Module 2

Surgical
Instrumentation
 Introduction
Surgical instruments are special
designed tools that assist health
care professionals to carr y out
specific actions during a surgical
operation.
 Introduction
Surgical instrument can be
generally divided into four classes
by function. These classes are:

[Link] and Dissecting

Instruments
[Link] or holding Instruments
[Link] Instruments
[Link] unifying instruments and
materials
 Surgical Instruments
Cutting and Dissecting
1. Scalpel
2. Scissors (Metzenbaum, Mayo)
Scalpel Blade
Metzenbaum and Mayo
 Surgical Instruments
Grasping or Holding Instruments
1. Forceps
• Tissue forceps
• Dressing forceps
• Hemostatic forceps
 FORCEPS
1. Kelly hemostatic forceps
- have transversely serrated tips, may be straight or
curved.
- serrated only on the distal half of its jaws.
 FORCEPS
2. Mosquito or Halsted forceps
- serration extends the entire length of their tips..
 FORCEPS
3. Crile forceps
- fully serrated jaws
 FORCEPS
4. Carmalt and Roscheter-Carmalt forceps
- with longitudinal serration.
- routinely used for clamping ovarian pedicles and the
uterus during a spay surgery.
 FORCEPS
5. Oschner hemostatic forceps
- heavy transversely serrated forceps with
interdigitating teeth at their tip.
 FORCEPS
5. Needle holder
- Mayo-hegar needle holder
- Olsen-hegar needle holder
 FORCEPS; Tissue Holding
1. Allis tissue forceps
- usually used to hold fascia or subcutaneous tissue
 FORCEPS; Tissue Holding
2. Babcock forceps
- usually used to hold fascia or subcutaneous tissue
 FORCEPS; Tissue Holding
3. Vulsellum tumor forceps
- used to hold tissue firmly where some trauma to the
tissue is acceptable.
 FORCEPS
Towel clamp
- used to secure drapes to the patient.
 FORCEPS: Hemostatic
1. Korcher’s forceps
- specifically designed to catch the bladder.
 FORCEPS: Hemostatic
2. Kelly forceps
- used for occluding blood vessels, manipulating
tissues or for assorted other purposes.
 FORCEPS: Hemostatic
3. Spencers Wells Artery forceps
- compress the artery, clamp and seal small blood
vessels or manipulate artery.
 FORCEPS: Hemostatic
3. Mosquito forceps
- used to hold delicate tissue or compress a bleeding
vessels.
 Tissue unifying surgical instruments
and materials
1. Needle holder
- are hinged instruments have a carbide. They are used
to hold needle when sewing body tissues.
 Tissue unifying surgical instruments
and materials
2. Surgical Needle
- are hinged instruments have a carbide. They are used
to hold needle when sewing body tissues.
 Tissue unifying surgical instruments
and materials
3. Staplers
- it reduces the local inflammatory response, width of
the wound, and the time it takes to close.
 Tissue unifying surgical instruments
and materials
4. Hand held Retractors
-
 Tissue unifying surgical instruments
and materials
5. Self-Retaining Retractors
-

Weislander Retractor

Gelpi Retractor
 Proper Handling of Surgical Instruments

1. Scissors and Hemostats:

- the thumb and rung finger are inserted into the rings
of the scissors while the index and middle finger are used
to guide the instruments.
 Proper Handling of Surgical Instruments

2. Scalpel
- can be held in a pencil, palm, or finger grip.
 Module 2

SUTURE MATERIALS
AND SUTURE PATTERNS
 SUTURE
• Selection of a specific suture type of use is dependent
on both its biological and physical characteristics.

1. Biological characteristics of the suture material relate

to the amount of tissue reaction that is induced.
 SUTURE
1. Biological characteristics

a. Tissue Reaction
- absorbable sutures such as surgical gut are gradually
digested by tissue enzymes or by hydrolysis in the body
fluids.
- non-absorbable sutures are encapsulated sutures by
fibroblasts and tend to remain where they are placed.
 SUTURE
1. Biological characteristics

b. Tissue to be sutured
- tissues that heal slowly should be closed with non-
absorbable sutures.
- tissues that heal rapidly should be closed with
absorbable sutures.
- if tissue is contaminates, AVOID multifilament
sutures.
 SUTURE
2. Physical characteristics of a suture

a. Durability
b. Handling
c. Knot security
 Characteristics of an Ideal Suture

1. Non- reactive to tissues

2. Easy to handle
3. Easy to sterilized
4. High tensile strength in small size
Suture size
 Tensile Strength
• The force exerted by the knot and not the needed to
break the suture.
• Inversely related to the number of zeroes is inversely
related to the size of the suture.
• Delicate tissue need materials of greater tensile
strength
• Dense tissue need suture materials of minimal tensile
strength.
 Tissue Strength
• The holding power of the tissue where the
sutures are placed to bring union to the wound.
• In soft tissues, skin and fascia have greater
suture holding power than fat.
• It is better to increase the number of sutures
than to increase the size of the suture materials.
 Types of Suture Materials
1. Absorbable sutures
- capable of being broken down the body’s
inflammatory response and are used internally to close
organs, fascial planes and subcutaneous tissues.
 Types of Absorbable Sutures
1. Surgical Catgut
- derived from submucosal layer of the sheep’s small
intestine.
- could be either tanned or chromicized to lengthen
absorption time.
 Types of Absorbable Sutures
2. Polyglactin 910 (Vicryl, Ethicon)
- braided multifilament
- copolymer of lactide and glycolide
 Types of Absorbable Sutures
3. Polydioxanone (PDS, Ethicon)
- monofilament
- absorbed by hydrolysis
 Types of Absorbable Sutures
4. Polyglycolic Acid (Devo, Davis and Geck)
- polyester made from hydroxy-acetic acid
- braided, may be coated or uncoated
 Types of Absorbable Sutures
5. Polyglyconate (Maxon, Davis and Geck)
- synthetic
- monofilament
 Types of Sutures
2. Non-Absorbable Sutures
- it maintain strength for longer than 60 days and
become encapsulated with fibrous tissue
- it is used where prolonged mechanical support is
needed and the mainly indicated for skin sutures and
slow healing tissues.
 Types of Non-Absorbable Suture
1. Polypropylene (Prolene, Ethicon)
-Monofilament
-Great tensile strength
 Types of Non-Absorbable Suture
2. Polyamide (Ethicon, Ethilon, Supramid)
-Monofilament or Multifilament
 Types of Non-Absorbable Suture
3. Polyesters (Ethibond, Mersilene, Ethicon)
-Braided
-poor knot tying characteristics
 Types of Non-Absorbable Suture
4. Stainless Steel
-monofilament/multifilament
-poor handling and knot characteristics
 Types of Non-Absorbable Suture
5. Silk
-braided usually
-good tensile strength, handling and tying
 Suture Needles
1. Swaged needles
- there needle that are attached to the suture
- A.K.A as atraumatic needles
 Suture Needles
2. Eyed Needles
- requires threading
- blunt and bend readily
- tend to be used for skin
 Common Suture Patterns
The use of a specific suture pattern may vary depending
on the area being sutures, the incision, the tension at the
suture line and the specific need for apposition, inversion,
or eversion of the tissues.
 Common Suture Patterns
Appositional
• Anatomically opposes edges of the incision
• Result in the fastest healing
 Common Suture Patterns
Inverting
• Turns incision edges inward, away form surgeon
• Desirable when closing for hollow organ
• Avoid in skin
 Common Suture Patterns
Everting
• Turns incision edges outwards surgeons
• Results in delayed healing
 Types of Suture Patterns
A. Interrupted Patterns
• are to relieve tension, or in areas where more strength
is required. Not must be tied after each suture
placement. Should one suture fails, this will not
affected the rest of the sutures placed in wounds.
 Types of Suture Patterns
B. Continuous Patterns
• The quickest type of suture pattern, used for areas of
low tension such as closure of body cavities, muscle
layers, adipose tissue, and skin.
 Types of Suture Patterns
Apposition Patterns
1. Simple Interrupted Suture
• Usages: skin, vessels, subcutaneous tissue, fascia. GI
and urinary tract.
 Types of Suture Patterns
Apposition Patterns
2. Interrupted Cruciate (Cross Mattress) Suture
• An X shape is created over the wound
• A bite is taken from one side, passing to the other,
before advancing forwards.
• A knot is then placed to join the suture ends.
 Types of Suture Patterns
Apposition Patterns
3. Simple Continuous Suture
• Place an initial knot
• Pull suture material tight so wound edges are
appositional.
 Types of Suture Patterns
Apposition Patterns
4. Ford Interlocking Suture
• A bite is taken from each side of wound.
• Before pulling the suture tight, the material is threaded
through the loop leaving an “L” shaped suture.
 Types of Suture Patterns
Apposition Patterns
5. Gambee Suture
• This is a specialized suture used in the repair of the
intestine
 Types of Suture Patterns
Inverting Patterns
1. Cushing Suture
• Penetrates into submucosa and mucosa.
• This technique is often used to close the incisions in
hollow organs such as stomach, urinary bladder and
uterus.
 Types of Suture Patterns
Inverting Patterns
2. Connell Suture
• Suture passed through the submucosa but not in
mucosa.
• This technique is often used to close the incisions in
hollow organs such as stomach, urinary bladder and
uterus.
 Types of Suture Patterns
Inverting Patterns
3. Lembert Suture
• As the holding layer of an organ is the submucosa, the
needle should penetrate only to this depth and never
into the lumen.
• As suture is tightened it inverts the tissues,
 Types of Suture Patterns
Inverting Patterns
4. Halsted Suture
• The technique is essentially the same as for a vertical
mattress suture except that two sutures are placed in a
parallel fashion before are tied.
 Types of Suture Patterns
Inverting Patterns
5. Parker Kerr Suture
• Two layer closure is historically utilized to aseptically
invert a transected, clamped viscus.
• A single layer of cushing sewn over a clamp and
tightened as the clamp is removed
• Followed by an inverting seromuscular
pattern(oversewn with lambert)
 Types of Suture Patterns
Inverting Patterns
6. Purse String Suture
• a bite is taken at regular intervals around the perimeter
of an opening so that when pulled tight, it can be made
smaller or closed completely.
 Types of Suture Patterns
Tension Sutures
1. Interrupted Horizontal Mattress Suture
• The needle is passed from one side of the wound to
other, then horizontally back across the wound, leaving
as short gap between the bites.
 Types of Suture Patterns
Tension Sutures
2. Interrupted Vertical Mattress Suture
• A bite is taken 8-10 mm away from the wound and
passes through to an equal distance away from the
wound on the opposite side.
• The suture is then repeated back across the wound, but
this time, a bite is taken vertically from original bite 3-4
mm away from the wound, creating a vertical suture on
either side.
 Types of Suture Patterns
Tension Sutures
2. Interrupted Vertical Mattress Suture
 Types of Suture Patterns
Tension Sutures
3. Far-Far-Near-Near and Far-Near-Near-Far
• Can provide necessary tension for wound approximation
without direct tension to wound edge.
Thank you!