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ethicon_wound_closure_manual.pdf

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  W OUND  C LOSURE  M ANUAL                                                                                                                                                                                                                 W  O UND  C  L  O S  URE  M AN UAL   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 and embrace 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 criticaldecision making, and provides an overview of materials availabletoday as well as basic 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 isalso committed to advancing the standard of care by providinginnovative products for suturing and topical skin closure. We arealso committed to you and value your importance to the medicalindustry. We have been with you since the beginning and arecommitted 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 the Jay Phillips Professor and Chairman of Surgery at the University of Minnesota. Thisdepartment has a long-standing tradition and has attained national and international recognition for excellence in trainingacademic general surgeons and surgical scientists. He is also theDivision Chief of General Surgery, Head of Surgical InfectiousDiseases, Director of Graduate Studies, and Residency ProgramDirector of the Department of Surgery.Dr. Dunn has published over 400 articles and book chapters in theareas of Surgical Infectious Diseases and Transplantation. He hasreceived regional and nationwide recognition in severalacademic organizations and is a Past President of the SurgicalInfection Society, the Association for Academic Surgery, the Minnesota Chapter of the American College of Surgeons, the Society of University Surgeons and the Society of University  Surgeons Foundation.  TABLE OF CONTENTS1 WOUND HEALING AND MANAGEMENT The Wound ..........................................................  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 Intention. .........................7  Delayed Primary Closure. .............................7  2 THE SUTURE What Is a Suture? ............................................... 10 Personal Suture Preference ............................... 10 Suture Characteristics ....................................... 11  Size and Tensile Strength ............................. . 11  Monofilament vs. MultifilamentStrands ......... . 11  Absorbable vs. Nonabsorbable Sutures ............. . 12 Specific Suturing Materials .............................. 13  Synthetic Absorbable Sutures .........................14 Nonabsorbable Sutures ................................16  Synthetic Nonabsorbable Sutures ....................17  Common Suturing Techniques ....................... 18 Ligatures. ................................................18 The Primary Suture Line. ............................19 Continuous Sutures. ...................................19 Interrupted Sutures. ...................................22 Deep Sutures. ...........................................22 Buried Sutures. .........................................22 Purse-String Sutures. ..................................22  Subcuticular Sutures. ..................................22 The Secondary Suture Line. ..........................23  Stitch Placement. .......................................24 Knot Tying .........................................................  24 Knot Security  ............................................24 Knot Tying Techniques Most Often Used  ..........25  Square Knot  .............................................25  Surgeon’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 3 THE SURGICAL NEEDLE Elements of Needle Design ............................. 42 Principles of Choosing a Surgical Needle ..... 44 The Anatomy of a Needle ................................ 45 The Needle Eye .........................................45 The Needle Body  .......................................46  Straight Needle .........................................46 Half-Curved Needle ...................................47  Curved Needle ..........................................47  Compound Curved Needle ...........................47  The Needle Point  ......................................48 Types of Needles ............................................... 48 Cutting Needles .........................................48 Conventional Cutting Needles .......................49 Reverse Cutting Needles ...............................49  Side Cutting Needles ...................................50 Taper Point Needles ...................................50 Tapercut Surgical Needles ............................51 Blunt Point Needles ....................................52 Needleholders ....................................................  52 Needleholder Use .......................................52 Placing the Needle in Tissue .........................53 Needle Handling Tips ......................................  53
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