眼科学suture choice.ppt

Sutures&Needles,1,Sutureselection,CharacteristicsCriteriaClassification,2,SizeTensilestrengthTissuereactionEaseofhandlingHoldtimeMemory,Characteristics,3,Suturesize,4,determinedbytheUSPharmacopoeiaratingsystembasedonthebreakingstrengthofthesuturematerial,notthediameter.,EasytohandleAdequatetensilestrengthMinimaltissuereactionGoodknotsecurityInexpensive,Criteria,5,Classification,origin,Natural:gut,silk,Synthetic:nylon,prolene,vicryl,Metallic:steel,configuration,Monofilament:nylon,prolene,etc,Multifilament:silk,vicryl,etc,behaviorintissue,Absorbable:gut,vicryl,PDS,Non-absorbable:silk,nylon,prolene,6,absorbedbyproteolysisinducemoreinflammationwhichleadtoincreasedscarring,absorbedbyhydrolysisproducelesstissuereaction,organic,synthetic,origin,7,lesssurfaceareaforbacterialcolonizationlowfrictionandcauselesstissuetraumadifficulttohandleandmorethrowsneededtomakeasecureknot,handleandknoteasilymayharborbacteriainacontaminatedarea,monofilament,multifilament,configuration,8,Usedwhenprolongedtensionisrequired,ElicitmoreinflammatoryreactionLoseatleast50%ofstrengthwithin4weeksofuse,nonabsorbable,absorbable,performance,9,Silkbraided,coated,blackdyed,EaseofhandlingSecuredknotting,Intenseinflammatoryreactionifleftin5daysLowtensilestrengthincreasedriskofinfection,Advantage,Disadvantage,10,Nylon-monoormultifilamentforms,ElasticityMinimalinflammationSuitableforskinclosure,KnotslippageDifficulttohandle,Advantage,Disadvantage,11,Prolenemonofilament聚丙烯,StrongtensilestrengthMinimaltissuereactionGoodplasticity,Poorknotsecuritydifficulttohandle,Advantage,Disadvantage,12,Staples,FasterLesstissuereactivityandinfectionGoodcosmesisCostmore,Neverontheface!,13,Vicryl,Synthetic,braidedEasyhandlingDragtissuesShouldnotbeusedontheskin?Notintraumacase,14,Needles,15,16,Quiz1,17,Quiz2,Howtochooseapropersutureandneedlewhenwehandlewithacontaminatedskinwoundontheface?,18,THANKYOU,19,Holdtime,CompletebreakdownofstrengthtimesofvariousEthiconSutures:VicrylRapide2weeksUndyedMonocryl3weeksDyedMonocryl4weeksCoatedVicryl4weeksPDS9weeks,20,21,capillaritytheprocessbywhichfluidandbacteriaarecarriedintotheintersticesofmultifilamentfibers.Capillarysuturematerialsshouldnotbeusedincontaminatedsites.Coatingreducescapillarityofsomesutures.memoryabilityofsuturetoreturntoormaintainitsoriginalshape(relatedtoelasticity,plasticity,anddiameter),22,PDS聚二氧六环酰胺,MonofilamentDelayed