Surgical Sutures Classification

Sutures

• Absorbable sutures: absorbed by the human body, used in deep tissues (e.g., Vicryl, catgut)
• Non-absorbable sutures: remain and maintain tensile strength, used in skin closure or when tensile strength is required (e.g., silk, polypropylene, stainless steel)
• Monofilamentous sutures: produce minimal tissue reaction and infection (e.g., polypropylene, Monocryl)
• Multifilamentous sutures: higher incidence of tissue reaction and infection (e.g., Silk, Vicryl)

Wound Dressing

• Aim of dressing: support wound healing, minimize wound contamination, and drain wound discharge if present
• Types of dressing:
  • Occlusive dressing: conventional gauze and adhesive plaster
  • Semiocclusive dressing: permeable to water vapor and gases, impermeable to bacteria
  • Dressing with osmotic agents: helps absorb wound discharge (e.g., Debrisan, honey)
  • Vacuum-assisted closure: applies negative pressure to remove tissue exudate and aid tissue growth

Burns

• Functions of the skin:
  • Barrier against infection
  • Prevents excess water evaporation
  • Provides sweat glands for regulating body temperature
  • Aids in vitamin D synthesis
• Rule of nine: calculates burn extent
• Aetiology of burns:
  • Scald (boiling water)
  • Flame burns (ignition of clothes)
  • Electrical burn
  • Chemical burn
  • Inhalation or respiratory burns
• Degrees of burns:
  • 1st degree: epidermis damaged only (e.g., sunburn); rapid healing
  • 2nd degree: epidermis and part of dermis destroyed; healing within weeks without scarring
  • 3rd degree: complete destruction of epidermis and dermis; slow healing with scarring and possible skin grafting
• Complications of burns:
  • General complications: inhalation injury, neurogenic shock, hypovolemic shock, renal failure, gastric ulceration, multi-organ failure
  • Local complications:
    • Early: infection, constricting eschar, suffocation, compartmental syndrome
    • Late: contracture, hypertrophic scar, malignant transformation
• Management of burns:
  • First aid: ensure patent airway, administer strong analgesics, use saline or tap water to limit tissue destruction
  • Admission to hospital indicated for: burnt area > 10% in adults, full-thickness burn, inhalation burn, associated injury, electric or chemical burn
  • Local wound care: water-soluble creams with bactericidal effect (e.g., silver sulphadiazine)

Multiple-Injury Patient

• Mechanisms of injury:
  • Penetrating trauma (low-velocity, high-velocity)
  • Blunt trauma (multiple direct blows, fall from height, road traffic accident)
• Organized trauma care:
  • Establish management priorities
  • Primary survey: A (airway and cervical spine control), B (breathing), C (stop hemorrhage), D (definitive treatment)
  • Resuscitation: restore blood volume, optimize oxygen delivery, monitoring

Decontamination and Antiseptics

• Decontamination: process of removing microorganisms
• Methods: cleaning, disinfection, sterilization
• Cleaning: removal of visible contaminants (e.g., hand wash, instrument wash)
• Disinfection: reduction of viable microorganisms to an acceptable level
• Antiseptics: disinfectants safe for application to epithelial surfaces (e.g., povidone-iodine, chlorhexidine, alcohols, hexachlorophene)
• Sterilization: destruction of all microorganisms (including spores, viruses, and mycobacteria)
• Modes of sterilization: autoclaving, chemical agents (e.g., ethylene oxide gas, glutaraldehyde), physical agents (e.g., gamma rays)

This quiz covers the classification of sutures based on their absorbability and other properties. It includes examples of different types of sutures and their characteristics.