![Dr Sushila Saini
Director Jaipur doorbeen hospital &
JDH healthcare training institute,
The center of excellence for Gynae endoscopic
surgery & training
President, Association of Gynae Endoscopic
Surgeon of Rajasthan [AGES-R]
Faculty Ethicon institute of surgical excellence [J&J]
Organizing secretory for Raj Endo Gynae 2015 ,
2016 & for upcoming sep 2017
Running regular fellowship & masters courses for
Gynae lap surgery training
Till now 87 doctors trained by various training
programmes.](https://image.slidesharecdn.com/choiceofsuturematerialinlapgyane-170906021807/85/Choice-of-suture-material-in-lap-gyane-2-320.jpg)
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Choice of suture material in lap gyane
- 1. Choice of suture materials in minimal invasive Gynecology Dr sushila saini
- 2. Dr Sushila Saini Director Jaipur doorbeen hospital & JDH healthcare training institute, The center of excellence for Gynae endoscopic surgery & training President, Association of Gynae Endoscopic Surgeon of Rajasthan [AGES-R] Faculty Ethicon institute of surgical excellence [J&J] Organizing secretory for Raj Endo Gynae 2015 , 2016 & for upcoming sep 2017 Running regular fellowship & masters courses for Gynae lap surgery training Till now 87 doctors trained by various training programmes.
- 3. A perfect suture would have the following properties Adequate strength for the time and forces needed for the wounded tissue to heal Minimal tissue reactivity Comfortable handling characteristics Unfavorable for bacterial growth and easily sterilized Non-electrolytic, non-capillary, non-allergenic, and non-carcinogenic
- 4. The perfect suture material should retain adequate strength throughout the healing process and disappear afterward with minimal associated inflammatory reaction.
- 6. Effects of Foreign Bodies and Excess Inflammation on Wound Healing The presence of foreign bodies (ie, suture material) in wounds induces excessive inflammatory tissue responses that lower the bodys defense mechanism against infection, interfere with the proliferative phase of wound healing, and ultimately lead to inferior wound strength due to excessive scar tissue formation. The degree of tissue reaction in turn depends on the chemical nature and physical characteristics of the suture materials. Inflammatory tissue reactions due to the presence of suture material will persist as long as the foreign body remains within the tissue
- 7. Suture Classification that best assist surgeons in choosing the proper suture material for surgery 6 categories Suture size Tensile strength Absorbable versus non-absorbable Multifilament versus monofilament Stiffness and flexibility Smooth versus barbed Determining the balance between the added strength the suture provides to the tissues while they heal versus the negative effects of inflammation is central to choosing the proper suture.
- 9. Why Not Knots? the surgical knot used with a length of smooth sutures is a significant necessary evil that is accepted as the only irrefutable means to anchor suture material within a wound. A knot-secured, smooth suture inevitably creates an uneven distribution of tension across the wound. Irrespective of the knot configuration and material, the weakest spot in a surgical suture is the knot and the second weakest point is the portion immediately adjacent to the knot, with reductions in tensile strength reported from 35% to 95% depending on the study and suture material used.
- 10. As barbed suture self-anchors at approximately every 1 mm of tissue, there is a more uniform distribution of wound tension across the suture line than with conventional running smooth suture, yielding more consistent wound opposition. The anchoring of barbed suture resists migration and can be conceptualized as a continuous interrupted suture without all the knots. Two separate studies demonstrate this point nicely by looking at suture line strength, In both trials, barbed suture lines consistently demonstrated more resistance to suture line failure than traditional knotted suture lines. Finally, the use of barbed sutures with more evenly distributed tension may yield stronger wounds by eliminating the high tension spots that are more prone to disrupted healing.
- 11. When considerations for blood loss and hemostatis are added, the need for faster, more secure suture lines becomes readily apparent. To this end, barbed suture materials are an ideal solution.
- 12. Bidirectional barbed sutures may offer multiple advantages they eliminate the need for a knot, which effectively reduces wound tissue reactions; there is a more uniform distribution of wound tension across the suture line, yielding more consistent wound opposition; and the secure anchoring of barbed suture at 1 mm intervals may provide a reduction in gaps and thereby create a more watertight seal.