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Sharp instruments (blade, bp handle, scissor needle, suture material)
- 1. SHARP INSTRUMENTS Dr. Asheesh Gautam AssistantProfessor Dept of Shalya Tantra Jeevak Ayurveda Medical College & Hospital Research Centre
- 2. PARTS OF ANINSTRUMENT BLADES/JAWS JOINT(PIVOT) SHANK/SHAFT /BODY RATCHET/ CATCH FINGER BOWS/RINGS
- 3. Instruments Instruments are classifiedby their function – 1. Cutting & Dissecting – 2. Grasping & Holding – 3. Clamping & Occluding – 4. Exposing & Retracting – 5. Suturing & Stapling – 6. Viewing – 7. Suctioning – 8. Dilating & Probing – 9. Measuring – 10. Microinstruments – 11. Powered instruments
- 4. Cutting & Dissecting Cutting instruments have sharp edges. They are used to dissect, incise, separate, or excise tissue. 1. Scalpels- (SURGICAL BLADES and BARD PARKER’S HANDLE) 2. SCISSORS
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- 10. For blade number10, 11,12, 15 – BP handle used number 3 or 7 For blade number 20, 21, 22, 23, 24 etc- BP handle used number 4 BARD PARKER’S HANDLE
- 12. Use of scalpel To make skin incisions (large or small) For incision and drainage For Stab incision for placing drains For sharp dissection For dividing /cutting tissues like ligated cystic duct etc
- 17. Finger tip grip Pencilgrip Palmer grip
- 18. Especially placing IndexFinger on upper surface of handle
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- 24. 3. SAWING- tofro motion for deep tissue cut
- 27. Scissors A commonsurgical tool for Cutting and Dissecting tissues Used to cut loose tissues, the blades of scissors stabilize the tissues during cutting. Provides very good control of depth and direction of cutting. More traumatic than scalpel because scissor crushes the tissue during cutting. Two advantages of Scissors over Scalpel in cutting 1. Precisely cut flaccid tissues 2. Excellent depth control
- 28. More Acuteangle b/w blades = more stability during cutting, more accurate cutting Scissors
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- 30. ( Index finger restingon shaft near the fulcrum)
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- 35. • Rub scissor •Curved Scissors have 30-40 % more mobility and visibility than straight ones
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- 37. Curved /angled tipwith small blades Used to cut suture stitches
- 38. Use of Scissors Scissors can be used to make A. Two types of cuts 1. Scissor-cuts 2. Push-cuts A. Blunt dissection Scalpel can cut through an intact surface whereas Scissors need an opening to insert the lower blade To cut through various tissues like muscles, fascia, aponeurosis, rectus sheath, skin etc To split muscles without cutting eg. Splitting internal oblique during McBurney’s Grid Iron incision For sharp and blunt dissection during surgery To cut tubes, drain sheets, dressings, surgical threads, suture and stitches etc
- 39. 1. SCISSORS CUTTING More traumatic than scalpel but gives excellent control Blades partially closed over tissue and slightly elevated slightly (to stabilize tissues). Tips closed to cut the tissue; use only the tips. 2. PUSH CUTTING Efficient cutting method, used for longer incisions in light fascia Begins with a scissor blades partially closed (tip still open) Continue by pushing the blade forward through the tissue Tissue is cut in one continuous motion without further opening/closing of the blades Use of Scissors
- 40. 3. BLUNT DISSECTION separate fine tissue attachments between anatomic tissue planes and isolate delicate structures nice for separating muscles, fat and fine fascial planes Advantage over hemostat; alternate sharp and blunt dissections can be made without changing instruments Use of Scissors
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- 42. According toeye- 1. Needle with Eye (Traumatic) 2. Needle without Eye (Swaged / Eyeless / Atraumatic) According to shape- 1. Straight Needle 2. Curved Needle According to cutting edge- 1. Round Body 2. Cutting Body – 1. conventional cutting 2. Reverse cutting According to Tip- Triangular Tip / Round Tip / Blunt Tip Others – Spatula needle, Micro point Needle, Cuticular Needle, Plastic Needle Classification- Surgical Needles
- 43. Atraumatic needle Suture isinserted at the end of needle by special technique, (also k/a Mersutures), Advantage of eyeless needle- 1. Causes minimal trauma to the tissue 2. Disposable after use – so no problemof loss of sharpness 3. Supplied in Presterilized pack- sterilization before use not needed 4. Faster and more Effiicient in surgery
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- 46. Muscles, Peritoneum, Intestine, vesselslike Easily penetrable delicate structures For suturing friable tissues like Liver, spleen, kidney Tough structures like Skin, Fascia Aponeurosis, Linea alba, Rectus sheath etc
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- 48. - Non Allergic,Non Carcinogenic, - Easily Available and Cheap
- 49. Classification of Suture Material Based on Behavior of Suture material in the Tissue- 1. Absorbable – get absorbed in tissue by enzymatic digestion or phagocytosis 2. Non Absorbable – remain in tissue for indefinite time Based on origin of suture material- 1. Natural - 2. Synthetic – Based on number of strands in suture material – 1. Monofilament- single strand of fiber, smooth and strong, chance of bacterial contamination is less but knot may get loose Prolene, Trulon/Ethiolon, Nylon, Catgut, Monocryl, PDS etc 2. Multifilament / Polyfilament – multiple strands braided together, easy to handle, knot tied does not slip, but bacteria may lodge in braided suture so chances of infection is high Silk, Linen, Dexon, Vicryl Etc
- 50. Various sutures NaturalAbsorbable- 1. Plain catgut ( Yellow )– derived from submucosa of sheep intestine or serosa of cattle intestine 2. Chromic catgut (brown) – plain catgut treated with chromium salt Both are Used to ligate blood vessels and subcutaneous fatty tissue, approximate subcutaneous tissue margins, during circumcision to suture cut margins of prepuce, to suture muscles etc Synthetic Absorbable- Polyglactin 910 (Vicryl)- (Purple/Violet)- used for general tissue approximation- intestine, peritoneum, Aponeurosis, rectus sheath and other fascias, muscles, vessels etc. Polyglyconic acid (Dexon)- (Green/Violet)- use same as vicryl but tensile strength less than vicryl Other- RapideVicryl, Polydioxanone Suture (PDS)- more tensile strength-used especially for midline or paramedian closure, Polyglecarpone (Monocryl), Polyglyconate(maxon)
- 51. Natural Non-Absorbable- 1. Linen/ Barbour Thread (White)- gain 10% tensile strength when used wet, excellent knotting properties 2. Silk (Mersilk) (Black) -- derived from silk worm larvae, best handling property, secure knot, longer tensile strength (2yrs) Used for intestinal anastomosis (seromuscular suture- with silk ), Both are used to ligate major blood vessels, cystic duct and artery ligation during cholecystectomy, to ligate pedicles during nephrectomy and spleenectomy, to to ligate vagus nerve during vagotomy, etc Synthetic Non - Absorbable- Polypropyline-(Proline)- (Blue)- least tissue reaction, prevent tissue strangulation (extends in length upto 30% before breakage hence accommodate post op swelling), very secured knotting, Used in hernioplasty, heniorrhaphy, incisional and umblical hernia repair, tendon injury repair, subcuticular suturing Polyamide (Ethiolon/Trulon)- (Black)- (a variety of Nylon), easily pass through tissue, minimal tissue reaction, tensile strength for 1yr, Used for skin closure in almost all major operations, fine suture in subcuticular suturing Other- Nylon, Polyester (Ethibond, Dacron), stainless steel wire (orthopedic) Various sutures
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- 55. CATGUT PLAIN ANDCHROMIC YELLOW BROWN MERSILK - BLACK TRULON - BLACK
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