Closure Technologies
Safil
Monosy
n
Safil
Quick
MonoPlu
s
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Closure Technologies
Indikasi umum
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Closure Technologies
mouth
pharynx
oesophagus
stomach
intesine
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Closure Technologies
The stomach
Relatif lembut dan lentur
Tebal dengan banyak pembuluh darah
3 lapis muscular
Penyembuhan yang cepat, maks 14-21 hari
Rekomendasikan: Safil, beberapa user menyukai
Premilene
Needles: HR
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Patologi:
Pengambilan tumor atau penanganan perdarahan ulcer hebat
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Interrupted sutures
through all layers of
the stomach
Safil / Monosyn
2/0-3/0 HR22-HR26
Billroth I
(end to end)
Gastroduodenosto
my
Aesculap. All it takes to operate.
Billroth II
(end to side)
Gastrojejunostomy
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stomach
4-Stomach approximation and anastomosis to the
duodenum
Safil 2/0-3/0 HR26
Monosyn 2/0-3/0 HR26
5-Closure (peritoneum, fascia, subcut., cut.)
Aesculap. All it takes to operate.
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(duodenum)
Therefore, the stomach empties
more quickly
Safil 2/0 HR26-HR30
Silkam 2/0
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Needles: HR
A non-abs. suture may be used in serosal layer for added
assurance
Rapid healing, reaching maximal strength in approx. 14 days
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Bowel anatomy
The submucosa is the layer that provides strength in the
gastrointestinal tract
1. Mucosa
2. Submucos
a
3. Muscle
layers
(musculari
s)
4. Serosa
Aesculap. All it takes to operate.
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Safil/Monosyn/Premilene 4/0-2/0
HR17-HR22, DR
6- Abdominal closure
Aesculap. All it takes to operate.
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The colon
High microbial content: absorbable sutures leave no channel for
microbial migration once absorbed
Leakeage could lead to serious concerns
Strong organ, it heals to a similar rate that
stomach and small intestine
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The rectum
Very slow healing
It has no serosa
A large bit of muscle should be included in the
anastomosis
Monofilament sutures reduce the risk of bacterial
proliferation in the rectum
http://www.healthcentral.com/animation/408/37/Colon_Cancer.html
Aesculap. All it takes to operate.
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Right hemicolectomy
Left hemicolectomy
Sigmoid Colectomy
Abdominal perineal
resection
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Safil/MonoPlus
/Silkam 4/0-2/0
HR17-HR22
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1- About 7-8cm
abdominal incision
2-Subcutaneous
/mesentery vessel
ligation Safil 4/0-0
3-Appendix is dettached
from the cecum and
removed. Ligation
Monosyn, Safil 2/0
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string is closed
5- Abdominal closure
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http://www.uclan.ac.uk/facs/health/nursing/sonic/scenarios/livjmanim/biliary_tract.html
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Cholecystectomy
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Parenchymatous organs
Organs composed of cells with little connective tissue for
support
Little tension is placed on the suture line
Small size sutures, they do not need to be placed close
together or deeply into the organ
Rapid healing
New fibrous tissue will form within 7-10 days
Large vessel ligatures: Safil
Surface repair: Safil Parenchyma or Mesh
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Peritoneum
Thin membrane, quick healing
Some surgeons think it does not require suturing, other
disagree
Continuous suturing with absorbable suture (Safil,
MonoPlus) (Interrupted suturing could be also used)
Skin
Subcuticular
tissue
Subcutaneous
fat
Anterior fascia
Muscle
Posterior fascia
Peritoneum
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Layered closure
Peritoneum (continued/interrupt)
Subcutaneous
Safil 3/0-2 HR26-HR37s
Safil 4/0-0 HR26-HR43
Monosyn 2/0-0 HR26s, HR30, HR37, HR40s, HR48
Intradermal
MonoPlus 3/0-1 HR22s-HR37s
Premilene/Dafilon 4/0-2/0 DSMP19Fascia
DSMP24
Monosyn 3/0-4/0 DSMP13-DSMP24
Safil 2/0-2 HR37s-HR48-HRT37
Skin (continuous)
Muscle
Safil Quick
Safil 0 HR37s
Premilene/ Dafilon 4/0-2/0 DSMP19Loop
DSMP24
MonoPlus 0-1 HR40s, HR76, HRT40s, HRT48
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Urological surgery
Nephrectomy
Vasectomy
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Urological surgery
Urologists are particularly concerned with suture
strength and ease of handling, since they work in confined
areas
Predictable absorption are specially important in the GU
tract becase: 1)the delicate passageways are subject to
blockage and calculi and 2) infection is often present
Because calculi can come from nonabsorb. sutures,
urologists prefer absorbable
sutures
Main surgeries: stone removal (bladder procedure),
kidney surgery (malformation, tumours), prostate
(cancer), urethra surgery, external genitalia
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healing in 7 days
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Renal vein
Renal
artery
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(diag.4)
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Surgical procedures-Hysterectomy
Surgery (abdominal hysterectomy):
1-Subcut. vessel ligatures
Safil 4/0-0 pre-cuts/reel
2-Clamping and cutting of pedicles
supporting the uterus
Safil/Monosyn 2/0-1 HR26s,
HR37s, HR37ss
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Surgical procedures-Hysterectomy
4-Closing of the vaginal cuff with interrupted or
continuous sutures
Safil/Monosyn/Safil Quick 3/0-0 HR26s,
HR37s, HR37ss
5-Abdominal closure
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HR37+Safil 1 HS37s)
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Episio Set
B0046916
EPIST SQU2X0 90HRT37S,2/0
70DSMP24(M)DDP
B0046911
EPIST SQU.2/0 70 DS24,2X0 90 HRT43(M)DDP
C0046910
EPIST S.Q.U.2/0 70 DS24,0 90 HRT43(M)DDP
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Common combinations in
Gynaecology/Urology
Mucous membrane
Monosyn 4/0-3/0-2/0 HR17-HR30
Ligatures
Monosyn 5/0 HR17
Urethra/Bladder
Monosyn 4/0-2/0 HR17-HR30
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Paediatric Surgery
Circumcision: to enable foreskin to be pulled back
Superficial veins ligation Safil Quick 4/0-3/0
Approximation of distal/proximal edges of the foreskin with
interrupted Safil Quick 5/0-4/0 (children) 4/0-3/0 (adults)
HR22-HR26
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Oral surgery
The oral cavity promotes rapid healing and inhibits
infection
Fast absorbable sutures are recommended to
minimize discomfort
Mucosa
Safil Quick/Monosyn
HR17, HR26s, DSMP11DSMP19
Subcutaneous
Safil Quick/Monosyn/Safil HR17-HR26
Skin
Dafilon/Premilene DS19-DS24, DSMP19DSMP24
Aesculap. All it takes to operate.
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Ophthalmic surgery
Safil Quick 6/0-8/0 DLm6s, VLM10 for conjuctiva
Safil 5/0-10/0 DLm6, HLm6, VLM8 for muscles, sclera,
conjuctiva
(i.e. Strabismus, Glaucoma (facilitate aqueous outflow to
reduce eye pressure))
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Orthopaedic Surgery
Capsule repair:
elbow, ankle)
Shoulder surgery
Spinal surgery
Open reduction of fractures:
Ligament repair
Knee repair: repair/replace of the soft tissue structures of the knee joint
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Knee joint
http://www.medterms.com/script/main/art.asp?articlekey=8845
Aesculap. All it takes to operate.
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Skin
Safil Quick / Non-absorbable sutures
Interrupted technique is usually preferred, absorbable
suture
If a non-abs suture is used, it is removed 3-10 days
postop, but it must be considered they are exposed to the
external environment being a serious contamination
threat. If chosen, Premilene or Dafilon
Key success is early suture
removal before
epithelialization of the suture tract occurs and before
contamination is converted into infection
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Plastic surgery
Monofilaments
Facelift
http://www.healthcentral.com/animation/408/41/Facelift.html
Breast reduction
http://www.healthcentral.com/animation/408/39/Breast_Reduction.html
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Dafilon
/Premilene/
Monosyn
Monosyn
Monosyn
Dafilon
/Premilene/
Aesculap. All it takes to operate.
Suture
Advantage
Property
Smooth surface
Absorbable
Absorbable
Non-absorbable
Surgeon's/patient
's benefit
Less trauma/
sawing effect
Better cosmetic
result
No suture
removal
Suture removal
needed
No suture
material
remaining
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Safil Quick
Gastrointestinal surgery
Urology
MonoPlu
s
Long-term wound support (28-35 days
50%)
Particularly recommended:
Abdominal closure
Neurosurgery
Paediatrics
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