The document discusses various surgical aids used in wound dressing and surgery. It describes different types of surgical dressings like gauze, bandages, adhesive tapes that are used as primary or secondary dressings. It also discusses absorbable and non-absorbable sutures and ligatures made of catgut, silk, polyglycolic acid. Other aids mentioned are gelatin sponges, meshes for hernia repair and different surgical staplers. The document provides classifications and properties of these various aids and concludes emphasizing on addressing the cause of wound and principles of moist wound healing.
4. Introduction
Surgical aids : These are materials used for dressing of wounds or
injured or diseased tissues to hold wound edges closely during
healing ,these materials are collectively called surgical aids.
Historically, a dressing was usually a piece of material, sometimes
cloth, but the use of dung, leaves and honey have also been
described.
Previously, the accepted wisdom was that to prevent infection of a
wound, the wound should be kept as dry as possible.
1860, English surgeon, Joseph Lister, began treating his surgical
gauze with carbolic acid, known today as phenol, and subsequently
dropped his surgical team's mortality rate by 45%.
1870, Robert Wood Johnson, co-founder of “Johnson & Johnson”,
began producing gauze and wound dressings treated with iodine.
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5. Modern wound dressings
1990, the surgical dressings expanded into the well-recognized
groups of products, such as vapour-permeable adhesive films,
hydrogels, hydrocolloids, alginates, and synthetic foam dressings.
Additionally, new groups of products, such as anti-adhesive, mostly
silicone meshes; tissue adhesives; barrier films; and silver- or
collagen-containing dressings, were introduced. Finally, combination
products and engineered skin substitutes were developed.
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6. Surgical dressings :
Def : Surgical dressing is a term applied to a wide range of materials
used for dressing wounds or diseased tissues.
Ideal wound dressings :
Provide an environment for moist wound healing.
Prevent maceration by permitting evaporation or absorption.
Promote haemostasis (i.e. stops bleeding)
Protect the wound from further damage
e.g. mechanical damage, microbial invasion, dehydration,
maceration,chemical damage, alteration in pH.
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7. Promote healing.
Reduce heat loss.
Control microbial growth by incorporation of antimicrobial drugs.
Provide compression, promoting haemostasis and reducing oedema.
Reduce pain, increase patient comfort and improve functional use for
wound site.
Reduce odour.
Improve appearance of the wound site.
Reduce overall costs associated with wound treatment.
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9. Primary Dressing: A dressing that touches the wound site.
Ex : Plain gauze , Impregnated Gauze , Paraffin gauze
dressing etc
Secondary Dressing (Bandage): Keeps the primary dressing in site
Ex : Absorbents , Bandages , Adhesive tapes etc
Some dressings function as primary dressing only. However some
could function both as primary as well as secondary dressing
Ex : Composite dressings , Hydrogel etc
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13. Hydrocolloids
Hydrocolloids slowly absorb fluids, leading to a change in the physical state
of the dressing & the formation of gel covering the wound
Provide moist wound environment
Provide PAIN RELIEF by covering nerve endings with both gel and
exudate.
Constituents are methylcellulose, pectin, gelatine, and poly-isobutylene.
Hydrocolloids are used both acute wounds and chronic wounds and for
different stages of light-to-heavy wounds
Brand: DueDERM®
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15. Gauze
Most readily available simple wound dressings
Non-adherent coating
Absorbs exudate
Promote desiccation in wounds
Can be used as a primary or secondary dressing
Inexpensive
Highly permeable
Relatively non-occlusive
FORMS: squares, sheets, rolls, and packing strips.
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16. Gauze film squares, sheets, rolls, and packing strips.
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17. Bandages (Medicated bandages)
Bandages : are use to hold dressing in place by providing pressure or
supports.
Bandages may be extensive or non extensive ,adhesive or non adhesive ,flat
or tubular or become rigid after shapping for immobilization.
Types of bandages :
Common Gauze Roller Bandage : it is prepared from absorbent gauze in
various width & lengths. . Each bandage is in one continuous piece, tightly
rolled and substantially free from loose threads.
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18. Muslin bandage rolls: are made of heavier unbleached materials.
They are very strong and are used wherever bandages do not provide
sufficient strength or support.
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19. Elastic bandages
Woven elastic bandage :is made of heavy elastic webbing containing
rubber threads. Good support & pressure are provided by this type of
rubber elastic bandages.
Crepe bandage : is elastic but contains no rubber. Its elasticity is due
to special weave that allow it to stretch to practically twice its
length.
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21. Orthopaedic bandages : used to provide immobilization and support in the
treatment of broken bones and in certain conditions of bones and joints.
Plaster of Paris impregnated gauze has been std material for this purpose.
This bandages are water resistant, light weight and durable.
Orthopaedic elastic plaster bandages : are plaster of Paris bandages
containing elastic thread in the fabric and are intended for specialized
prosthetic uses.
Orthopaedic bandage Orthopaedic elastic bandage
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22. Cast bandages : are soft, absorbents, protective padding, applied like
a bandage to the affected areas. They are composed of various fibre
constructions that confirms and cling, absorb moisture, and allow
the skin to breathe.
Brand name : Gelocast
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23. Adhesive tapes
Permeable surgical adhesive tapes : it is an alternative permeable woven or
non- woven surgical synthetic adhesive tapes BP spread with a polymeric
adhesive.
Semi-permeable surgical adhesive tapes : these are waterproof and therefore
protect wound from micro-organisms and environmental conditions.
Permeable taps Semi permeable taps
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24. Occlusive surgical adhesive tapes : these are used to secure or cover
dressing where air and water vapour is required.
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25. Sutures & Ligatures
A surgical suture is a strand or fibre used to hold wound edges in
application during healing.
A ligature is a thread or string without a needle which is used to tie
blood vessels and other tissues together.
Sutures materials may be divided into two principle classes:
Absorbable & non-absorbable.
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26. Absorbable sutures : are those materials that are capable of being
broken down or digested by the body.
Ex : Polyglycolic acid, Poly-galactine, polypropylene etc
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27. Surgical guts
Synthetic absorbable sutures
Non-absorbable sutures : are made from various materials such as
polyesters, nylon etc. these materials incite a minimal foreign body
reaction at the site of placement. They are frequently used for
cardiovascular, ophthalmic and neurological procedures.
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28. Silk : is an important non absorbable surgical sutures consist of
protein fibroin as extruded by the silk worm. Silk sutures are handled
easily and tolerated well by body tissues.
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29. Dermal silk : these sutures consists of natural twisted silk with
insoluble coating of tanned gelation or other protein.
Cotton and Linen : Sutures derived from cellulose, they are twisted
from fibre staple, have moderately high tensile strength and are
stable to heat sterilization.
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30. Metallic sutures
Silver: silver wire, foil and other forms are used to some extent as
suture. Silver has some antiseptic action but in some tissues it
produce irritation.
Stainless steel : is a ferrous alloy is resistant to chemical attack has
been used widely in the form of wire sutures, fixation plates, screws
and other items.
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32. Catgut is a natural absorbable suture is obtained by longitudinally
slitting the intestinal sub-mucosa of sheep and goat, twisting the
ribbons and joining them in wet condition giving monofilament
finish.
Brand name : Trugut, Progut, etc.
Catgut available in Plain (ivory colour) and Chromic in dark brown
colour.
Plain catgut :
Loses 50% tensile strength in 3 days and 100% strength by 15 days
Gets completely absorbed in tissue by 60 days.
Uses:
To tie small subcutaneous vessels.
To repair the wound of lip or the oral cavity.
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33. Chromic catgut
Is treated with chromic salt solution. mild chromic sutures are
specially treated for ophthalmic and cuticular applications
Loses 50% tensile strength in 7 days and 100% strength by 28 days
Gets completely absorbed in tissue in 90-100 days
Plain catgut Chromic catgut
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34. Absorbable gelation sponges (Gelatine foam)
Absorbable gelation sponge is made from animal skin gelatine
(denatured collagen).
As the sponges fills with blood, platelets, come into contact with
clotting of blood.
If soaked in thrombin it directly acts on the coagulation and has an
increased Haemostatic action.
Ex : Gel-foam ,Surgi-foam etc
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35. Surgical equipment's
Surgical needle
Initially stainless steel needles were being used. Now high nickel
stainless steel is used. It gives better resistance to bending and
breakage
Types of needles :
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36. Round bodied
minimise the tissue trauma and used for suturing peritoneum,
abdominal viscera, myocardium etc.
Cutting needle
Have two opposing cutting edges
Designed to cut through tough difficult to penetrate structures
Used in plastic surgery, especially of the face
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37. Reverse cutting needle
Designed with cutting edge
on the outer convex side
For skin, oral mucosa,
tendon sheaths
Blunt needles
To dissect to friable tissue
rather than cutting through
it
For suturing liver and
kidney
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39. Surgical mesh is a woven fabric used for chest wall reconstruction,
strengthening tissues, provide support for internal organs, and to treat
surgical or traumatic wounds.
The most common types of surgical meshes are hernia mesh, stress
urinary incontinence slings and mesh for treating prolapse.
Titanium mesh has been used in some back surgeries
As with any surgical implant, some complications can occur,
including infection, inflammation, tissue damage, and septic shock.
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40. Types of meshes :
Polypropylene mesh (Benlene mesh)
• Monofilament
• Inert; can be used in presence of infection
• Good elasticity and high tensile strength
Used for
• Hernia repair
• Abdominal wall construction
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41. Stainless steel meshes
• Rigid and difficult to work
• Causes discomfort to patient
Polyester mesh (Mersilene)
• Least inert synthetic mesh
• Never be used in presence of infection
• Trans-vaginal mesh (Pelvisoft , Pelvitex)
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43. Surgical staples are specilized staples used in surgery in place of
suture to close skin wound.
Basic principles
Preservation of adequate tissue vascularization
Evading of tissue tension
Hemostasis
Advantages
Less tissue reaction
Accelerated wound healing
Efficiency
Less anaesthesia and intra operative time
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44. Types of staplers
Circular staplers
Disposable linear stapler
Disposable linear cutting staplers
Skin staplers
Disposable curved cutter staplers
Disposable endo-cutter staplers
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45. Conclusion
Determine and address cause of wound
Establish plan of care that includes dressings that will address
principles of moist wound healing
Keep dressings as simple as possible
Assure Pain is addressed
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46. Reference
Remington 2-The Science and Practice of Pharmacy (20th edition) Pg no 1846-
1856.
Bentley’s Textbook of Pharmaceutics 8th edition, Pg no 669-677.
Volten-Wound management product and surgical dressings .Pg no 315-320
Rebecca Pieknik Suture and Surgical Haemostasis Pg no . 65-70
Ellen stolle satteson, Material for wound closure. Medical research sci. (2012)
Wei Sun et al. Haemostatic absorbable gelatine sponge loaded with 5-
fluorouracil for treatment of tumour's. International Journal of Nano-medicine
(Apr.2013 ) Pg no 1-8
Mike Ralf Langenbach et al. Polypropylene versus Polyester Mesh for
Laparoscopic Inguinal Hernia Repair: Short-Term Results of a Comparative
Study. Surgical science scientific journal (2013) pg no 29-34
www. Medicalstapler.com/surgical-stapler-knowledge.html
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