3. Surgical aids
• Surgical aids : These are materials used for
dressing of wounds or injured or diseased tissues
to hold wound edges closely during healing, these
materials are collectively called surgical aids.
• Historically, a dressing was usually a piece of
material, sometimes cloth, but the use of dung,
leaves and honey have also been described.
• Previously, the accepted wisdom was that to
prevent infection of a wound, the wound should
be kept as dry as possible.
4. Surgical dressings
• Def : Surgical dressing is a term applied to a wide range
of materials used for dressing wounds or diseased
Ideal wound dressings :
• Provide an environment for moist wound healing.
• Prevent maceration by permitting evaporation or
• Promote haemostasis (i.e. stops bleeding)
• Protect the wound from further damage
e.g. mechanical damage,
chemical damage, alteration in pH.
5. • Promote healing.
• Control microbial growth by incorporation of
• Provide compression, promoting haemostasis and
• Reduce pain, increase patient comfort and improve
functional use for wound site.
• Reduce odour.
• Improve appearance of the wound site.
• Reduce overall costs associated with wound
7. • Primary Dressing: A dressing that directly come in
contact with wound and provide absorptive capacity and
may prevent infection and adhesion of secondary dressing
to the wound.
Ex : Plain gauze , Impregnated Gauze , Paraffin gauze
• Secondary Dressing (Bandage): A dressing placed over
the primary dressing for further protection, absorptive
capacity, compression and occlusion.
Ex : Absorbents , Bandages , Adhesive tapes etc
• Some dressings function as primary dressing only.
However some could function both as primary as well as
Ex : Composite dressings , Hydrogel etc 7
8. Primary wound dressings
• This is a soft cotton cloth of plain weave, open texture
and filmsy appearance.
• Because the cotton is in the form of spun threads and not
loose fibres (contrast cotton wool) gauze can be applied
directly to the wounds.
• It absorbs water readily.
• It gives adequate protection to a large wounds if applied
as many folds.
• It gives more absorptive and protective dressing. 8
9. Impregnated Gauze
• Cotton, rayon or cellulose acetate gauze has
been impregnate with a variety of substances
such as petroleum or paraffin, vaseline or
• They are used to reduce its adherence to
10. Paraffin gauze dressings
• This is a sterile dressing consisting of pieces of cotton,
rayon or cotton and rayon gauze impregnated with yellow
soft paraffin or it for use in warm countries, soft and hard
• Uses: Paraffin gauze dressings are used in skin grafting
and paraffin prevents adherence to the tissues.
• The open nature of the gauze allows air to reach the
wound and exudate to drain away into secondary
11. Film dressing
• These are films of polyurethane with acrylic or
• Uses: In lightly exuding wounds they permit enough
evaporation to promote moist wound healing and
• Film dressings exclude bacteria from wounds and
permit bathing and observation of the wound.
• They will adhere well to intact skin and have a low
adherence for wound tissues.
• Hydrogels are cross-linked polymer such as poly-
vinyl-pyrrolidone (PVP), cross-linked polyethylene
oxide gel or polyacrylamide in which the wound
exudate may be trapped.
• Uses: Hydrogels are non adherent dressings, which
through semipermeable film allow a high rate of
evaporation (and cooling) without compromising
wound hydration. This makes them useful in burn
• Hydrogels are very useful in hairy areas where
entrapment of hair into the dressing would not be
16. Calcium alginate dressings
• Alginic acid is naturally occurring polysaccharide
derived from a type of seaweed.
• Incorporation of calcium salt makes it fibrous non-woven
dressings which are highly absorbent.
• Use: They are used on moderate to highly exuding
• They may be held in place with gauze tape or a film
18. Surgical cotton
• The raw cotton fibre, mechanically cleaned of dirt and processed
to remove the natural waxes on the cotton fibres. The fibres are
defatted with alkali, bleached, washed and dried. It is available as
rolls or small balls.
• It absorbs water readily hence used for absorbing wound exudates.
However, as its fibres are loose (i.e. not in the form of a thread),
they irritate and adhere to raw tissues, hence cotton should be
separated from wounds by a woven fabric dressing.
• It can be used for cleaning, swabbing and medicating wounds and
for applying bactericidal solutions to the skin before surgery.
19. Surgical gauzes
• The function of surgical gauze is to provide an
absorbent material of sufficient tensile strength for
• Processing: Raw cotton fibre is cleaned and spun or
twisted into thread, and the threads are woven into an
open-mesh cloth. It is then bleached white and
defatted to increase the absorbency.
• Use: Various forms of pads, compressed and
dressings are made from surgical gauze, alone or with
absorbent cotton, tissue paper and other materials.
21. Bandages (Medicated bandages)
• Bandages : are use to hold dressing in place
by providing pressure or supports.
• Bandages may be extensive or non extensive,
adhesive or non adhesive, flat or tubular or
become rigid after shaping for immobilization.
Types of bandages :
• Common gauze or roller bandage
• Muslin bandage rolls
• Elastic bandages
• Orthopaedic bandages
22. Common Gauze Roller Bandage
• It is prepared from absorbent gauze in various
width & lengths.
• Each bandage is in one continuous piece,
tightly rolled and substantially free from loose
23. • These are made of heavier unbleached materials.
• They are very strong and are used wherever bandages
do not provide sufficient strength or support.
• They are used to hold splints or bulky compression in
Muslin bandage rolls
24. • Woven elastic bandage: is made of heavy elastic webbing
containing rubber threads. Good support & pressure are
provided by this type of rubber elastic bandages.
• Crepe bandage : is elastic but contains no rubber. Its elasticity
is due to special weave that allow it to stretch to practically
twice its length.
25. • Used to provide immobilization and support in the treatment of
broken bones and in certain conditions of bones and joints.
Plaster of Paris impregnated gauze has been std material for
this purpose. This bandages are water resistant, light weight
• Orthopaedic elastic plaster bandages: are plaster of Paris
bandages containing elastic thread in the fabric and are
intended for specialized prosthetic uses.
Orthopaedic bandage Orthopaedic elastic bandage
26. Adhesive tapes
• When some adhesives are spread over a backing membrane it is
called an adhesive tape.
• This tapes are used
(i) to secure dressings and appliances firmly in place.
(ii) for support and compression e.g. for fractured ribs and
clavicles, sprains and leg ulcers etc.
• The adhesive tapes differ with the type of backing membrane (e.g.
pain cloth, elastic cloth, plastic film).
• Depending on the adhesive the tapes may be subdivided into two
1. Rubber based adhesive and
2. Acrylate adhesive. 26
27. Rubber based adhesive tapes
• These are cloth-backed rubber adhesives. these are used
principally where heavy support and a high level of adhesion
• Rubber adhesives generally contains a large number of
components of which few may cause the allergy.
Acrylate adhesive tapes
• In this case non-woven or fabric backing are spread with
• Acrylate adhesives are hypoallergenic i.e. they do not
produce any allergic reaction.
• Because acrylate adhesives are basically a unipolymeric
system, they eliminate the possibility of allergy.
29. Sutures & Ligatures
• A surgical suture is a strand or fibre used to hold wound
edges in application during healing.
• A ligature is a thread or string without a needle which is
used to tie blood vessels and other tissues together.
• Sutures materials may be divided into two principle
classes: Absorbable & non-absorbable.
30. • Absorbable sutures : are those materials that are capable
of being broken down or digested by the body.
• Ex : Cat – gut and synthetic materials like Polyglycolic
acid, Poly-galactine, polypropylene etc
• Catgut is a natural absorbable suture is obtained by
longitudinally slitting the intestinal sub-mucosa of sheep
and goat, twisting the ribbons and joining them in wet
condition giving monofilament finish.
32. Preparation of cat-gut:
1. Raw material washing
2. Splitting into ribbons
3. Mechanical processing
4. Chemical processing: Tanning and hardening.
33. Plain cat-gut
1. Looses 50 % of TS in 3 days
and 100% in 15 days.
2. Gets completely absorbed in
tissues by 60 days.
3. Used to tie small SC vessels
4. To repair the wound of lip
and oral cavity.
1. Looses 50 % of TS in 7 days
and 100% in 28 days.
2. Gets completely absorbed in
tissues by 90 – 100 days.
3. Used for opthalmic and
34. Synthetic absorbable sutures:
• These are made up of polymers derived from :
• Condensing the cyclic derivative of Glycolic acid
• Mixture of Glycolide and Lactide
• Dioxanone and Glycolide with tetramethylene carbonate.
• Sterilized by Ethylene oxide.
• Undergoes hydrolysis in tissues and it is responsible for
its absorption into tissues.
35. Non-absorbable sutures
• These are made from various materials such as
polyesters, nylon etc. these materials incite a
minimal foreign body reaction at the site of
• They are frequently used for cardiovascular,
ophthalmic and neurological procedures.
• Silk fibres, Nylon, Polyester fibres, Polyolefin
fibres, Linen, Metallic sutures.
36. • Silk : is an important non absorbable surgical sutures
consist of protein fibroin as extruded by the silk worm.
• Many of such fibres are twisted into a single strand of
various diameters as specified. Silk sutures are handled
easily and tolerated well by body tissues.
• Tissue reaction may occurs because of microbes that
remain in the silk strands.
37. • Nylon:
• Nylon is a polyamide obtained from the condensation of
adipic acid and hexamethylenediamine or from the
polymerization of caprolactum.
• It is strong, water resistant and can be used for all
suturing and ligating.
38. • Polyester:
• Prepared by melting and extruding of PET, into fine
filaments which are then cutted into different sizes.
• They do not loose strength on contact with water or
body fluids and thus they are used for permanent
reinforcement as installation of artificial heart valves.
39. • Polyolefin fibers:
• Made up of Polyethylene or Polypropylene.
• Compared to nylon, these fibers tie more secure knots
and have a very low tissue reactivity.
• Very smooth and because of this, they slip through tissue
in growth, they may be removed easily when necessary.
• Widely used in cardiovascular and other surgeries.
40. • Cotton and Linen : Sutures derived from cellulose,
they are twisted from fibre staple, have moderately high
tensile strength and are stable to heat sterilization.
41. Metallic sutures
• Silver: silver wire, foil and other forms are used to
some extent as suture. Silver has some antiseptic action
but in some tissues it produce irritation.
• Stainless steel: is a ferrous alloy is resistant to
chemical attack has been used widely in the form of
wire sutures, fixation plates, screws and other items.
42. Absorbable gelatin sponges (Gelatine foam)
• Absorbable gelation sponge is a sterile sponge intended for
application to bleeding surfaces as haemostatic.
• It is made from animal skin gelatine (denatured collagen), and is
water insoluble, off -white, non elastic and porous medical device.
• It may be cut into desired size and when placed can be able to
absorb blood and other fluids.
43. • If soaked in thrombin it directly acts on the coagulation
and has an increased Haemostatic action.
• As soon as after removal from package, it can be applied
directly with pressure to the bleeding site.
• It may be used either dry or saturated with sterile,
isotonic sodium chloride solution.
Ex : Gel-foam, Surgi-foam etc