LIGATURE and Sutures 4
WHAT IS POLYGLYCONATE?
Maxon (Davis & Geck):
This is a monofilament synthetic
absorbable suture prepared from a coplymer of glycolic acid and
trimethylene carbonate.
The process of absorption is by non-
enymatic hydrolysis. Approximately 70% of the original suture
strength remains 2 weeks after implantation, and approximately
55% of the original suture strength remains 3 weeks after
implantation.
Absorption is completed 6 months after
implantation.
Maxon is available in sizes 0.7 (6/0)-3 (2/0)(Clear), and
sizes 1(5/0)04(1)(Green), mounted on atraumatic needles.
WHAT IS POLYGLACTIN 910?
Vicryl is a pliable, smooth fibre, which is made in nine sizes
from 0.3 to 5. Date from implantation studies show that more
than 55% of the original strength remains at 14 days, and over 20
per cent at 21 days.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Friday, October 15, 2010
Friday, October 8, 2010
WOUND CLOSURE 3
SUTURES AND LIGATURES 3
WHAT IS CATGUT Chromic?
The origin of this suture material is the same as catgut (plain)
The material obtained from animal intestine is treated by immersion in a dichromate bath.
It is sterilized and packaged in a similar manner as plain catgut. Its treatment in a chromic bath delays its disintegration and this
suture loses 70% of its strength later by the end of second week.
USES
It is used as a ligature for blood vassals, and also for
suturing the mucosa, of the G.I. Tract, Urinary Tract, Respiratory
Tract, Peritoneum, and Muscle.
Surgical catgut is wet packaged in alcohol in sealed pack and pre-sterilised
WHAT IS POLYGLYCOLIC ACID?
Dexon (Davis and Geck) - This is a synthetic polymer of glycolic acid. The strands are made by extrusion as fine threads which are then braided to form a uniform gauge thread of seven sizes from 0.7 to 4. Polyglycolic acid sutures are extremely inert and cause minimal tissue reaction.
Compared with catgut, dexon suture is stronger, do not fray and are
not slippery, when knotting.
The sutures are sealed in two coverings and sterilized by a two-stage ethylene oxide process. With this method, the inner envelope is sterilized before sealing.
Gas sterilizes the outer envelope to complete the sterilization.
The increased strength compared with catgut, Dexon and other sythetic absorbable sutures, generally a size smaller than for catgut can be used with safety.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
WHAT IS CATGUT Chromic?
The origin of this suture material is the same as catgut (plain)
The material obtained from animal intestine is treated by immersion in a dichromate bath.
It is sterilized and packaged in a similar manner as plain catgut. Its treatment in a chromic bath delays its disintegration and this
suture loses 70% of its strength later by the end of second week.
USES
It is used as a ligature for blood vassals, and also for
suturing the mucosa, of the G.I. Tract, Urinary Tract, Respiratory
Tract, Peritoneum, and Muscle.
Surgical catgut is wet packaged in alcohol in sealed pack and pre-sterilised
WHAT IS POLYGLYCOLIC ACID?
Dexon (Davis and Geck) - This is a synthetic polymer of glycolic acid. The strands are made by extrusion as fine threads which are then braided to form a uniform gauge thread of seven sizes from 0.7 to 4. Polyglycolic acid sutures are extremely inert and cause minimal tissue reaction.
Compared with catgut, dexon suture is stronger, do not fray and are
not slippery, when knotting.
The sutures are sealed in two coverings and sterilized by a two-stage ethylene oxide process. With this method, the inner envelope is sterilized before sealing.
Gas sterilizes the outer envelope to complete the sterilization.
The increased strength compared with catgut, Dexon and other sythetic absorbable sutures, generally a size smaller than for catgut can be used with safety.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Friday, October 1, 2010
WOUND CLOSURE 2
SUTURES AND LIGATURES 2
WHAT ARE ABSORBABLE SUTURE?
Catgut (Plain):- The origin of the fiber, is from the intestine of animals, and after processing 98% of the extracted material is collagen, and is absorbed when left in body tissues.
Each of the strands, is then graded and separated into six metric
sizes:
from the thinnest to the thickest, 2(4/0), 3(3/0),
3.5(2/0), 4(0), 5(1), and 6(2). (The sizes refer to metric
gauge, the sizes in brackets are the USP equivalents).
The metric size approximates the diameter of the strand in
millimeters X 10.
USES
The finished catgut is cut into lengths of about 70 cm.(30 in) or
1.52 m(5 ft) to form ligatures or `needled' sutures.
The attachment of non-traumatic suture needles is a machine
procedure.
There are two basic methods of needle attachment Fig.
A hole may be drilled into the blunt end of the needle shaft, or the needle can be flanged at this end to form a grove.
Machines are used to close the prepared needle tightly around the suture material, which is the "pull tested" to ensure that it is firmly attached to the needle.
This material is then sterilized and package in a fluid in small easy to handle packages.
Catgut passes through tissues smoothly and easily.
- It swells and loses its strength at the end of one week there
is loss of 70% of its strength
- It disintegrates by proteolysis and is rapidly absorbed.
- There is an inflammatory response to its presence in the body
tissues.
It is used as ligature for small vessels and also as a suture
for a subcutaneous stitch under the skin.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
WHAT ARE ABSORBABLE SUTURE?
Catgut (Plain):- The origin of the fiber, is from the intestine of animals, and after processing 98% of the extracted material is collagen, and is absorbed when left in body tissues.
Each of the strands, is then graded and separated into six metric
sizes:
from the thinnest to the thickest, 2(4/0), 3(3/0),
3.5(2/0), 4(0), 5(1), and 6(2). (The sizes refer to metric
gauge, the sizes in brackets are the USP equivalents).
The metric size approximates the diameter of the strand in
millimeters X 10.
USES
The finished catgut is cut into lengths of about 70 cm.(30 in) or
1.52 m(5 ft) to form ligatures or `needled' sutures.
The attachment of non-traumatic suture needles is a machine
procedure.
There are two basic methods of needle attachment Fig.
A hole may be drilled into the blunt end of the needle shaft, or the needle can be flanged at this end to form a grove.
Machines are used to close the prepared needle tightly around the suture material, which is the "pull tested" to ensure that it is firmly attached to the needle.
This material is then sterilized and package in a fluid in small easy to handle packages.
Catgut passes through tissues smoothly and easily.
- It swells and loses its strength at the end of one week there
is loss of 70% of its strength
- It disintegrates by proteolysis and is rapidly absorbed.
- There is an inflammatory response to its presence in the body
tissues.
It is used as ligature for small vessels and also as a suture
for a subcutaneous stitch under the skin.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Friday, September 24, 2010
WOUND CLOSURE 1
LIGATURE AND SUTURE MATERIALS 1
Surgical procedures require superficial tissue layers to be cut, to reach the required Organ.
-On closure at the end of the procedure, all these cut layers, must be stitched back in position, accurately to its opposing layer.
-Anatomical continuity, interrupted while opening up the body needs to be restored.
WHAT ARE THE SUTURES AND LIGATURES IN USE?
Surgeons have made use of sutures for achieving closure.
The following are some available techniques for skin closure.
1. Needle and suture
2. Skin clips
3. Staples
4. Adhesive closure
SUTURE
A suture or a stitch holds cut tissue layers, or structure
Together, this helps the process of healing.
LIGATURE
A ligature, or metal ligature, is the use of the material, to
Encircle a cut end of a blood vessel, so as to control bleeding.
Staples have been used to anastomose(join) hollow organs, and vassal
Suture can be:-
1 Absorbable or
2 Nonabsorbable
And both these varieties may be made of either natural or
synthetic fibre have to be used with a needle.
WHAT ARE THE NEEDLES AVAILABLE?
These are pointed metal instruments with an eye where thread has to be passed through so that two strands pass through the tissues causing little trauma.
* The same is true of sprng eye needles Fig.3.4
* Shapes of needles are shown in fig. and vary from quarter circle
to straight and the shape of the tip of the needle Fig.3.1A to D
* Atraumitic needle come with the suture materiel (single
strand) attached to the needle fig.3.2
These are pre-sterilized and come in double wraps. Fig 3.3
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Surgical procedures require superficial tissue layers to be cut, to reach the required Organ.
-On closure at the end of the procedure, all these cut layers, must be stitched back in position, accurately to its opposing layer.
-Anatomical continuity, interrupted while opening up the body needs to be restored.
WHAT ARE THE SUTURES AND LIGATURES IN USE?
Surgeons have made use of sutures for achieving closure.
The following are some available techniques for skin closure.
1. Needle and suture
2. Skin clips
3. Staples
4. Adhesive closure
SUTURE
A suture or a stitch holds cut tissue layers, or structure
Together, this helps the process of healing.
LIGATURE
A ligature, or metal ligature, is the use of the material, to
Encircle a cut end of a blood vessel, so as to control bleeding.
Staples have been used to anastomose(join) hollow organs, and vassal
Suture can be:-
1 Absorbable or
2 Nonabsorbable
And both these varieties may be made of either natural or
synthetic fibre have to be used with a needle.
WHAT ARE THE NEEDLES AVAILABLE?
These are pointed metal instruments with an eye where thread has to be passed through so that two strands pass through the tissues causing little trauma.
* The same is true of sprng eye needles Fig.3.4
* Shapes of needles are shown in fig. and vary from quarter circle
to straight and the shape of the tip of the needle Fig.3.1A to D
* Atraumitic needle come with the suture materiel (single
strand) attached to the needle fig.3.2
These are pre-sterilized and come in double wraps. Fig 3.3
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Saturday, September 18, 2010
DISPOSABLES & INCINERATION
CAN YOU ACHIEVE STERILIZATION BY IONIZING RADIATION?
Most equipment, available prepackaged from the manufacturer, has been sterilized by ionizing radiation, Items such as
sutures,
sponges,
and disposable drapes, are just a few of the many types of presterilized products available. Included are anhydrous materials such as powders and petroleum goods.
NEW METHODS STERILIZATION BY LOW-TEMPERATURE STEAM AND FORMALDEHYDE (LTSF)
This is a physicochemical method which uses a combination of dry saturated steam and formaldehyde to kill vegetative bacteria, bacterial spores and most viruses and the method is thus suitable for heat-sensitive materials and items of equipment with intergal plastic components susceptible to damage by other processes.
Prior to removal of sterilized objects all formaldehyde must be removed to provide a dry, sterile, formalin-free load.
DISPOSE USED CONTAMINATED MATERIAL BY INCINERATION
This is the preferred method of disposal for all combustible and other material of an infectious nature .
contaminated needles,
plastic syringes and
clinical waste.
Disposable linen, and infected protective clothing, and drapes, should be by incinerated.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Most equipment, available prepackaged from the manufacturer, has been sterilized by ionizing radiation, Items such as
sutures,
sponges,
and disposable drapes, are just a few of the many types of presterilized products available. Included are anhydrous materials such as powders and petroleum goods.
NEW METHODS STERILIZATION BY LOW-TEMPERATURE STEAM AND FORMALDEHYDE (LTSF)
This is a physicochemical method which uses a combination of dry saturated steam and formaldehyde to kill vegetative bacteria, bacterial spores and most viruses and the method is thus suitable for heat-sensitive materials and items of equipment with intergal plastic components susceptible to damage by other processes.
Prior to removal of sterilized objects all formaldehyde must be removed to provide a dry, sterile, formalin-free load.
DISPOSE USED CONTAMINATED MATERIAL BY INCINERATION
This is the preferred method of disposal for all combustible and other material of an infectious nature .
contaminated needles,
plastic syringes and
clinical waste.
Disposable linen, and infected protective clothing, and drapes, should be by incinerated.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Friday, September 10, 2010
VIRUS IN THE OT
OT accidents 2
WHAT IS HIV INFECTION?
THE VIRUS
The acquired immune deficiency syndrome (AIDS) was first described in 1981 and the human immunodeficiency virus (HIV) was first identified in 1983.
- Antibody tests were developed which revealed the HIV status of the individual.
- In 1986 a second strain, HIV 2, was isolated
.
- Like hepatitis B, the virus is present in blood and body fluids, but unlike hepatitis B is relatively easily destroyed outside the body, and is not as infectious as the hepatitis B virus.
- Infection of the surgeon can occur from contamination from infected blood or body fluids, either through an open wound, or from a puncture wound like a needle-stick injury.
- Following infection there is an asymptomatic period during which antibody to the virus is not yet present in the blood, and thus HIV tests will be negative.
- After approximately 6 months the infected individual may seroconvert, and the HIV antibody be detected.
- A high proportion will then progress to develop AIDS.
LOOK FOR
- A common presenting feature is AIDS sufferers is the Kaposi sarcoma, with an incidence of between 25%and 50%. Biopsy of such lesions may be the first indicator for the surgeon that the patient has this disease.
- Kaposi sarcomas present as pink to purple blotches like a bruise or blood blister.
They may be flat or raised.
They are skin cancer arising from the endothelial cells such as those lining blood vessels. Histological, malignant transformation causes the endothelial cells to become stippled with spindle-shaped tumor cells; lymphatic obstruction may occur, but they do not metastasize, and remain multimodal both on the skin and in the alimentary tract.
SURGEON’S RISK.
Despite the worry of surgeons about risks of infection, these risks are small.
- The prevalence rate of HIV 0.3-7% in our country.
Surgeons have been shown to contaminate themselves with blood in 8.7% cases, and sustain penetrating injuries in 1.7% cases
The transmission rate is 0.3-0.4%, yet statistically the risk of sero-conversion for a surgeon is one infection every 8 years in a high-risk area with a case-load of 15000 patients per year.
As small as one infection every 80 years, in a low risk area.
Thus the risk to surgeon at work, is exceptionally low
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
WHAT IS HIV INFECTION?
THE VIRUS
The acquired immune deficiency syndrome (AIDS) was first described in 1981 and the human immunodeficiency virus (HIV) was first identified in 1983.
- Antibody tests were developed which revealed the HIV status of the individual.
- In 1986 a second strain, HIV 2, was isolated
.
- Like hepatitis B, the virus is present in blood and body fluids, but unlike hepatitis B is relatively easily destroyed outside the body, and is not as infectious as the hepatitis B virus.
- Infection of the surgeon can occur from contamination from infected blood or body fluids, either through an open wound, or from a puncture wound like a needle-stick injury.
- Following infection there is an asymptomatic period during which antibody to the virus is not yet present in the blood, and thus HIV tests will be negative.
- After approximately 6 months the infected individual may seroconvert, and the HIV antibody be detected.
- A high proportion will then progress to develop AIDS.
LOOK FOR
- A common presenting feature is AIDS sufferers is the Kaposi sarcoma, with an incidence of between 25%and 50%. Biopsy of such lesions may be the first indicator for the surgeon that the patient has this disease.
- Kaposi sarcomas present as pink to purple blotches like a bruise or blood blister.
They may be flat or raised.
They are skin cancer arising from the endothelial cells such as those lining blood vessels. Histological, malignant transformation causes the endothelial cells to become stippled with spindle-shaped tumor cells; lymphatic obstruction may occur, but they do not metastasize, and remain multimodal both on the skin and in the alimentary tract.
SURGEON’S RISK.
Despite the worry of surgeons about risks of infection, these risks are small.
- The prevalence rate of HIV 0.3-7% in our country.
Surgeons have been shown to contaminate themselves with blood in 8.7% cases, and sustain penetrating injuries in 1.7% cases
The transmission rate is 0.3-0.4%, yet statistically the risk of sero-conversion for a surgeon is one infection every 8 years in a high-risk area with a case-load of 15000 patients per year.
As small as one infection every 80 years, in a low risk area.
Thus the risk to surgeon at work, is exceptionally low
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review
Friday, September 3, 2010
THE NEW VIRUS IN OT
OT ACCIDENTS
WHAT IS HEPATITIS B (SERUM HEPATITIS)?
How does it occur in OT?
This is one of the most infective viruses.
- It may be transmitted from patient to patient by as little as 0.0001 ml. of infected blood.
- The virus remains active, for up to 6 months in dried blood, consequently instruments which have been poorly cleaned or disinfected, may be responsible for infecting other patients, whilst poor surgical technique, may result in the doctor becoming infected from the patient, or vice versa thru a needle prick.
- It has been estimated that there are possibly 200 million carriers of hepatitis in the world, representing up to 20% of the population in African, Pacific, and other tropical countries, and 0.5% of the population in Northern Europe. The current prevalence in the population is from 1-15.8%
- Thus, statistically the doctor or nurse has a 1 in 200 chance of treating a hepatitis B carrier.
- If the doctor becomes accidentally infected with the hepatitis B virus, not only may the disease develop, but the doctor may become a hepatitis B carrier, and is an unacceptable risk to patients and may have to give up surgery.
The transmission role in case of needle stick is 6 to 37%.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review.
WHAT IS HEPATITIS B (SERUM HEPATITIS)?
How does it occur in OT?
This is one of the most infective viruses.
- It may be transmitted from patient to patient by as little as 0.0001 ml. of infected blood.
- The virus remains active, for up to 6 months in dried blood, consequently instruments which have been poorly cleaned or disinfected, may be responsible for infecting other patients, whilst poor surgical technique, may result in the doctor becoming infected from the patient, or vice versa thru a needle prick.
- It has been estimated that there are possibly 200 million carriers of hepatitis in the world, representing up to 20% of the population in African, Pacific, and other tropical countries, and 0.5% of the population in Northern Europe. The current prevalence in the population is from 1-15.8%
- Thus, statistically the doctor or nurse has a 1 in 200 chance of treating a hepatitis B carrier.
- If the doctor becomes accidentally infected with the hepatitis B virus, not only may the disease develop, but the doctor may become a hepatitis B carrier, and is an unacceptable risk to patients and may have to give up surgery.
The transmission role in case of needle stick is 6 to 37%.
Any questions be sent to drmmkapur@gmail.com
All earlier posts are stored in archives for access and review.
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