1. SURGICAL
Sutures & Knots/
Operation Theater
21 Oct, 2009
Dr. Mansoor Khan
Resident Surgery, MBBS, FCPS-I
Khyber Teaching Hospital, Peshawar

2. 1650 BC – 2000’s AD
Through the ages,
Practitioners have used a wide
range of materials and
techniques for closing tissue…
The origins of surgery can be
traced back many centuries

3. In the 10th
century BC, ANTS was held over the wound until it
seized the wound edges in its jaws. It was then decapitated.

4. The thorn, used by African
tribes to close tissue,
was passed through the skin
on either side of the wound.
A strip of vegetable fibre
was then tied
around the edge in a figure eight.

5. The tough membrane of sheep intestine was provided
to the surgeon pre-sterilised and required threading
through the eye of the needle before use.

6. Post World War II brought the swaged-on needle. The thread fits
into the hollow end of the needle, allowing it to pass through tissue
without the double loop of thread that exists with a conventional
needle, reducing tissue trauma.

7. Sutures
Absorbable Non-absorbable
Natural Synthetic Natural Synthetic
Mono-filament
Multi-filament
Mono-filament
Multi-filament
Mono-filament
Multi-filament
Mono-filament
Multi-filament

8. Multifilament (braided)Multifilament (braided)MonofilamentMonofilament

9. SterilitySterility
Low
tissue reactivity
Low
tissue reactivity
Easy
handling
Easy
handling
knot
security
knot
security
Tensile
strength
Tensile
strength
QUALITIESQUALITIES

10. ABSORBABLE!
Usually lose their tensile strength within
60 days.
ABSORBED by
Hydrolysis or enzymatic degradation

11. Derived from the small intestine
of healthy sheep.
Loses 50% of tensile strength by
5-7 days.
Used on mucosal surfaces.
P
L
A
I
N
G
U
T

12. Treated with chromic acid to
delay tissue absorption time.
50% tensile strength by 10-14
days.
Used in episiotomy repairs.
C
H
R
O
M
I
C
G
U
T

13. Monofilament
50% tensile strength = 30+ days
Sites = need for prolonged
strength,
POLYDIOXANONE
(PDS
®)

14. Braided, synthetic polymer
50% tensile strength for 30 days
Used: subcutaneous
Polyglycane
910
(vicyle
®
)

15. NON-ABSORBABLE!
Permanent, used for long term strength

16. Appears to be stronger then
nylon and has better overall
wound security.
Polypropylene
(Prolene®
)

17. Braided
Before the advent of synthetic fibers,
silk was the mainstay of wound closure.
Easy handling, excellent knot security.
High reactivity and infection due
to the absorption of body fluids
by the braided fibers.
S
I
L
K

18. 5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0
Thick
Thin
Suture size
USP (United States Pharmacopoeia)
General

19. Bowel: 2/0 - 3/0
Fascia: 1 - 0
Ligatures: 0 - 3/0
Pedicles: 2 - 0
Skin: 2/0 - 5/0
Arteries: 2/0 - 8/0
Micro surgery 9/0 - 10/0
Corneal closure: 9/0 - 10/0
SUTURE SELECTION

21. The Suture Packaging
STRAND
SIZE
MATERIAL
STRAND
LENGTH
PRODUCT
CODE
NEEDLE
CODE
WITH LIFE
SIZE
PICTURE
OF
NEEDLE
NEEDLE
LENGTHCOLOUR
POINT
TYPE
NEEDLE
CIRCLE

22. BASIC SURGICAL KNOTS
& SUTURING

23. Operation TheatresOperation Theatres

24. “Place where life saving or life improving
invasive procedures are performed on human
body under strict aseptic measures!!!!!!”

25. History of Hygiene
• Aristotle Greek Philosopher recommends
Boiling water to armies. Advises the Alexander.
Recommends hygiene for healthy living

26. HAND WASHING-
Semmelweis
Practices, emphasizes
the importance of
washing hands with
chlorinated water in
Obstetrics to reduce
maternal mortality

27. Florence Nightingale creates
fundamentals in Nursing care
“The Very First Requirement in hospitals that should do the
sick no harm”
Florence Nightingale 1860

28. • 1867 –Dr.Joseph
Lister first identifies
airborne bacteria
and uses Carbolic
acid spray in
surgical areas
• 1880 – Johnson and
Johnson introduce
antiseptic surgical
dressings.Beginning of Safe Operation Theatre
Practices

29. “Soap, Water and Common Sense Yet the best
Antiseptic”
William Osler
Factors which influence Safety in
Hospital Environment

30. WET HANDS &
APPLY SOAP
RIGHT PALM
OVER LEFT, LEFT
OVER RIGHT
PALM TO PALM
FINGER
INTERLACED
ROTATIONAL
RUBBINGROTATIONAL
RUBBING OF
RIGHT THUMB IN
LEFT PALM &
VICE VERSA
BACK FINGERS
TO OPPOSING
FINGERS
INTERLOCKED
1
3
2
5
46
H
A
N
D
S
W
A
S
H
I
N
G

31. • Which suits the
Circumstances.
• Availability of Resources.
• Economical.
• Safe to you.
• Some chemical
containing compounds
can cause sensitization
and Allergic reactions.
BEST HAND WASH IS….

32. Good Hand Washing Practices
Save many Lives

33. Cleaning more
Important than
Disinfection and
Sterilization

34. Sterilization!
is absolute, removes microbes and spores too.
To achieve Sterilization is Expensive, not
sustainable, many times not needed.
Disinfection!
reduces the infections drastically.

35. • Paying great attention
to Floors Using
unnecessary, too
many chemical not
necessary
• Keep the floor Clean
and Dry - Bacteria are
reduced,
• Most Important
component of Bacteria
is water a dry areas
causes natural death
except spores

36. • Do not disturb
unnecessarily,
• Do not use ceiling fans
they cause aerosol
spread
• Clean only when
remodeling or
accumulated ,good
amount of dust.
Do not disturb the Roof

37. Who/What is Important in prevention of
Infections

38. Remember we are More important than
many

39. Operation Theatre Safety is
Responsibility Of….????????

40. Everyone……..

41. THANKS
QUESTIONS PLEASE