Absorbable Suture Indication

8/19/2019 Absorbable Suture Indication

1/57

Aesculap. All it takes to operate. Closure Technologies 1

Synthetic absorbable sutures


2/57


Safl®

Safl®Quick

Monosy

n®

MonoPlu

s®

Synthetic absorbable sutures


3/57


B. Braun absorbable suture

range


4/57


Indikasi umum


5/57


General and Gastrointestinal surgery

•Laparotomy

•holecystectomy

•!ppendectomy

•Bo"el anastomosis

•Gastrectomy

•Pyloroplasty


6/57


#he gastrointestinal tract

•Lambung dan intestine kaa akanasupan darah dengan resiko edema

•!otensi ter"adina kebocoran angdapat memicu peritonitis

•#katan ang terlalu kuat dapat merobek "aringan dan menebabkan kebocoran

•$ebocoran anastomosis tidak hanater"adi pada single laer tapi "uga doblelaer closure

mouth

pharn%

oesophagus

stomach

intesine


7/57

Aesculap. All it takes to operate. Closure Technologies &

$pper alimentary tract procedures

•'ral ca(it) penembuhan ang relati* cepat+ ,-!/little tension0+ absorbable

•on absorbable monolament mengurangi resiko reaksi "aringan+ /suture remo(al0

•sophagus) tidak ada lapisan serosa+ prosespenembuhan relati* lama+ lapisan muscular ang tebal


8/57

Aesculap. All it takes to operate. Closure Technologies

#he stomach

•elati* lembut dan lentur

• Tebal dengan banak pembuluh darah

•3 lapis muscular

•!enembuhan ang cepat+ maks 14721 hari

•ekomendasikan) Safl®+ beberapa user menukai !remilene8

•!liable suture) pre(ent cutting and allo9 smooth passage

•eedles) %&


9/57

Aesculap. All it takes to operate. Closure Technologies :

Stomach ' Surgical Procedures(Gastrectomy

Gastrectomy) pengambilan sebagian atau keseluruhan "aringan padaorgan lambung

Patologi)

!engambilan tumor atau penanganan perdarahan ulcer hebat


10/57

Aesculap. All it takes to operate. Closure Technologies 1;



11/57


Surgery)

•Attachment o* the remaining portion o* the stomach to the small intestine

•#n the case o* cancer+ it is almost al9as per*ormed b traditional open surger

•


12/57


Surgery)

17 Abdominal incision

Ligation o* subcutaneous blood (essels

27 Clamp and ligation o* ma"or stomach (essels

Safl® 0+-(-

37Clamp and cutting o* the diseased part o* thestomach

47-tomach appro%imation and anastomosis to the

duodenumSafl® ,+-(+- %&,/

Monosyn® ,+-(+- %&,/

57Closure /peritoneum+ *ascia+ subcut.+ cut.0



13/57




14/57


Pyroloplasty) reparation o* plorusstenosis

Pathology)

•!lorus narro9ing•!re(ents stomag e(acuation tosmall intestine

•!rimarl occurs in small babies /upto 6 months0

•273 cases e(er 1.;;; in*ants

• Treatment *or high7risk patients *orgastric ulcer disease

Stomach ' Surgical Procedures(Pyloroplasty


15/57


Pyroloplasty) reparation o*plorus stenosis

Surgery)

The plorus is cut and resutured torela% the muscle and 9iden theopening into the intestine/duodenum0

There*ore+ the stomach emptiesmore >uickl

Safl® ,+- %&,/(%&-Silkam® ,+-

Stomach ' Surgical Procedures(Pyloroplasty


16/57


#he small intestine

•-imilar considerations than the stomach

•!rimaril bile or pancreatic "uices ma cause a se(erechemical peritonitis

•Absorbable sutures are pre*erred cause the 9ill notpermanentl limit the lumen diameter

•?onolament sutures are recommended. Lack o* capillaritresists intestinal bacteria. -moothness minimises tissue drag

•eedles) %&

•A non7abs. suture ma be used in serosal laer *or addedassurance

•apid healing+ reaching ma%imal strength in appro%. 14 das


17/57

Aesculap. All it takes to operate. Closure Technologies 1&

Intestine ' Surgical Procedures

esection 9ith anastomosis


18/57


Bo"el anatomy

• The submucosa is the laer that pro(ides strength in thegastrointestinal tract

1. ?ucosa

2. -ubmucosa

3. ?uscle

laers/muscularis0

4. -erosa


19/57

Aesculap. All it takes to operate. Closure Technologies 1:

Surgical procedures( Bo"elanastomosis

Surgery)

17Abdominal incision

27@etermine the e%tent o*resection ligation o* mesenteric(essels

Safl®+Monosyn® 0+-(- pre(cuts+reel1 %&2(%&-

BThe gold standard) esection 9ith anastomosis7 sero7submucosal single laer anastomosis


20/57



37=o9el is cut and remo(ed large(essel ligated

47=o9el side appro%imationinterrupted suturing


21/57



5a7 !lacement o* interrupted sero7submucosal sutures on anteriorlaer-al8DMonosyn®+@alon8D!remilene8 +- 30+-(,+-4 %&251%&,,1 %&,/1 %&-1 6&

67 Abdominal closure


22/57


5b7 Eound appro%imation 9ithsutures

5b7 ?uscle suturing 9ith interruptes stitches

Safl®+Monosyn®+!remilene8 0+-(,+- %&25(%&,,1 6&

5b7 -erosa suturing

Safl®+Monosyn®+!remilene8 0+-(,+-%&25(%&,,1 6&




23/57


#he colon

•Figh microbial content) absorbable sutures lea(e no channel *ormicrobial migration once absorbed

•Leakeage could lead to serious concerns

•-trong organ+ it heals to a similar rate thatstomach and small intestine

•Absorbable sutures /non abs might be used as 9ell0

•!lacement o* sutures in the submucosa+a(oiding penetration o* the mucosa+

9ill help pre(ent complications


24/57


#he rectum

•Ger slo9 healing

•#t has no serosa

•A large bit o* muscle should be included in theanastomosis

•?onolament sutures reduce the risk o* bacterialproli*eration in the rectum

http)DD999.healthcentral.comDanimationD4;D3&DColonHCancer.html


25/57


Surgical procedures ( olorectalresection

ight hemicolectom Le*t hemicolectom

-igmoid Colectom Lo9 anterior resection

Abdominal perinealresection


26/57


Surgical procedures( olorectal anastomosis bycontrol release sutures

Safl®+MonoPlus®+-ilkam8 0+-(,+-%&25(%&,,


27/57


Surgical procedures( !ppendectomy

-urgical remo(al o* the appendi%

17 About &7cmabdominal incision

27-ubcutaneousDmesenter (esselligation Safl® 0+-(-

37Appendi% is dettached*rom the cecum and

remo(ed. LigationMonosyn®1 Safl® ,+-


28/57


Surgical procedures( !ppendectomy

47 Cecum is closed. !urse stringsuture Monosyn®1 Safl® 0+-%&25 %&,,Silkam®

57The appendi% stump is in(ertedinto the cecum and the pursestring is closed



29/57


#he biliary tract

•apid healing

• The presence o* a *oreign bod ma lead to stones*ormation+ since the organ is prone to crstal *ormation

•Absorbable suture in the nest siIe possible that lea(esthe least sur*ace e%posed

•?ultilaments are not recommended

http)DD999.uclan.ac.ukD*acsDhealthDnursingDsonicDscenariosDli("manimDbiliarHtract.html


30/57


Surgical procedures ( holecystectomy

-urgical remo(al o* the gallbladder


31/57

Aesculap. All it takes to operate.Closure Technologies 31

holecystectomy


32/57


Surgery)

17-ubcutaneous blood (esselligation

Safl® 0+-(- pre(cuts+reel

27


33/57


Parenchymatous organs

•'rgans composed o* cells 9ith little connecti(e tissue *orsupport

•Little tension is placed on the suture line

•-mall siIe sutures+ the do not need to be placed closetogether or deepl into the organ

•apid healing

•e9 brous tissue 9ill *orm 9ithin &71; das

•Large (essel ligatures) -al8

•-ur*ace repair) -al8 !arenchma or ?esh


34/57


Peritoneum

• Thin membrane+ >uick healing

•-ome surgeons think it does not re>uire suturing+ otherdisagree

•Continuous suturing 9ith absorbable suture /-al8+?ono!lus80 /#nterrupted suturing could be also used0

•-kin

•-ubcuticulartissue

•-ubcutaneous

*at

•Anterior *ascia

•?uscle

•!osterior *ascia

•!eritoneum


35/57


Layered closure

Peritoneum /continuedDinterrupt0

-al8 3D;72 F267F3&s

?onosn8 2D;7; F26s+ F3;+ F3&+ F4;s+ F4

?ono!lus8 3D;71 F22s7F3&s

7ascia

-al8 2D;72 F3&s7F47FT3&

Muscle

-al8 ; F3&s

Loop

MonoPlus® 0-1 HR40s, HR76, HRT40s, HRT48

Subcutaneous-al8 4D;7; F267F43Intradermal!remilene8D@alon8 4D;72D; @-?!1:7@-?!24?onosn8 3D;74D; @-?!137@-?!24

Skin /continuous0-al8 Juick!remilene8D @alon8 4D;72D; @-?!1:7@-?!24-nthol8 4D;73D; @-1:7@-24


36/57


$rological surgery

•8ephrectomy

•9asectomy


37/57


$rological surgery

•,rologists are particularl concerned 9ith suturestrength and ease o* handling+ since the 9ork in connedareas

•!redictable absorption are speciall important in the


38/57


$rinary tract surgery

•!re(ent leakage

•o use o* non7abs sutures cause the can lead to calculi*ormation

•Absorbable sutures) ?onosn8+ -al8+

•apid healing

• The bladder 9all regains 1;;K tensile strength 9ithin 14 das•,reter) narro9 tube 9ith (ulnerable blood suppl. as tomanipulate and penetrate+ unless brous or hardened. ormalhealing in & das


39/57


Surgical procedures( 8ephrectomy

emo(al o* the kidne dueto in*ection+ cancer+ trauma

Surgery)

17@issection and clamp o*

renal arter and (ein.Ligatures

Safl®1 Monosyn® +-(,+-

27,reter is clamped and

ligated37$idne remo(al

47Eound closure/peritoneum+ muscle+0

enal (ein

enalarter


40/57


Surgical procedures( 9asectomy

!rocedure *or male steriliIation+but is commonl per*ormed priorto prostatic surger to pre(entspread o* in*ection

Surgery)171 cm incision in the scrotum tocompletel access the (as. -mall(essel ligatures

27Clamp+ cutting and ting the ends o*

the tube /cauteriIationDclips0Safl®+Safl® Quick 5+-(:+- 6&2-16&2,1 %&2

3.17Mascial interposition to create anatural barrier bet9een the t9o cutends /diag.30

3.27'pen (asectom /diag.40


41/57


;bstetrical < Gynaecological surgery

•%ysterectomy

•esarian section

•=pisiorrhaphy


42/57


7emale genital tract

•!otentiall contaminated area

•Limited surger eld to 9ork

•Fandling properties o* sutures *or internal use are(er important

•-al8 D-al8 Juick ,-! ; *or muscular+ highl(ascular tissues o* pel(is and (agina

•-al8 Juick *or episiotom repair

• The uterus is (er (ascular+ tough and muscular.Complete healing achie(ed in 5 das

•Gagina) (er thick+ tough and (ascular. Feals in 1;das

•Mast healing tissue re>uire shortDmid term support)-al8 Juick+ ?onosn8+ -al8


43/57


Surgical procedures( %ysterectomy

•-urgical remo(al o* the uterus

•Gaginal hsterectom or abdominal hsterectom /5;K75;K0

• The cer(i% might be also remo(ed /total0 and the (agina/radical0


44/57


Surgical procedures(%ysterectomy

Surgery /abdominal hsterectom0)

17-ubcut. (essel ligatures


27Clamping and cutting o* pediclessupporting the uterus

Safl®+Monosyn® ,+-(2 %&,/s1%&5s1 %&5ss

37,terus and cer(i% remo(al


45/57


Surgical procedures(%ysterectomy

47Closing o* the (aginal cuN 9ith interrupted orcontinuous sutures

Safl®+Monosyn®+Safl® Quick +-(- %&,/s1%&5s1 %&5ss

57Abdominal closure


46/57


Surgical procedures( esarian section3(section4

-urger

17-ubcut (essel ligatures


27ectus muscles and uterus incision

37=ab deli(er

47,terus closure 9ith continuous suturing

Safl®+?onosn8 ,+-(2 %&5s1 %&5ss1 %&0>

57Laered closure

=1;4:;;; esarian set 2 /-al8 1 F3&O-al8 2D;F3&O-al8 1 F-3&s0


47/57


Surgical procedures (=pisiorrhaphy

-urger

17GaginaDmuscle closure 9ith continuous suturing) Safl®Quick+-al8 $SP - %&51 %&5s1 %&0-s1 %&0>1 %51%

27 -kin closure) Safl® Quick $SP ,+- 6S,01 6S-1 6SMP,0

=pisio Set=;;46:16 !#-T -J,2P; :;FT3&-+2D;&;@-?!24/?0@@!=;;46:11 !#-T -J,.2D; &; @-24+2P; :; FT43/?0@@!C;;46:1; !#-T -.J.,.2D; &; @-24+; :; FT43/?0@@!


48/57


ommon combinations inGynaecology+$rology

Mucous membrane

?onosn8 4D;73D;72D; F1&7F3;

Ligatures

?onosn8 5D; F1&

$rethra+Bladder

?onosn8 4D;72D; F1&7F3;


49/57


Paediatric Surgery

ircumcision) to enable *oreskin to be pulled back

-upercial (eins ligation Safl® Quick 0+-(+-

Appro%imation o* distalDpro%imal edges o* the *oreskin 9ithinterrupted Safl® Quick :+-(0+- /children0 0+-(+- /adults0%&,,(%&,/


50/57


;ral surgery

The oral ca(it promotes rapid healing and inhibitsin*ection

Mast absorbable sutures are recommended tominimiIe discom*ort

?ucosa

Safl® Quick+Monosyn® %&251 %&,/s1 6SMP22(6SMP2?

-ubcutaneous

Safl® Quick+Monosyn®+Safl® %&25(%&,/

-kin

6aflon®+Premilene® 6S2?(6S,01 6SMP2?(6SMP,0


51/57


;phthalmic surgery

Safl® Quick 6D;7D; @Lm6s+ GL?1; *or con"ucti(a

Safl® 5D;71;D; @Lm6+ FLm6+ GL? *or muscles+ sclera+con"ucti(a

/i.e. -trabismus+ ueous outQo9 toreduce ee pressure00


52/57


;rthopaedic Surgery

•apsule repair) repair o* the brous tissues that enclose a "oint /ngers+ toes+elbo9+ ankle0

• @oint replacement) replacement o* an entire "oint 9ith a prosthetic de(ice

•#otal 3#%!4 or partial 3endoprosthesis4 hip replacement /arthroplast+ hemiarthroplast0) replacement o* the *emoral head and o* the acetabulum

9ith prostheses

•Shoulder surgery

•Spinal surgery

•;pen reduction o* *ractures) reposition and immobiliIe *racturedbones in their anatomical position

•Ligament repair•Anee repair) repairDreplace o* the so*t tissue structures o* the knee "oint


53/57


Anee oint

http)DD999.medterms.comDscriptDmainDart.asparticlekeR45


54/57


Skin

•-al8 Juick D on7absorbable sutures

•#nterrupted techni>ue is usuall pre*erred+ absorbablesuture

•#* a non7abs suture is used+ it is remo(ed 371; daspostop+ but it must be considered the are e%posed to the

e%ternal en(ironment being a serious contaminationthreat. #* chosen+ !remilene8 or @alon8

•$e success is earl suture remo(al be*oreepithelialiIation o* the suture tract occurs and be*orecontamination is con(erted into in*ection


55/57


Plastic surgery

•?onolaments

•Maceli*thttp)DD999.healthcentral.comDanimationD4;D41DMaceli*t.html

•=reast reductionhttp)DD999.healthcentral.comDanimationD4;D3:D=reastHeduction.html


56/57


Monoflaments) Ideal *or plasticsurgery

!roduct !ropert-uture

Ad(antage-urgeonSsDpatient

Ss benet

6aflon® DPremilene®+

Monosyn® -mooth sur*ace

Less traumaD

sa9ing eNect

=etter cosmetic

result

Monosyn® AbsorbableLess risk o* post7op reacti(it

Monosyn® Absorbable o sutureremo(al

Time and costsa(ing

Less discon*ort*or patient

6aflon® DPremilene®+ on7absorbable

-uture remo(alneeded

o suturematerialremaining


57/57

A l All it t k t t Cl T h l i

Safl®

• -o*t tissue appro%imations /14 das5;K0

• !articularl recommended)

Documents

Absorbable Suture Indication