Manual De Suturas



W O U N D C L O S U R E M A N UA L

WOUND 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 andembrace 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 asbasic 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 skinclosure. 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 theJay 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 ProgramDirector 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 ofSurgeons, the Society of University Surgeons and the Society of University Surgeons Foundation.

TABLE OF CONTENTS 1
WOUND HEALING AND MANAGEMENT
Knot Tying ......................................................... 24 Knot Security............................................ 24 Knot Tying Techniques Most Often Used .......... 25 Square Knot ............................................. 25Surgeon’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

TheWound.......................................................... 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...