Surgical aids are referred to a wide range of materials used for dressing of wounds or injured or diseased tissues (Surgical dressings); some are used to hold wound edges closely during healing (sutures and ligatures). All these materials are collectively called surgical aids.
Surgical aids are classified into 6 different categories or types. Let's study what are those, and what they are used for.
Surgical Dressing
Surgical dressing is a term applied to a wide range of materials used for the dressing of wounds or injured or diseased tissues.
Classification of Surgical Dressings
- Primary wound dressings.
- Primary/secondary wound dressings.
- Secondary dressings.
- Absorbents.
- Bandages.
- Adhesive tapes.
- Protectives.
A. Primary Wound Dressings
A primary dressing directly comes in contact with the wound. It may provide absorptive capacity and may prevent desiccation, infection and adhesion of the secondary dressing to the wound.
| Term | Description |
|---|---|
| Plain Gauze | This is a soft cotton cloth of plain weave, open texture and filmy appearance. It absorbs water readily but unless many fold thickness are used, it is not bulky enough to cope with the exudate or give adequate protection to a large wound. Hence, it is usually covered with more absorptive and protective dressing. Wicks of gauze are used, after surgery, for draining exudate from large wounds. |
| Impregnate Gauze | Cotton, rayon or cellulose acetate gauze has been impregnated with a variety of substances such as petroleum or paraffin, vaseline or petrolatum emulsion. They are used to reduce its adherence to wounds. |
| Paraffin Gauze Dressing | This is a sterile dressing consisting of pieces of cotton, rayon or cotton and rayon gauze impregnated with yellow soft paraffin or it for use in warm countries, soft and hard paraffin. Used in skin grafting and for paraffin prevents adherence to the tissues and the open nature of the gauze allows air to reach the wound and exudate to drain away into secondary absorbent dressing. |
| Film Dressing | Films of polyurethane with acrylic or polyether adhesives. In lightly exuding wounds they permit enough evaporation to promote moist wound healing and prevent maceration. Film dressings exclude bacteria from wounds and permit bathing and observation of the wound. They will adhere well to intact skin and have a low adherence for wound tissues. |
B. Primary / Secondary Wound Dressings
Some dressings are solely primary or secondary in nature, others have the characteristics of both.
| Term | Description |
|---|---|
| Composite Dressings | Consists of lightly absorbent rayon or cotton pads sandwiched between porous polyethylene films. It absorbs water readily but unless many fold thickness are used, it is not bulky enough to cope with the exudate or give adequate protection to a large wound. Hence, it is usually covered with more absorptive and protective dressing. Wicks of gauze are used, after surgery, for draining exudate from large wounds. |
| Hydrogels | These are cross-linked polymers such as poly-vinyl-pyrrolidone (PVP), cross-linked polyethylene oxide gel or polyacrylamide in which the wound exudate may be trapped. Polymers used in hydrogels include chitosan, dextran, alginate/gelatin and collagen/ glycosaminoglycan. Hydrogels are non adherent dressings, which through semipermeable film allow a high rate of evaporation (and cooling) without compromising wound hydration. This makes them useful in burn treatment. Hydrogels are very useful in hairy areas where entrapment of hair into the dressing would not be traumatic. |
C. Secondary Dressings
A secondary dressing is placed over the primary dressing for further protection, absorptive capacity, compression or occlusion.
i. Adsorbents
| Term | Description |
|---|---|
| Surgical Cotton | The raw cotton fibre, mechanically cleaned of dirt and processed to remove the natural waxes on the cotton fibres. The fibres are defatted with alkali, bleached, washed and dried. It is available as rolls or small balls. It absorbs water readily hence used for absorbing wound exudates. It can be used for cleaning, swabbing and medicating wounds and for applying bactericidal solutions to the skin before surgery. |
| Surgical Gauzes | The function of surgical gauze is to provide an absorbent material of sufficient tensile strength for surgical dressings. Various forms of pads, compressed and dressings are made from surgical gauze, alone or with absorbent cotton, tissue paper and other materials. |
Other forms of secondary dressings are:
- Sanitary napkins
- Eye pads
- Disposable under BANDAGES
- Cotton-tipped appliances etc.
ii. Bandages
The function of bandages is to hold dressings in place by providing pressure or support. They may be inelastic, elastic or become rigid after shaping for immobilization.
| Term | Description |
|---|---|
| Common Gauze Roller Bandages | Each bandage is in one continuous piece, tightly rolled and substantially free from loose threads. It may be of various widths and lengths for various purposes. |
| Muslin Bandage Rolls | This bleached cotton cloth is plain but closely weaved. They are very strong and are used wherever gauze bandages do not provide sufficient strength or support. They are frequently used to hold splints or bulky compressive dressing in place. |
| Elastic Bandages | a. Cotton and Rubber Elastic Bandages: This bandage has a cotton weft but the warp contains rubber threads. b. Crepe Bandage: It is elastic but contains no rubber. The warp threads are of cotton and wool and the weft threads are cotton. The wool content is not less than 33 (1/3)% Crepe bandage conforms well to body contours allowing limited movement and stretching if swelling takes place. Hence it is very useful for: Giving light support to sprains and strains, Correctional purposes, A compression bandage. |
| Triangular Bandage | A triangular bandage is made from a strong type of cloth which has been cut into a right-angle triangle. The triangle can be folded down into a “cravat.” This is because they can be used as a triangle bandage. They are used also for applying pressure to a wound to control bleeding. |
| Orthopedic Bandaging | Immobilization and Support in the treatment of broken bones. Restriction of Use. Prevention or Inhibition of Swelling. Protection from Contamination. Prevention of Self Mutilation. |
| Orthopedic Elastic Plaster Bandage | These are plaster of Paris bandages containing elastic thread in the fabric and are intended for specialized prosthetic uses. |
| Cast Bandages | These are soft, absorbents, protective padding, applied like a bandage to the affected areas. They are composed of various fibre constructions that confirm and cling, absorb moisture, and allow the skin to breath. |
iii. Adhesive Tapes
When some adhesives are spread over a backing membrane it is called an adhesive tape.
These tapes are used,
- To secure dressings and appliances firmly in place.
- For support and compression e.g. for fractured ribs and clavicles, sprains and leg ulcers etc.
The adhesive tapes differ with the type of backing membrane (e.g. pain cloth, elastic cloth, plastic film).
D. Protectives
To be Updated.
Sutures and Ligatures
A surgical suture is a strand of fiber 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.
Classification of Sutures
- Absorbable
- Synthetic Absorbable
- Non-Absorbable
- Synthetic Non-Absorbable
- Metallic Sutures
A. Absorbable Sutures
These are digested in the tissue of the body after the wound has healed.
Examples: CATGUT, KANGAROO Tendon, BROCAIL.
Surgical Gut / Catgut
Catgut is prepared from the intestine of the sheep. The name is said to be derived from the word “kit-gut” (a ‘kit’ being a small violin used in olden times).
The variations in catgut depends on the variations in patients and on the sites of implantation.
Two varieties of catgut, as distinguished by their resistance to absorptive action by tissue enzymes are described in the USP as
- Type - Plain or untreated and
- Type C - medium treatment.
In other terms they may be called ‘plain’, ‘chromic’ or ‘extra chromic’.
B. Synthetic Absorbable Sutures
Polymers derived from
- Condensing the cyclic derivative of glycolic acid (glycolide)
- Mixtures of glycolide and lactide (derived by cyclizing lactic acid)
- Dioxanone and glycolide with tetramethylene carbonate have shown to possess high tensile strength and absorbability.
The first two polyesters mentioned are melt-extruded into multifilament yarns which then are braided into various sizes of sutures. The second two polyesters are provided as pliable monofilaments.
C. Non-Absorbable Sutures
This group of sutures are relatively resistant to attack by normal tissue fluids.
When non-absorbable sutures are used for skin closure, they usually are removed after the wound has healed to the point where suture support is no longer necessary.
These are classified into 2 types
- Monofilament sutures
- Braided sutures
| Term | Description |
|---|---|
| Monofilament Sutures | It has a smooth surface so it can easily pass through the tissues. It is having less strength. |
| Braided Sutures | These are formed by twisting of monofilament sutures. It is rough in nature so the tissue is ruptured. It is overcome by using silicon fluid. Silicon fluid enhances the smoothness of surface i.e., Surface lubricant. Braided suture has more strength. |
Generally silk, linen, cotton, metallic wire, nylon and dacron are given in USP.
| Term | Description |
|---|---|
| Silk | Degummed commercial silk fibres consist chiefly of the protein fibroin as extruded by the silk-worm. Many such fibers are twisted into a single strand of various diameters as specified in USP, and sold in the natural colour or after dyeing. Silk sutures are handled easily, and tolerated well by body tissue, although they may cause significant tissue reaction. The microorganisms can remain concealed in the interstices of silk strand and may protect them from antimicrobial agents. So chronic wounds may not heal unless the suture is removed. Silk occasionally migrates from the site of implantation and comes to the surface. In certain sites the knots may produce irritation and may remain encapsulated in the tissue. |
| Dermal Silk | These sutures consist of natural twisted silk encased in an insoluble coating of tanned gelatin of other proteins. This coating must withstand autoclaving without stripping. Its purpose is to prevent the in-growth of tissue cells which would interfere with its removal after use as a skin or dermal suture. |
| Cotton and Linen | Sutures derived from cellulose are twisted from fiber staple, have moderately high tensile strength and are stable to heat sterilization. |
D. Synthetic Non-Absorbable
| Term | Description |
|---|---|
| Nylon | Nylon is a polyamide obtained from the condensation of adipic acid and hexamethylenediamine or from the polymerization of caprolactam. It is strong, water-resistant and can be used for all suturing and ligating Nylon (Ethilon) and Prolene are both non-absorbable monofilament suture materials which provide good tensile strength with low tissue reactivity and are therefore widely used. |
| Polyester Fibres | Polyester fibres are multifilament synthetic fibres. They are prepared by melt-extruding polyethylene terephthalate into fine filaments which are then braided into various sizes. The polyester sutures do not lose strength in contact with water or body fluids, for this reason they are used for permanent reinforcement as, for example, in installation of artificial heart valves. They have the advantage of excellent knot holding characteristics and are available in the natural colour or dyed to enhance visibility in the surgical field. |
| Polyolefin Fibres | Examples are polyethylene and polypropylene. Polypropylene sutures compared to monofilament nylon, tie more secure knots and have a very low order of tissue reactivity. Because of the smoothness, they slip through tissue in-growth, they may be removed easily when necessary. They are widely used in cardiovascular and other surgical specialties |
E. Metallic Sutures
| Term | Description |
|---|---|
| Silver | Among the older materials which are still used to some extent are silver wire, foil and other forms. Silver though has some antiseptic action but in some tissues it produces irritation. |
| Stainless Steel | It is a ferrous alloy that is resistant to chemical attack and has been used widely in the form of wire sutures, fixation plates, screws and other items Stainless steel sutures are available both as twisted and monofilament strands and present the strongest available material. |
However, they are relatively difficult to use and are employed most commonly in areas where great strength is required, such as in the repair of the sternum after chest surgery.
Absorbable Gelatin Sponge
An absorbable gelatin sponge is a material used in fresh open wounds to stop bleeding. It's put directly on the base of the wound and helps the blood form a clot. Another bandage is put on top of the dressing to protect it and keep it in place.
The material that touches the wound base will dissolve or fall off with the scab. Any material that's left may be taken off.
Surgical Staples
Surgical staplers and staples are used both externally and internally. These are specialized staples used in surgery in place of sutures to close skin wounds, connect or remove parts of the bowels or lungs.
The use of staples over sutures reduces the local inflammatory response, width of the wound, and the time it takes to close.
Advantages of surgical staples
- Quick placement
- Minimal tissue reaction
- Low risk of infection
- Strong wound closure
- A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.
| Term | Description |
|---|---|
| Circular staples | Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in oesophago-gastric surgery. |
| Disposable linear cutting stapler | The linear cutting stapler is used in abdominal surgery, thoracic surgery, gynecology and pediatric surgery. Generally, the stapler is used for dissection and transection of organs or tissues. This type of linear cutting stapler is available in sizes ranging from 55 mm to 100mm |
| Disposable Curved Cutter Stapler | This disposable curved cutter stapler is used for transection and anastomosis in rectal surgery. With this disposable curved cutter stapler and reloads, it can be a cross-cutting surgery organization. It is suitable for the reconstruction of the digestive tract and the construction of stoma in the organ resection surgery and the closure of the stump or incision when the surgical vision is difficult. |
| Disposable Endo Cutter Stapler | Places two, triple-staggered rows of titanium staples and simultaneously divides the tissue between the two, triple-staggered rows. The Endo linear cutter staplers have applications in abdominal, gynecologic ,pediatric and thoracic surgery for resection ,transection and creation of anastomosis. |
| Skin Stapler | It is used to close epidermis layers. Skin Stapler is intended to be used single time only. If it is used multiple times it may lead to cross contamination / Infection, Hence it is a single patient disposable skin Stapler. It is typically used at the end of a surgical procedure for routine wound closure. Skin Stapler has many advantages over suture for wound closure such as: Saves Time for wound closure, Easy to use for nurses and doctors, Lesser Trauma to the patients, Easy extraction of Staple pins from patients, Better cosmetic effect |
Surgical Meshes
Surgical mesh is a medical device that is used to provide additional support for weakened or damaged tissue. (or) Surgical mesh is a loosely woven sheet which is used as either a permanent or temporary support for organs and other tissues during surgery.
| Term | Description |
|---|---|
| Polypropylene mesh | Polypropylene mesh is a synthetic surgical mesh used for hernia (A bulging of an organ or tissue through an abnormal opening) and other soft tissue repairs. ADVANTAGES: Durability, Low infection risk, Comfortable to patient. DISADVANTAGES: Lack of flexibility, High adhesion risk, Can shrink - allowing recurrence. |
| Polyester mesh | The polyester mesh fabrics are used in medical device applications, such as surgical mesh, breast support, skin closure tapes, wound dressing, molded silicone reinforcement, catheter anchoring, allograft tissue carriers, and pacemaker lead stabilizers. |
| Transvaginal mesh | Transvaginal mesh is a net-like implant used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Doctors rely on transvaginal mesh to reinforce a weakened vaginal wall or support the urethra or bladder neck. |
Needles
A slender, solid, usually sharp-pointed instrument used for puncturing tissues, suturing, or passing a ligature around or through a vessel.
| Term | Description |
|---|---|
| Round Bodied needles | These are designed to separate tissue fibres rather than cut them. They are used either for soft tissue or in situations where easy splitting of tissue fibres is possible. After the passage of the needle ,the tissue closes tightly round the suture material, thereby forming a leak proof suture line which is particularly vital in intestinal and cardiovascular surgery. |
| Cutting Needles | These are required wherever fibrous or dense tissue needs to be sutured. |
| Reverse cutting needles | The body of this needle is triangular in cross section, having the apex cutting edge on the outside of the needle curvature. This improves the strength of the needle and particularly increases its resistance to bending. |
| Blunt needles | These needles have been designed for suturing extremely friable tissue such as the liver. |
0 Comments