Wound Closure Manual 2007.pdf

W OUND

C LOSURE

M ANUAL

PREFACE

As a surgeon and medical professional, the complexities and

importance of tissue repair and wound closure are critical to your

success. From your first days in medical school to training in

residency and as a practicing professional, you have recognized

the need to continually learn and embrace the best practices

to provide the best possible outcomes for your patients.

At ETHICON, INC., we understand the importance of

that and are pleased to provide you with the updated

Wound Closure Manual to aid you in your quest for excellence.

This manual includes helpful information to assist you in critical

decision making, and provides an overview of materials available

today as well as basic principles of tissue healing and wound

closure. Please use this as a guide, a reference, a training tool for

your staff, or any other way you find most useful.

ETHICON, INC., a Johnson & Johnson company, is not only

the world's leader in providing quality surgical sutures, but is

also committed to advancing the standard of care by providing

innovative products for suturing and topical skin closure. We are

also committed to you and value your importance to the medical

industry. We have been with you since the beginning and are

committed to being with you in the future.

CONTRIBUTING EDITOR

David L. Dunn, MD, PhD

Jay Phillips Professor and Chairman of Surgery,

University of Minnesota

We thank Dr. Dunn for his contributions to the Wound Closure

Manual. Dr. Dunn is currently the Jay Phillips Professor and

Chairman of Surgery at the University of Minnesota. This

department has a long-standing tradition and has attained

national and international recognition for excellence in training

academic general surgeons and surgical scientists. He is also the

Division Chief of General Surgery, Head of Surgical Infectious

Diseases, Director of Graduate Studies, and Residency Program

Director of the Department of Surgery.

Dr. Dunn has published over 400 articles and book chapters in the

areas of Surgical Infectious Diseases and Transplantation. He has

received regional and nationwide recognition in several

academic organizations and is a Past President of the Surgical

Infection Society, the Association for Academic Surgery, the

Minnesota Chapter of the American College of Surgeons, the

Society of University Surgeons and the Society of University

Surgeons Foundation.

TABLE OF CONTENTS

WOUND HEALING

AND MANAGEMENT

Knot Tying ......................................................... 24

Knot Security ............................................ 24

Knot Tying Techniques Most Often Used .......... 25

Square Knot ............................................. 25

Surgeon’s or Friction Knot ............................ 26

Deep Tie ................................................. 26

Ligation Using a Hemostatic Clamp ............... 26

Instrument Tie .......................................... 26

Endoscopic Knot Tying Techniques .................. 26

Cutting the Secured Sutures .......................... 26

Suture Removal ................................................. 27

Suture Handling Tips ....................................... 27

Suture Selection Procedure ............................. 27

Principles of Suture Selection ......................... 27

Surgery Within the Abdominal Wall Cavity ....... 28

Closing the Abdomen .................................. 30

Closing Contaminated or Infected Wounds ........ 40

The Wound .......................................................... 2

Recovery of Tensile Strength ............................ 2

Patient Factors That Affect Wound Healing ........ 2

Surgical Principles ....................................... 4

Classification of Wounds ................................... 5

Types of Wound Healing ................................... 6

Healing by Primary Intention . ....................... 6

Healing by Second Intention . ......................... 7

Delayed Primary Closure . ............................. 7

THE SUTURE

What Is a Suture? ............................................... 10

Personal Suture Preference ............................... 10

Suture Characteristics ....................................... 11

Size and Tensile Strength ............................. . 11

Monofilament vs. Multifilament Strands ......... . 11

Absorbable vs. Nonabsorbable Sutures ............. . 12

Specific Suturing Materials .............................. 13

Synthetic Absorbable Sutures ......................... 14

Nonabsorbable Sutures ................................ 16

Synthetic Nonabsorbable Sutures .................... 17

Common Suturing Techniques ....................... 18

Ligatures . ................................................ 18

The Primary Suture Line. ............................ 19

Continuous Sutures. ................................... 19

Interrupted Sutures . ................................... 22

Deep Sutures . ........................................... 22

Buried Sutures . ......................................... 22

Purse-String Sutures. .................................. 22

Subcuticular Sutures. .................................. 22

The Secondary Suture Line. .......................... 23

Stitch Placement. ....................................... 24

THE SURGICAL NEEDLE

Elements of Needle Design ............................. 42

Principles of Choosing a Surgical Needle ..... 44

The Anatomy of a Needle ................................ 45

The Needle Eye ......................................... 45

The Needle Body ....................................... 46

Straight Needle ......................................... 46

Half-Curved Needle ................................... 47

Curved Needle .......................................... 47

Compound Curved Needle ........................... 47

The Needle Point ...................................... 48

Types of Needles ............................................... 48

Cutting Needles ......................................... 48

Conventional Cutting Needles ....................... 49

Reverse Cutting Needles ............................... 49

Side Cutting Needles ................................... 50

Taper Point Needles ................................... 50

Tapercut Surgical Needles ................ ............ 51

Blunt Point Needles .................................... 52

Needleholders .................................................... 52

Needleholder Use ....................................... 52

Placing the Needle in Tissue ......................... 53

Needle Handling Tips ...................................... 53

PACKAGING

PRODUCT TERMS

AND TRADEMARKS

An Integral Part of the Product ..................... 56

RELAY* Suture Delivery System .................... 56

Modular Storage Racks ................................ 56

Dispenser Boxes ......................................... 57

Primary Packets ........................................ 57

E-PACK* Procedure Kit .................................. 59

Expiration Date ................................................. 60

Suture Sterilization ........................................... 60

Anticipating Suture Needs ............................... 61

Sterile Transfer of Suture Packets .................... 61

Suture Preparation in the Sterile Field ............. 62

Suture Handling Technique .......................... 63

PRODUCT INFORMATION

INDEX

TOPICAL SKIN ADHESIVES

DERMABOND* Topical Skin Adhesive ....... 68

High Viscosity DERMABOND

Topical Skin Adhesive ..................................... 68

OTHER SURGICAL

PRODUCTS

Adhesive Tapes ................................................... 74

Indications and Usage ................................. 74

Application .............................................. 74

Aftercare and Removal ................................ 74

Skin Closure Tapes ..................................... 75

Polyester Fiber Strip ................................... 75

Umbilical Tape ........................................ 75

Surgical Staples ................................................. 75

Indications and Usage ................................. 76

Aftercare and Removal ................................ 76

PROXIMATE* Skin Staplers ........................ 76

Looped Suture ................................................... 77

Retention Suture Devices ................................ 77

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