive. Not absorbed by the body. On the use on the outside then the thread should be reopened.
Available in various sizes, ranging from the number 00 000 (5 zero is the smallest size for a surgical bag) until the number 3 (which is the largest size). The most frequently used is the number 00 (two zeros) and 0 (1 zero) and the number one. The bigger its much smaller zero thread
Uses is to sew the skin, binding arteries (mainly large arteries), as teugel (control).
Yarn must be sterile, otherwise would be a hotbed of germs (infection focus), sebeb germs in the protected stitching, while the thread itself can not be absorbed by the body.
u Plain Catgut
Originally he is a cat (cat) and gut (intestine). First yarn is made from cat gut, but this time made from the intestines of sheep or cow intestine. Can be absorbed by the body, absorption takes place in 7-10 days, and it's white and yellow.
Available in various sizes, ranging from 00 000 (5 zero which is the smallest size) up to number 3 (merupakn largest size). Often used to 000 (three zeros), 00 (two zeros), 0 (1 zero), the number 1 and number 2.
Uses is to tie the source of bleeding is small, subcutaneous stitch and can also be used to sew the loose skin, especially for areas (stomach, face) are not a lot of moves and a small wound area.
Plain Catgut should disimpul at least 3 times, because the body will expand, when it concluded two times will be open again. Plain Catgut should not be submerged in lisol because it will expand and become soft, so it can not be used.
u chromic Catgut
Unlike the Catgut plain, before the yarn spun added chrome. With the chrome, then thread akn become harder and stronger, and longer penyerapannnya, ie 20-40 days.The color is brown and bluish. This yarn is available in size 000 (3 zeros is the smallest size) up to number 3.
Its use in suturing the wound is deemed not docked within ten days, to sew the tendon in patients who do not cooperate and if mobilization should be done immediately.
u Nylon. (Dafilon, monosof, dermalon ,Ethilon)
Is a synthetic yarn in packing atraumatis (direct yarn together with a sewing needle) and made of nylon, strong leboh seide or Catgut. Not absorbed by the body, and not menimbilkan irritation to the skin or other body tissues.
The color is dark blue. Available in sizes 10 to one zero zero. Penggunanan in plastic surgery, a larger size commonly used skin, a small number used in eye surgery.
u Ethibond
Is a synthetic yarn (made of polytetra methylene adipate). Available in packs atraumatis.Is soft, strong, body reaction to a minumum, not absorbed, and the colors green and white. Size of 7 zero to number 2. Its use in cardiovascular surgery and urology.
u Vitalene / Prolene / surgilen
Is a synthetic yarn (made from polymer profilen). Very strong and gentle, not absorbed, the color blue. Available in packs atraumatis. Size from 10 to zero to number 1. Used in microsurgery, particularly for heart and blood vessels, eye surgery, plastic surgery, also suitable for sewing leather.
u POLY ACID AS GLICOLIC: POLISORB, Dexon, Vicryl
Is a synthetic yarn in packing atraumatis. Absorbed by the body, and not cause a reaction in the body tissues. Within three weeks of subcutaneous last dive, dive in the muscle last 3 months. This yarn is very soft and the color purple.
Size from 10 to zero to number 1. The use of the eye surgery, orthopedics, urology and plastic surgery.
u Supramid
Is a synthetic yarn, in atraumatis packaging. Berdsifat strong, soft, flexible, minimum tubu reaction and is not absorbed. The color is black and white. Used to sew kutis and subcutis.
u Linen (catoon)
Made with natural cotton fibers by spinning. Is soft, strong and easy disimpul, not absorbed, the body's reaction to a minimum, is white.
Available in sizes 4 to 1 zero zero. Used to sew the gut and skin, especially facial skin.
u Steel wire
Is made of metal thread polifilamen stainless steel tahn. Very strong, non-corrosive, and reactions to a minimum body. Disimpul easy. Metallic white color. Contained in packaging and packaging atraumatis usual. size from six to zero to number 2. To sew the tendon n .
CHAPTER III
Technique sutures
III .1. PURPOSE
Basic suturing wounds is making adequate pressure on the wound to be closed without the distance but also loose enough to avoid ischemia and necrosis. Stitches can also aims to treat hemostasis or bleeding occurs. Can be the first action to peryolongan.Reduce postoperative pain. Stitching is also a manufacturer's bond restrictions on the network to recover and no longer needed. Jahtan can also prevent the bone that may be exposed to the healing of old wounds and resorption are not required. It also needs to be done on the flap action.
III .2. PRINCIPLES sutures
Complete the knot should be tight, and powerful that it will not be released. To avoid bacterial infections, nodes are placed on the incision line. The knot should be small.Do mengiakt too tight to avoid damaging the threads. Do not do a lot of movement that would damage the stitching. Avoid damaging the material by pinning hecting using needle holder shall be binding unless at the time. Do not be too kauat diatakutkan necrosis.Traction should be adequate.
III .3. THE TYPES SUTURES
1. Interrupted sutures
Most used because it is simple and easy. Each suture disimpul own. Can be done akulit pad or other body parts, and is suitable for areas that many move away, because every stitch mutually supporting each other.
Interrupted sutures (interupted sutures), each node stands alone. In cosmetics coarse yarn / large or tense when menyimpulnya will give the former is less good, which is bleak picture of a centipede.
2. single knot stitches
Synonyms: Disconnected Stitch Simple, Simple Inerrupted sutures . It is frequently used type of seam. also used for stitching the situation.
Technique:
F Conducting the insertion of needles to the distance between half to 1 cm on the edge of the wound and simultaneously take all subkutannya network with a needle in a perpendicular to the direction of the line or injuries.
F node is done by a single thread of a 1cm distance absorbable premises.
F knot in place the edge of the wound on one of the puncture
F The thread is cut approximately 1 cm.
3. Horizontal mattress stitches
Synonyms: Horizontal Mattress sutures, Interrupted mattress
Stitches by pricking like a knot, before continuing with the stabbing disimpul parallel as far as 1 cm from the first puncture.
Providing strong stitching.
4. Vertical Mattress Suture
Synonyms: Vertical Mattress sutures, Donati, Near to near and far to far
Sutures to sew in depth below the wound was followed by sewing the edges of the wound.Usually results in rapid wound healing because the wound edges dekatkannya by these sutures.
5. Modified Mattress Stitch
Synonyms: Half Burried Mattress sutures
Modification of the horizontal mattress stitch the wound but on the other side subkutannya.
6. Continuous suture
Often called doorloven. Node only at the ends of the suture., So there are only two nodes. Terbuak Bial one of the stitches will be terbuak entirely. Stitches are rarely used for sewing leather. Secar cosmetic scar stitching at the seams as disconnected. Continuous suture can be performed faster than sutures interrupted.
7. simple tack
Synonyms: Simple running sutures, Simple continuous, continuous over and over
This very simple stitching, baste with our clothes. Usually produces a good cosmetic hasiel, not recommended for use on a loose connective tissue.
8. tack Feston
Synonyms: Running locked sutures, suture Interlocking
Continuous suture with the suture thread linked earlier, used often used to suture the peritoneum. Tack is a variation of normal.
9. tack horizontal
Synonyms: Running Horizontal sutures
Continuous sutures interspersed with horizontal stitches.
10. stitches intradermal
Giving out the best cosmetic result (only a single line only). Can not be used for areas that are a lot of moves. It is best to face. There are various modifications of this intradermal sutures. Takes lots of practice to memahirkan intradermal suturing this way.
11. Suture Knots Intrakutan
Synonyms: Subcutaneus interupted sutures, burried intradermal suture, dermal Interrupted stitch.
Suture knot on intrakutan area, usually used to sew in the area and then sewn on the outside as well with a simple knot.
12. tack Intrakutan
Synonyms: Running subcuticular suture, subcuticular stitches baste
Tack is performed under the skin, stitching is famous for producing good cosmetic
CHAPTER IV
CONCLUSION
Suture material
Material tailoring berkualiatas is covering certain heavy-laden. The first is comfort to be used or to be held. Then the security alert on each appliance. Must always be sterile. Quite elastic. Made up of Bahn is not reactive. Enough power to wound healing. The ability for biodegradation of chemicals to the destruction of objects menceah a sewing wounds need some good preparation tools, materials and some other equipment. Sequence techniques should also be understood by the operator and his assistant.
Tools needed:
§ Naald Voeder (Needle Holder) or the needle holder is usually a fruit.
§ Tweezers or forceps Surgical Chirrurgis single
§ Cut out the pieces of yarn.
§ Suture Needles, depending on the size of just two pieces only.
Materials needed:
§ Seide or silk sewing thread
§ Sewing Yarn Cat chromic and plain gut.
Other:
§ Doek sterile hole
§ Sterile Gauze
§ Handscoon sterile
Engineering operations
wound suturing technique sequence (suture techniques)
wound suturing technique sequence (suture techniques)
A. Preparation tools and materials
2. Preparation assistant and operator
3. Disinfection of the operating field
4. Anesthesia operating field
5. debridement and excision of the wound edges
6. suturing wounds
7. wound care
Types of suture
A. Stitches Single Node
2. Horizontal mattress stitches
3. Vertical Mattress Suture l
4. Modified Mattress Stitch
Five. tack sederhan
6. tack Feston
7. tack horizontal
8. Suture Knots Intrakutan
9. tack Intrakutan
REFERENCES
A. Karakata S, Bachsinar B. Minor Surgery. Of 1995. Hippocrates: Jakarta
2. Ethicon Inc, Wound Closure Manual. Of 1994. Johnson and Johnson company
3. Doherty GM. Current Surgical Diagnosis and Treatment . USA: McGraw Hill.2006.
4. Sjamsuhidajat R, Wim De Jong. Textbook of Surgery . Second edition. New York: Medical Books EGC
5. Reksoprodjo S. Lecture set of Surgery . New York: Binarupa script. Of 2000.
7. Remie R, Kramer. Material and Technique sutures. Accessed on 2 9 May 2010. Available at URL www.scribd.co
8. Dwi Court. Wounds and Stitches curing technique. Accessed on 2 9 May 2010. Available at URL www.wordpress.co
9.
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