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SUTURE MATERIALS:

A. Instrumen Bedah

I. PISAU BEDAH / SKALPEL

Digunakan terutama untuk menyayat / insisi permukaan kulit. Skalpel tersedia dalam
berbagai ukuran.

- no.10: untuk pemakaian umum, insisi sederhana, dan skin grafting

- no.11: mempunyai sisi tajam yg lurus digunakan untuk membuat tusukan. Misalnya

untuk menginsisi abses

- no.15 : untuk pekerjaan yang membutuhkan ketelitian tinggi. Misalnya digunakan


saat operasi tangan dan eksisi jaringan parut.

7 handle with 15 blade (deep knife)


Digunakan pada sayatan yang dalam, jaringan yang halus.

3 handle with 10 blade (inside knife)

Digunakan untuk menyayat jaringan yang superfisial

4 handle with 20 blade (skin knife)


Digunakan untuk menyayat kulit.

B. GUNTING

Ada 4 macam:

- Gunting Mayo

- Gunting Metzenbaum

- Gunting Runcing

- Gunting Balutan

a. Straight Mayo scissors

Digunakan untuk menggunting jahitan. Biasa disebut sebagai: Suture scissors.

b. Curved Mayo scissors

Digunakan mengunting jaringan yang tebal (fascia, muscle, uterus, breast).


Tersedia dalam berbagai ukuran.

c. Metzenbaum scissors

Digunakan untuk menggunting jaringan halus. Tersedia dalam berbagai


ukuran.

Kriteria yang harus dipenuhi berupa kuat, aman, tidak mudah patah, mudah untuk
digunakan, reaktivitas terhadap jaringan minimal, daya tahan terahdap infeksi bakteri tinggi.
Ada 2 jenis suture materials :

1) absorbable (dapat diserap)

2) non-absorbable (tidak dapat diserap)

a. Absorbable

Adalah yang dapat kemudian diabsopsi atau didigesti oleh tubuh, jaringan dan sel serta
cairan tubuh yang kemudian diserap selama dan sesudah proses penyembuhan.

1. SURGICAL GUT: Paling sering digunakan. Berasal dari usus halus domba yang
sehat. Memiliki bentuk yang kuat dan elastis. Tanpa campuran apapun. Diserap kira-
kira dalam waktu 1 minggu. Untuk jahitan yang diharapkan penyembuhannya 5-7
hari. Untuk jahitan mukosa dan kandung kemih.
2. DEXON (POLYGLYCOLIC ACID): Absorbable suture material of a synthetic,
braided polymer. Dexon memiliki reaktivitas dan reaksi infeksi yang rendah dan
memiliki keamanan simpul yang sangat baik dan kuat.

3. CHROMIC SUTURE MATERIAL: Dengan campuran larutan asam kromat. Diserap


dalam waktu 2-3 minggu. Baik untuk ligasi dan mendekatkan jaringan.

Absorbable

Braided, coated synthetic absorbale PGA.


Predictable absorption time. High initial tensile strength. Easy and secure knotting. Excellent
knot sliding, smooth to handle. Violet and undyed (white). Absorption essentially complete
between 60 and 90 days.
Braided, coated synthetic absorbable PGA.
Predictable shorter absorption time. High initial tensile strength. Easy and secure knotting
with excellent knot sliding, smooth to handle. Undyed (white) only. Tensile strength loss after
9-11 days and complete between 17-21 days.

The first quality of raw material used ensures a


dependable absorption and high tensile strength. All strands are precision-polished to an
uniform diameter.

Monofilament synthetic absorbable


PDO (Polydioxanone), violet. High initial tensile strength, easy to handle and smooth passage
through tissue. Strength retention above 75% after 3 weeks.

b. Non-absorbable

Adalah yang tidak dapat diabsorpsi oleh tubuh, jaringan, sel serta cairan tubuh.

1. ALAMI (PILINAN): sutera, linen, kapas

Untuk jahitan terputus (interrupted). Daya tegang cukup dan dapat diperkuat dengan
dibasahi larutan garam sebelum digunakan.

2. SINTESIS (MONOFILAMEN): nilon, polipropamid yang dilapisi teflon atau dakron,


polyester

Untuk jahitan kontinyu. Daya tegang tinggi. Benang tidak bisa diserap biasa
digunakan pada jaringan yang sukar sembuh.
NYLON (ETHILON): Monofilamen nylon sering digunakan untuk m,enutup area
yang terbuka. Memiliki reaktivitas jaringan yang minimal dan lebih tahan terhadap
infeksi dibandingkan dengan braided suture material. Memiliki kekuatan yang tinggi
dan keamanan terhadap penutupan luka.

PROLENE: Polymer polypropylene (Prolene) lebih kuat dari nilon dan lebih aman
terhadap luka.

BRAIDED: Terdiri dari cotton, silk, braided nylon and multifilament Dacron. Paling
baik dan bagus terhadap keamanan knotting. Kerugian: Reaktivitas tinggi dan infeksi.

Non-Absorbable

Blue monofilament polypropylene is flexible and ties


securely. Extremely well tolerated, its smooth and uniform surface allows easy passage
through tissue with minimum trauma.

braided surgical silk on twisted core for greater tensile strength.


Wax treatment and new braiding technique render the silk uniform and smooth and facilitate
its handing

Black. Blue monofilament polyamide


with high tensile strength. The uniform and smooth surface permits effortless passage through
tissue with minimum trauma. Extremely well tolerated
Green braided polyester with improved tensile strength
and knot security, siliconized. A modern braiding technique gives the strand a smooth and
uniform surface that minimizes the trauma

Twisted stainless steel with very high tensile


strength and excellent knot security. This strand causes minimum tissue reaction. Available
also as monofilament.

Black monofilament polyamide with supersoft core,


resulting in superior pliability and knot security. Supramid is extremely well tolerated.

c. Suture sizes
The size of suture material is measured by its width or diameter and is vital to proper
wound closure. As a guide the following are specific areas of their usage:
1-0 and 2-0: Used for high stress areas requiring strong retention, i.e. - deep fascia repair
3-0: Used in areas requiring good retention, i.e. - scalp, torso, and hands
4-0: Used in areas requiring minimal retention, i.e. extremities. Is the most common size
utilized for superficial wound closure.
5-0: Used for areas involving the face, nose, ears, eyebrows, and eyelids.
6-0: Used on areas requiring little or no retention. Primarily used for cosmetic effects

SURGICAL NEEDLES
Ada beberapa jenis jarum untuk menutup luka:
Curved needles dengan 2 bentuk dasar: tapered and cutting.
1. Reverse cutting needle khusus untuk luka dan laserasi. Dibuat khusus agar sisi
ujung terluar jarum tajam agar penetrasi ke kulit dan fascia atraumatik dan halus.
2. Tapered needles untuk jaringan lunak, seperti usus dan subkutan, atau agar lubang
yang ditimbulkan diameternya kecil atau minimal.

Needle Identification

Needle shape

Penjahitan luka
Penjahitan luka membutuhkan beberapa persiapan baik alat, bahan serta beberapa
peralatanlain. Urutan teknik juga harus dimengerti oleh operator serta asistennya.

A. Alat, bahan dan perlengkapan yang di butuhkan


Alat yang dibutuhkan
1. Naald Voeder ( Needle Holder ) atau pemegang jarum biasanya satu buah.

2. Pinset Chirrurgis atau pinset Bedah satu buah

3. Gunting benang satu buah.

4. Jarum jahit, tergantung ukuran cukup dua buah saja.

Bahan yang dibutuhkan

1. Benang jahit Seide atau silk

2. Benang Jahit Cat gut chromic dan plain.

Lain-lain

1. Doek lubang steril


2. Kasa steril
3. Handscoon steril

B. Teknik operasi
Urutan teknik penjahitan luka ( suture techniques)

1. Persiapan alat dan bahan

2. Persiapan asisten dan operator

3. Desinfeksi lapangan operasi

4. Anestesi lapangan operasi

5. debridement dan eksisi tepi luka

6. penjahitan luka
7. perawatan luka

C. Macam-macam jahitan luka

1. Jahitan Simpul Tunggal


Sinonim : Jahitan Terputus Sederhana, Simple Inerrupted Suture

Merupakan jenis jahitan yang sering dipakai. digunakan juga untuk jahitan situasi.

Teknik : - Melakukan penusukan jarum dengan jarak antara setengah sampai 1 cm ditepi luka
dan sekaligus mengambil jaringan subkutannya sekalian dengan menusukkan jarum secara
tegak lurus pada atau searah garis luka.

- Simpul tunggal dilakukan dengan benang absorbable denga jarak antara 1cm.

- Simpul di letakkan ditepi luka pada salah satu tempat tusukan

- Benang dipotong kurang lebih 1 cm.

2. Jahitan matras Horizontal

Sinonim : Horizontal Mattress suture, Interrupted mattress

Jahitan dengan melakukan penusukan seperti simpul, sebelum disimpul dilanjutkan dengan
penusukan sejajar sejauh 1 cm dari tusukan pertama.

Memberikan hasil jahitan yang kuat.

3. Jahitan Matras Vertikal

Sinonim : Vertical Mattress suture, Donati, Near to near and far to far

Jahitan dengan menjahit secara mendalam dibawah luka kemudian dilanjutkan dengan
menjahit tepi-tepi luka. Biasanya menghasilkan penyembuhan luka yang cepat karena di
dekatkannya tepi-tepi luka oleh jahitan ini.

4. Jahitan Matras Modifikasi


Sinonim : Half Burried Mattress Suture

Modifikasi dari matras horizontal tetapi menjahit daerah luka seberangnya pada daerah
subkutannya.

5. Jahitan Jelujur sederhana

Sinonim : Simple running suture, Simple continous, Continous over and over

Jahitan ini sangat sederhana, sama dengan kita menjelujur baju. Biasanya menghasilkan
hasiel kosmetik yang baik, tidak disarankan penggunaannya pada jaringan ikat yang longgar.

6. Jahitan Jelujur Feston

Sinonim : Running locked suture, Interlocking suture

Jahitan kontinyu dengan mengaitkan benang pada jahitan sebelumnya, biasa sering dipakai
pada jahitan peritoneum. Merupakan variasi jahitan jelujur biasa.

7. Jahitan Jelujur horizontal

Sinonim : Running Horizontal suture

Jahitan kontinyu yang diselingi dengan jahitan arah horizontal.

8. Jahitan Simpul Intrakutan

Sinonim : Subcutaneus Interupted suture, Intradermal burried suture, Interrupted dermal


stitch.

Jahitan simpul pada daerah intrakutan, biasanya dipakai untuk menjahit area yang dalam
kemudian pada bagian luarnya dijahit pula dengan simpul sederhana.

9. Jahitan Jelujur Intrakutan

Sinonim : Running subcuticular suture, Jahitan jelujur subkutikular

Jahitan jelujur yang dilakukan dibawah kulit, jahitan ini terkenal menghasilkan kosmetik
yang baik
D. Tutup atau Bebat Luka
Setelah luka di jahit dengan rapi di bersihkan dengan desinfeksan (beri salep)
Tutup luka dengan kasa steril yang dibasahi dengan betadine
Lekatkan dengan plester atau hipafix ( bila perlu diikat dengan Verban)

E. Angkat Jahitan
Adalah proses pengambilan benang pada luka

Berdasarkan lokasi dan hari tindakan:

Muka atau leher hari ke 5

Perut hari ke7-10

Telapak tangan 10

Jari tangan hari ke 10

Tungkai atas hari ke 10

Tungkai bawah 10-14

Dada hari ke 7

Punggung hari ke 10-14

d. SURGICAL INSTRUMENTS: It is not necessary to have large numbers of instruments for


emergency wound care. Wounds and lacerations can be managed with the following
instruments:

1. NEEDLE HOLDERS: Needle holders come in various sizes and shapes, but for most
lacerations a standard size 4" will complete the task. For larger, deeper wound
closures a larger needle and needle holder may be required.
2. FORCEPS: Grasping and controlling tissue with forceps is essential to proper suture
placement. However, whenever force is applied to skin or other tissues, inadvertent
damage to cells can occur if an improper instrument or technique is used. Be gentle
when grasping tissue, and never fully close the jaws on the skin.

3. SCISSORS: There are three types of scissors that are useful in minor wound care.

a. IRIS SCISSORS: Iris scissors are predominantly used to assist in wound


debridement and revision. These scissors are very sharp and are appropriate in
situations that require very fine control. They are very delicate and are not
recommended for cutting sutures. However, when very small sutures require
removal they can be use.

b. DISSECTION SCISSORS: Used for heavier tissue revision as necessary for


wound undermining.

c. SUTURE REMOVAL SCISSORS: Standard 6-inch, single blunt-tip, suture


scissors are most useful for cutting sutures, adhesive tape, and other dressing
materials. Because of their size and bulk, these scissors are very durable and
practical.

5. HEMOSTATS: Hemostats have three functions in minor wound care: clamping small
blood vessels for hemorrhage control, grasping and securing facia during debridment,
and are an excellent tool for exposing, exploring and visualizing deeper areas of the
wound.

6. KNIFE HANDLES AND BLADES: The knife handle holds the blade and is used in
the debridment and excisions during wound revision. Common blades are the #10
blade (used for large excisions), #15 blade (small, versatile and well suited for precise
debridement and wound revision), and the #11 blade (ideal for incision and drainage
of superficial abscesses and the removal of very small sutures).

k. WOUND EVALUATION: In most circumstances wounds penetrating the epidermis and


dermis, with involvement of subcutaneous fat will require suturing. Before suturing take in to
account the following factors:

1. Time of incident - most wounds will not be closed if 12 hours have past from time of
injury.
2. Size of wound.

3. Depth of wound.

4. Tendon/nerve involvement.

5. Bleeding at site.

l. CONTRAINDICATIONS

1. If there is reddening and edema of the wound margins


2. Infection manifested by discharge or pus

3. Persistent fever or toxemia

4. Puncture wounds or animal bite

5. Tendon, verve, or vessel involvement

6. Any wound more than 12 hours old. With the exception of the face and hands

m. CLOSURE TYPES: There are three types of closure when determining wound repair:
primary closure, secondary closure, and tertiary closure (delayed).

1. PRIMARY CLOSURE (PRIMARY INTENTION): Primary closure can only be done


on lacerations that are relatively clean and minimally contaminated, with minimal
tissue loss. Repair is usually necessary within 8-12 hours from the time of injury.
2. SECONDARY CLOSURE (SECONDARY INTENTION): Skin ulceration, abscess
cavities, punctures, animal bites, and large tissue losses are often best left to heal by
secondary intention. They are not primarily closed with sutures but are allowed to
gradually heal by granulation of the epithelial tissues and then sutured as required.

3. TERTIARY CLOSURE (DELAYED PRIMARY CLOSURE): These are wounds that


are too contaminated to close primarily. Wounds that fall into this category are often
older, excessively contaminated with soil, feces (caused by human or animal bites), or
the result of high-velocity missiles wounds. Once casuistry effects or infection have
passed (4 to 5 days), normal closure can take place.
4. FOLLOW-UP CARE

a. Following the placement of the sutures cleanse the suture site with normal saline.
b. Apply a small amount of Bacitracin and cover with an appropriate size sterile non-
adherent dressing.

c. Depending on nature and extent of the wound, antibiotic therapy or Tetanus Toxoid
way be indicated.

d. Attending MO will provide orders and instructions regarding dressing changes, suture
removal, and further follow-up care.

e. Inform the patient theta the suture site needs to be checked in approximately 24 hours
for signs of infection or complications.

5. SUTURE REMOVAL

a. TIME FRAME FOR REMOVING SUTURES: Times will vary according to the
location and depth of the wound. However, the average time frame is 7-10 days after
application. The following general rules can be sued in deciding when to remove
sutures:
b. FACE: 4-5 days.

c. BODY & SCALP: 7 days.

d. SOLES, PALMS, BACK OR OVER JOINTS: 10 days

e. Any suture with pus or signs of infections should be removed immediately.

f. Once MO determines that the sutures should be removed, a suture removal kit,
consisting of scissors and a pair of tweezers is utilized to remove the sutures.

g. Using the tweezers, grasp the knot and snip the suture below the knot with the scissors
as close as possible to the skin.

h. Pull the suture line through the tissue and place on a 4x4.

i. Once all sutures have been removed count the sutures.


j. The number of sutures needs to match the number indicated in the patient's health
record.

REFERENCE (S):

1. Emergency War Surgery

2. Advanced Trauma Life Support

3. Advanced Special Operations Medical Training Course

4. Hospital Corpsman 3&2 (NAVEDTRA 10669)

Sumber :

1. Padilla RS. Dermabrasi. Dalam : wheeland RG. Cutaneous Surgery. WB Saunders.


Philadelphia. 1994 : p. 479-90
2. Alt Th, Coleman WP, Hanke CW, Yarborough JM. Dermabration. Dalam : Coleman
WP, Hanke CW, Alt TH, Asken S. Cosmetic Surgery of the skin principles And
Techniques. 1991 : p.147-95

3. Thompson, J. A Practical Guide to Wound Care.REgitered Nursing. 2000 : p. 48-50