Suggest me brief notes on single interrupted sutures , vertical matres

Suggest me brief notes on single interrupted sutures , vertical matress , horizontal matress sutures when they are preferred and also give short video links that i can show in my seminar

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single interrupted suture vertical horizontal mattress suture technique YouTube video tutorial surgery

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vertical mattress suture horizontal mattress suture indications preferred uses wound closure surgery

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Excellent - I have rich content from both sources. Let me compile the complete notes now.

Suture Techniques: Brief Seminar Notes

1. Simple Interrupted Suture

Technique:

Each suture is placed and tied independently, then cut before the next is placed
Needle enters 3-5 mm from the wound edge perpendicular to skin, passes through the full dermis in a "flask-shaped" or slightly wider-at-base bite to evert wound edges
Each throw tied with a surgeon's knot (3 throws for monofilament), knot placed laterally (not over the incision)
Suture spacing: approximately equal to the distance from the wound edge

When preferred:

Most wounds - it is the workhorse technique
Wounds with risk of infection (each suture is independent; if infection develops, individual sutures can be removed without the entire wound opening)
Irregular or curved wounds that need precise alignment
Wounds under moderate tension
Layered closures (buried deep dermal + epidermal interrupted)
Learning/teaching situations - most forgiving technique

Advantages: Simple to place, easy to remove selectively, allows wound inspection, mistakes are isolated Disadvantages: Time-consuming if many sutures needed; more suture marks if left too long

2. Vertical Mattress Suture

Technique (Far-Far / Near-Near = "F-F/N-N"):

Far-far pass: Enter 5-10 mm from the wound edge, pass deep below the dermis, exit 5-10 mm on the opposite side (deeply-placed interrupted suture)
Near-near pass: Re-enter 2-4 mm from the wound edge on the same side you exited, pass more superficially through just the papillary dermis, exit 2-4 mm from the edge on the starting side
Tie the two ends - this produces marked wound edge eversion

(Andrews' Diseases of the Skin, Fig. 37.9)

When preferred:

Wounds where edges tend to invert (posterior neck, concave surfaces, dorsal hand, areas with thick skin)
High-tension wounds - distributes tension over a larger tissue column
Areas prone to scar depression/spreading (back, shoulders)
When you need both deep closure and surface approximation in a single suture
Eyelid margin repair (precise eyelid margin alignment)
Wound edges at risk of separation

Advantages: Excellent eversion, good tensile strength, eliminates dead space Disadvantages: More complex to place, higher risk of suture marks (cross-hatching), can compromise vascular supply if tied too tight, time-consuming

3. Horizontal Mattress Suture

Technique:

Enter 5-8 mm from the wound edge, pass through full dermis, exit on the opposite side
Move laterally 3-5 mm along the wound
Re-enter on the far side and pass back across to the original side
Tie both ends - creates a stitch that runs parallel to the wound on the skin surface

(Andrews' Diseases of the Skin, Fig. 37.10)

When preferred:

Wide, gaping wounds under high tension (lacerations over joints - knee, elbow, scalp)
Fragile or thin skin (elderly patients, steroid-atrophied skin) - distributes tension broadly and prevents suture tear-through
Closing dead space where tissue is thin
Hemostatic suture - compresses superficial vessels beneath the stitch
As anchoring stitches at the tips of skin flaps and V-Y advancements
Can be placed as "stay sutures" to hold a wound before definitive closure

Advantages: Fastest way to close a high-tension wound, good hemostasis, reduces dead space, distributes tension over a wide surface Disadvantages: Can compromise vascular supply (ischemia/necrosis at wound edges if too tight), leaves track marks, poor eversion compared to vertical mattress, not ideal for cosmetically sensitive areas

Quick Comparison Table

Feature	Simple Interrupted	Vertical Mattress	Horizontal Mattress
Eversion	Moderate	Excellent	Moderate
Tension handling	Low-moderate	Moderate-high	High
Hemostasis	Minimal	Minimal	Good
Speed	Moderate	Slow	Faster
Tissue trauma	Low	Moderate	Higher
Best site	Most wounds	Posterior neck, back, concave areas	Joints, fragile skin, scalp
Vascular risk	Low	Low-moderate	Moderate-high

Video Links for Your Seminar

Suture	Source	Link
Simple Interrupted	Suture tutorial HD	Watch on YouTube
Vertical Mattress	Stanford Dept. of Surgery	Watch on YouTube
Horizontal Mattress	CSL Interrupted Sutures	Watch on YouTube
Both Mattress (combined)	Behind The Knife Boot Camp	Watch on YouTube
Horizontal Mattress (alternate)	General tutorial HD	Watch on YouTube

The Behind The Knife Boot Camp Ep. 6 video is especially useful for seminars as it covers both mattress types together with side-by-side comparisons.

Key Teaching Points to Emphasize

Eversion is the goal - scars contract and flatten over time; an everted wound heals flatter
Vertical mattress = eversion + tension (two functions in one stitch)
Horizontal mattress = tension + hemostasis (broad load distribution)
Simple interrupted = versatility + safety (gold standard for most wounds)
Mattress sutures must never be tied too tightly - ischemia causes track marks and edge necrosis

Sources: Andrews' Diseases of the Skin (Clinical Dermatology), Fitzpatrick's Dermatology Vol. 1-2, AAFP - "The Mattress Sutures" (AFP 2002)

Give detail about continuous suturing and continuous inturupted suture

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continuous running suture types simple continuous locking subcuticular technique indications surgery

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continuous interlocking locking suture vs simple running suture subcuticular differences YouTube video

I have all the content needed. Here are the detailed notes:

Continuous Suturing - Detailed Notes

What is a Continuous (Running) Suture?

A continuous suture uses a single strand of suture that runs the entire length of the wound, secured with a knot only at each end. The loops form a helical coil through the tissue - only the exposed portions of this coil are visible on the skin surface.

General advantages over interrupted:

Faster to place (fewer knots)
Only 2 knots - fewer weak points
Even distribution of tension along the entire wound length
Better hemostasis
Accommodates mild postoperative wound swelling

General disadvantages:

If one loop breaks or gets infected, the entire wound may open ("run like a zipper")
Cannot be used over joints (movement disrupts the entire suture line)
Fine adjustments along individual points are difficult
Tends to invert wound edges unless deep sutures first eliminate tension

Types of Continuous Sutures

Type 1: Simple Continuous Running Suture

Technique:

Start with a standard interrupted suture at one end of the wound - tie it but cut only the free tail (leave the needle-end long)
Continue by passing the needle through both wound edges at equal intervals (same angle, same depth as interrupted)
Each pass is at approximately 45° to the wound edge
The suture spirals down the wound without being locked or looped
At the far end, the last loop is left as a loop and the needle end is tied to this loop (or an interrupted stitch placed and the running suture tied to it)

When preferred:

Long wounds where tension has already been eliminated by deep buried sutures
Wounds in areas of thin, lax skin - eyelids, ears, neck, scrotum
Attaching split-thickness or full-thickness skin grafts to wound edges
Clean, low-risk surgical incisions on flat, immobile surfaces
When you need speed and the wound is well-supported underneath

Key rule: The underlying dead space and tension MUST be eliminated with buried dermal sutures first, otherwise this technique will invert the wound edges.

(Roberts and Hedges' Clinical Procedures in Emergency Medicine; Fitzpatrick's Dermatology)

Type 2: Running Locking (Interlocking) Suture

Technique:

Begin exactly like a simple running suture
After each pass through the tissue, pass the needle back through the previous loop before making the next pass - this locks each stitch in place
Continue locking each loop down the wound
End with a loop and tie

The locking creates a visible "chain-link" pattern on the skin surface.

When preferred:

Wounds under moderate tension (stronger than simple running)
Well-vascularized wounds where hemostasis is needed - scalp lacerations are the classic site
Areas without a tendency for inversion (locking worsens inversion)
When you want the suture to stay where placed and not creep or bunch

Caution: If placed too tightly or if significant postoperative swelling occurs, wound-edge necrosis is a real risk because each locked loop cannot give. Stronger than simple running but less forgiving.

(Fitzpatrick's Dermatology, p.3748)

Type 3: Running Subcuticular (Intradermal) Suture

Technique:

Needle enters the skin at the very apex of the wound and exits horizontally into the superficial dermis (not through the skin surface)
The needle then passes horizontally within the dermis from side to side - each bite stays just beneath the epidermis, taking small dermal bites alternately on each side
The suture runs entirely within the skin without any exposed surface loops
Exit at the far apex, leave a tail or tie off
If non-absorbable (prolene): both tails left out at each apex for later removal
If absorbable (Monocryl/Vicryl Rapide): buried entirely

When preferred:

Cosmetically sensitive areas where suture track marks must be avoided (face, neck, breast, abdomen)
Wounds that will need sutures longer than 5-7 days (no surface loops = no track marks)
Patients prone to keloid formation
When suture removal is not possible or inconvenient (absorbable version)
Clean surgical incisions where deep layers have been properly closed
Pediatric patients (avoids need for suture removal in an anxious child)

Key limitation: Provides minimal mechanical approximation on its own - works only when deep buried sutures have already closely approximated the wound edges. The subcuticular suture's job is cosmetic finishing, not structural closure.

(Fitzpatrick's Dermatology, p.3748; Roberts and Hedges)

What is "Continuous Interrupted" - Clarification

The term "continuous interrupted" is not a standard surgical term - it may refer to one of two things:

A combination technique - alternating interrupted sutures with running sutures along the same wound (interrupted stitches placed at corners or areas of tension, running sutures fill the rest)
Continuous suture placed in interrupted segments across a long wound - the running suture is divided into 2-3 shorter segments, each tied independently. This combines the speed of running with the safety of interrupted - if one segment fails, the others hold

This segmented approach is used in bowel anastomosis, vascular surgery, and long incisions where full-length single-strand running carries too much risk.

Comparison Table

Feature	Simple Running	Locking Running	Subcuticular
Speed	Fast	Moderate	Slow
Tension handling	Low	Moderate	Minimal
Hemostasis	Moderate	Good	None
Wound eversion	Moderate	Poor (inverts)	Dependent on deep sutures
Track marks	Possible	Possible	None
Failure risk	Entire wound	Entire wound	Entire wound
Suture removal	Required (if non-absorbable)	Required	Optional (absorbable)
Best use	Long clean incisions	Scalp, moderate tension	Cosmetic closures, face, neck
Over joints?	No	No	No

Video Links for Seminar

Technique	Source	Link
Simple Continuous Running	Surgical Knowledge channel	Watch on YouTube
Running Locking (Lock Stitch)	VATA Suture Trainer	Watch on YouTube
Subcuticular (Continuous)	CSL Sutures series	Watch on YouTube
Continuous Subcuticular Closure	J&J MedTech	Watch on YouTube

Key Teaching Points

Always close dead space and eliminate tension with deep buried sutures FIRST before placing any continuous surface suture
Simple running = speed without sacrifice of strength - ideal for supported wounds
Locking running = adds strength but increases ischemia risk - best on the scalp
Subcuticular = best cosmesis - no suture marks - but provides no structural support
The single biggest danger of all continuous sutures: one failure = total wound dehiscence
Never use continuous sutures over joints or infected/contaminated wounds

Sources: Fitzpatrick's Dermatology Vol. 1-2, p.3747-3748; Roberts and Hedges' Clinical Procedures in Emergency Medicine, p.795; Andrews' Diseases of the Skin

Make a comparison poster: Interrupted vs Continuous sutures

Generating Image

A professional medical education comparison poster titled "Interrupted vs Continuous Sutures" for a surgery seminar. The poster has a clean clinical white background with two main columns side by side. Left column has a dark blue header "INTERRUPTED SUTURES" and right column has a teal/green header "CONTINUOUS (RUNNING) SUTURES". At the top of each column, include a simple clear line diagram illustration: left shows 3 separate individual suture loops each tied independently with knots on top; right shows a single continuous running thread zigzagging along a wound with knots only at the two ends. Below each illustration, show these comparison rows with icons or bullet points: INTERRUPTED column: - Definition: Each stitch tied and cut individually - Knots: Multiple (one per stitch) - Speed: Slower - Tension: Isolated per stitch - Infection risk: Selective removal possible - If one fails: Rest of wound stays closed - Hemostasis: Minimal - Track marks: More likely - Best for: Irregular wounds, infected wounds, high-risk areas, learning - Types: Simple interrupted, Vertical mattress, Horizontal mattress CONTINUOUS column: - Definition: Single thread runs entire wound length - Knots: Only 2 (at each end) - Speed: Faster - Tension: Evenly distributed - Infection risk: Entire wound may open - If one fails: Entire wound can dehisce - Hemostasis: Better (locking variant) - Track marks: Fewer (especially subcuticular) - Best for: Long clean wounds, cosmetic closures, well-supported wounds - Types: Simple running, Locking running, Subcuticular At the bottom, a comparison summary bar showing: "Both: Never use over joints | Close dead space first with deep buried sutures" Color scheme: navy blue and teal on white, with red warning icons for risks, green checkmarks for advantages. Medical, clean, professional poster style suitable for a surgical seminar presentation.

Interrupted vs Continuous Sutures Comparison Poster

Here's your comparison poster! It covers:

Diagrams of each suture pattern at the top
Side-by-side rows comparing definition, knots, speed, tension, infection risk, failure behavior, hemostasis, track marks, best indications, and types
A shared reminder at the bottom about never using either over joints and closing dead space first

This is ready to use directly in your seminar slides or print as a handout. Let me know if you'd like any changes - different colors, more detail on a specific row, or a version with suture technique diagrams added.

Generate a PowerPoint presentation on wound closure covering all suture types

Reading File

Running Command

ls -la /home/daytona/workspace/

Writing File

~/wound-closure-ppt/generate.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Wound Closure: Suture Types & Techniques";
pres.author = "Surgery Seminar";

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  midblue: "2E6DA4",
  skyblue: "AED6F1",
};

// ─── HELPERS ─────────────────────────────────────────────
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}
function addFooter(slide) {
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    rectRadius: radius,
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function sectionBadge(slide, text, color, x, y) {
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  slide.addText(text, { x, y, w: 1.5, h: 0.32, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
}

// ══════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════
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  s.addShape(pres.shapes.RECTANGLE, { x: 0.18, y: 5.545, w: 9.82, h: 0.08, fill: { color: C.accent } });

  // Suture line decorative element
  for (let i = 0; i < 6; i++) {
    s.addShape(pres.shapes.RECTANGLE, { x: 0.4 + i * 1.55, y: 1.35, w: 0.9, h: 0.04, fill: { color: C.grey } });
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  // Divider
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  const topics = ["Interrupted Sutures", "Continuous (Running) Sutures", "Subcuticular Sutures", "Clinical Comparison"];
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// ══════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW: PRINCIPLES OF WOUND CLOSURE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Principles of Wound Closure", C.navy);
  addFooter(s);

  const principles = [
    { icon: "①", title: "Eversion", desc: "Wound edges must be slightly everted — scars contract and flatten during healing. An everted closure heals flat; an inverted closure heals depressed." },
    { icon: "②", title: "Eliminate Dead Space", desc: "Dead space allows blood/serum to collect → hematoma → infection. Deep buried sutures close dead space before surface closure." },
    { icon: "③", title: "Tension-Free Closure", desc: "Surface sutures should approximate, not hold. Buried deep dermal sutures bear the tension. Excessive tension → necrosis, suture marks, wound dehiscence." },
    { icon: "④", title: "Layered Closure", desc: "Subcutaneous → deep dermal → epidermal. Each layer has a specific purpose: strength, eversion, and cosmesis." },
    { icon: "⑤", title: "Suture Selection", desc: "Match suture size to anatomic site. Face: 5-0/6-0. Neck: 4-0/5-0. Trunk/extremities: 3-0/4-0. Scalp: 3-0/4-0." },
    { icon: "⑥", title: "Timing of Removal", desc: "Face 5-7 days · Neck 7 days · Scalp 7-14 days · Trunk/limbs 10-14 days. Longer in high-tension sites." },
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// ══════════════════════════════════════════════════════════
// SLIDE 3 — INTERRUPTED SUTURES: OVERVIEW
// ══════════════════════════════════════════════════════════
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  addFooter(s);

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  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 4 — SIMPLE INTERRUPTED SUTURE
// ══════════════════════════════════════════════════════════
{
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  addFooter(s);

  // Steps card
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  const steps = [
    "Enter skin 3–5 mm from wound edge, perpendicular to skin surface",
    'Pass needle through dermis in a "flask-shaped" arc — wider at base for eversion',
    "Exit 3–5 mm from opposite wound edge (mirror entry depth)",
    "Tie with surgeon's knot (3 throws for monofilament)",
    "Place knot to one side — never directly over the incision",
    "Cut, leaving 3–5 mm tails. Repeat at equal intervals along wound",
  ];
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  // Preferred / indications card
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  // Key points card
  card(s, 6.1, 3.1, 3.65, 1.9, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 3.1, w: 0.08, h: 1.9, fill: { color: C.red } });
  s.addText("KEY POINTS", { x: 6.25, y: 3.15, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.red, margin: 0 });
  const kps = ["Bite size = distance from wound edge", "Knot lateral to incision line", "Remove before 7 days on face", "Evert edges — flask-shaped bite", "Most forgiving technique to learn"];
  kps.forEach((k, i) => {
    s.addText("• " + k, { x: 6.25, y: 3.55 + i * 0.27, w: 3.38, h: 0.27, fontSize: 9, color: "333333", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 5 — VERTICAL MATTRESS SUTURE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "2.  Vertical Mattress Suture  (Far-Far / Near-Near)", C.navy);
  addFooter(s);

  card(s, 0.25, 0.75, 5.7, 4.25, C.white);
  s.addText("TECHNIQUE  (F-F / N-N)", { x: 0.38, y: 0.8, w: 5.4, h: 0.35, fontSize: 11, bold: true, color: C.navy, margin: 0 });

  const steps = [
    { num: "FF", step: "FAR-FAR PASS: Enter 5–10 mm from wound edge, pass deep below dermis, exit 5–10 mm on opposite side" },
    { num: "NN", step: "NEAR-NEAR PASS: Re-enter 2–4 mm from wound edge (same side as exit), pass superficially through papillary dermis" },
    { num: "3", step: "Exit 2–4 mm from wound edge on the starting side (needle returns to starting side)" },
    { num: "4", step: "Tie both ends together — produces marked wound edge eversion" },
    { num: "5", step: "The stitch shows 2 parallel loops crossing the wound on the skin surface" },
  ];
  steps.forEach((st, i) => {
    s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.28 + i * 0.62, w: 0.42, h: 0.28, fill: { color: C.navy } });
    s.addText(st.num, { x: 0.35, y: 1.28 + i * 0.62, w: 0.42, h: 0.28, fontSize: 8, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(st.step, { x: 0.86, y: 1.27 + i * 0.62, w: 5.0, h: 0.55, fontSize: 9.5, color: "333333", margin: 0, wrap: true, valign: "middle" });
  });

  card(s, 6.1, 0.75, 3.65, 2.0, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 0.75, w: 0.08, h: 2.0, fill: { color: C.teal } });
  s.addText("WHEN PREFERRED", { x: 6.25, y: 0.8, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.teal, margin: 0 });
  const indics = [
    "Wounds that tend to INVERT (posterior neck, dorsal hand, concave surfaces)",
    "High tension wounds — back, shoulders",
    "When deep + surface closure needed in one stitch",
    "Eyelid margin repair",
    "Wounds at risk of edge separation",
  ];
  indics.forEach((ind, i) => {
    s.addText("▸ " + ind, { x: 6.25, y: 1.22 + i * 0.3, w: 3.38, h: 0.3, fontSize: 8.5, color: "333333", margin: 0, wrap: true });
  });

  card(s, 6.1, 2.9, 3.65, 2.1, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 2.9, w: 0.08, h: 2.1, fill: { color: C.red } });
  s.addText("CAUTIONS", { x: 6.25, y: 2.95, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.red, margin: 0 });
  const caut = ["Remove early — embedded track marks", "Never tie too tightly → ischemia/necrosis", "More complex to place correctly", "Cross-hatching scars if delayed removal"];
  caut.forEach((c, i) => {
    s.addText("⚠ " + c, { x: 6.25, y: 3.35 + i * 0.35, w: 3.38, h: 0.35, fontSize: 9, color: C.red, margin: 0, wrap: true });
  });

  // Summary bar
  s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 4.62, w: 5.7, h: 0.35, fill: { color: C.navy } });
  s.addText("Best for: EVERSION  +  TENSION  in one stitch", {
    x: 0.25, y: 4.62, w: 5.7, h: 0.35, fontSize: 10, color: C.white, align: "center", valign: "middle", bold: true, margin: 0
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 6 — HORIZONTAL MATTRESS SUTURE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "3.  Horizontal Mattress Suture", C.navy);
  addFooter(s);

  card(s, 0.25, 0.75, 5.7, 4.25, C.white);
  s.addText("TECHNIQUE", { x: 0.38, y: 0.8, w: 5.4, h: 0.35, fontSize: 11, bold: true, color: C.navy, margin: 0 });

  const steps = [
    "Enter 5–8 mm from wound edge, pass full dermis depth, exit opposite side",
    "Move LATERALLY 3–5 mm along wound (parallel to wound)",
    "Re-enter on the far side and pass back across to original side",
    "Exit same side as entry — suture now runs PARALLEL to wound on surface",
    "Tie both ends — creates broad tension distribution across wound",
    "Surface shows two parallel threads running along (not across) the wound",
  ];
  steps.forEach((st, i) => {
    s.addShape(pres.shapes.ELLIPSE, { x: 0.35, y: 1.28 + i * 0.55, w: 0.28, h: 0.28, fill: { color: C.midblue } });
    s.addText(String(i + 1), { x: 0.35, y: 1.28 + i * 0.55, w: 0.28, h: 0.28, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(st, { x: 0.72, y: 1.27 + i * 0.55, w: 5.1, h: 0.5, fontSize: 9.5, color: "333333", margin: 0, wrap: true, valign: "middle" });
  });

  card(s, 6.1, 0.75, 3.65, 2.0, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 0.75, w: 0.08, h: 2.0, fill: { color: C.midblue } });
  s.addText("WHEN PREFERRED", { x: 6.25, y: 0.8, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.midblue, margin: 0 });
  const indics = [
    "Wide GAPING wounds under HIGH tension",
    "Lacerations over joints (knee, elbow)",
    "Fragile/thin skin — elderly, steroid atrophy",
    "Scalp lacerations",
    "Skin flap tips (corner/Gillies variant)",
    "Stay / anchoring stitches",
    "Hemostatic suture — compresses vessels",
  ];
  indics.forEach((ind, i) => {
    s.addText("▸ " + ind, { x: 6.25, y: 1.22 + i * 0.25, w: 3.38, h: 0.25, fontSize: 8.5, color: "333333", margin: 0, wrap: true });
  });

  card(s, 6.1, 2.9, 3.65, 2.1, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 2.9, w: 0.08, h: 2.1, fill: { color: C.red } });
  s.addText("CAUTIONS", { x: 6.25, y: 2.95, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.red, margin: 0 });
  const caut = ["Highest risk of wound edge ISCHEMIA/NECROSIS if too tight", "Poor eversion vs. vertical mattress", "Track marks if left >7 days", "Not for cosmetically sensitive areas"];
  caut.forEach((c, i) => {
    s.addText("⚠ " + c, { x: 6.25, y: 3.35 + i * 0.38, w: 3.38, h: 0.38, fontSize: 9, color: C.red, margin: 0, wrap: true });
  });

  s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 4.62, w: 5.7, h: 0.35, fill: { color: C.midblue } });
  s.addText("Best for: TENSION RELIEF  +  HEMOSTASIS  +  FRAGILE SKIN", {
    x: 0.25, y: 4.62, w: 5.7, h: 0.35, fontSize: 10, color: C.white, align: "center", valign: "middle", bold: true, margin: 0
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 7 — CONTINUOUS SUTURES OVERVIEW
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Continuous (Running) Sutures — Overview", C.teal);
  addFooter(s);

  card(s, 0.25, 0.75, 9.5, 0.72, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 0.75, w: 0.08, h: 0.72, fill: { color: C.accent } });
  s.addText("A single strand of suture runs the ENTIRE wound length, forming a helical coil through tissue. Only TWO knots are needed — one at each end.", {
    x: 0.5, y: 0.8, w: 9.1, h: 0.62, fontSize: 12, color: C.dark, italic: true, valign: "middle", margin: 0, wrap: true
  });

  card(s, 0.25, 1.58, 4.6, 2.3, C.white);
  s.addText("✔  ADVANTAGES", { x: 0.38, y: 1.63, w: 4.35, h: 0.35, fontSize: 11, bold: true, color: C.green, margin: 0 });
  const advs = ["Fastest technique for long wounds", "Only 2 knots — fewer weak points", "Even tension distribution along entire wound", "Better hemostasis than interrupted", "Accommodates mild postoperative swelling", "Fewer suture track marks (subcuticular variant)"];
  advs.forEach((a, i) => {
    s.addText("• " + a, { x: 0.38, y: 2.08 + i * 0.28, w: 4.35, h: 0.28, fontSize: 9.5, color: "333333", margin: 0 });
  });

  card(s, 5.1, 1.58, 4.65, 2.3, C.white);
  s.addText("✖  DISADVANTAGES / WARNINGS", { x: 5.2, y: 1.63, w: 4.4, h: 0.35, fontSize: 11, bold: true, color: C.red, margin: 0 });
  const disadvs = ["One loop breaks → ENTIRE wound may open", "Infection → cutting one loop = full dehiscence", "Cannot be used OVER JOINTS", "Fine adjustments per point are difficult", "Tends to invert edges without deep buried sutures", "Puckering risk on thin/lax skin"];
  disadvs.forEach((d, i) => {
    s.addText("⚠ " + d, { x: 5.2, y: 2.08 + i * 0.28, w: 4.4, h: 0.28, fontSize: 9.5, color: C.red, margin: 0 });
  });

  s.addShape(pres.shapes.RECTANGLE, { x: 0.25, y: 4.0, w: 9.5, h: 0.28, fill: { color: C.navy } });
  s.addText("TYPES:  Simple Running  ·  Locking (Interlocking) Running  ·  Subcuticular (Intradermal)", {
    x: 0.25, y: 4.0, w: 9.5, h: 0.28, fontSize: 10.5, color: C.white, align: "center", valign: "middle", bold: true, margin: 0
  });

  card(s, 0.25, 4.38, 9.5, 0.7, C.lgrey);
  s.addText("Critical Rule:", { x: 0.4, y: 4.43, w: 1.5, h: 0.28, fontSize: 10, bold: true, color: C.navy, margin: 0 });
  s.addText("Always close dead space and eliminate tension with DEEP BURIED SUTURES first. Continuous surface sutures are for approximation and cosmesis — not structural support.", {
    x: 1.9, y: 4.43, w: 7.7, h: 0.6, fontSize: 9.5, color: "333333", margin: 0, wrap: true
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 8 — SIMPLE CONTINUOUS RUNNING SUTURE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "4.  Simple Continuous (Running) Suture", C.teal);
  addFooter(s);

  card(s, 0.25, 0.75, 5.7, 4.25, C.white);
  s.addText("TECHNIQUE", { x: 0.38, y: 0.8, w: 5.4, h: 0.35, fontSize: 11, bold: true, color: C.teal, margin: 0 });

  const steps = [
    "Place interrupted stitch at one end — tie it, but cut only the FREE TAIL (leave needle-end long)",
    "Pass needle through both wound edges at 45° to the wound, same depth as interrupted",
    "Continue passing at equal intervals — do NOT lock or loop back through previous stitch",
    "Suture spirals down the wound as a simple helix (no locking)",
    "At the far end, leave last loop as a loop; tie the running end to this loop",
    "Alternatively, place a final interrupted stitch and tie running suture to it",
  ];
  steps.forEach((st, i) => {
    s.addShape(pres.shapes.ELLIPSE, { x: 0.35, y: 1.28 + i * 0.55, w: 0.28, h: 0.28, fill: { color: C.teal } });
    s.addText(String(i + 1), { x: 0.35, y: 1.28 + i * 0.55, w: 0.28, h: 0.28, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(st, { x: 0.72, y: 1.27 + i * 0.55, w: 5.1, h: 0.5, fontSize: 9.5, color: "333333", margin: 0, wrap: true, valign: "middle" });
  });

  card(s, 6.1, 0.75, 3.65, 2.35, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 0.75, w: 0.08, h: 2.35, fill: { color: C.teal } });
  s.addText("WHEN PREFERRED", { x: 6.25, y: 0.8, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.teal, margin: 0 });
  const indics = ["Long clean incisions well-supported by deep sutures", "Thin, lax skin — eyelids, ears, neck, scrotum", "Skin graft attachment to wound edges", "Flat, immobile skin surfaces", "When speed is needed with minimal tension", "Low-risk, clean surgical wounds"];
  indics.forEach((ind, i) => {
    s.addText("▸ " + ind, { x: 6.25, y: 1.22 + i * 0.3, w: 3.38, h: 0.3, fontSize: 8.5, color: "333333", margin: 0, wrap: true });
  });

  card(s, 6.1, 3.25, 3.65, 1.72, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 3.25, w: 0.08, h: 1.72, fill: { color: C.red } });
  s.addText("DO NOT USE WHEN:", { x: 6.25, y: 3.3, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.red, margin: 0 });
  const dont = ["Deep space not closed first", "Wound overlies a joint", "Infected / contaminated wound", "Wound edges uneven or irregular", "High-tension skin"];
  dont.forEach((d, i) => {
    s.addText("✗ " + d, { x: 6.25, y: 3.72 + i * 0.27, w: 3.38, h: 0.27, fontSize: 9, color: C.red, margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 9 — LOCKING RUNNING SUTURE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "5.  Running Locking (Interlocking) Suture", C.teal);
  addFooter(s);

  card(s, 0.25, 0.75, 5.7, 3.4, C.white);
  s.addText("TECHNIQUE", { x: 0.38, y: 0.8, w: 5.4, h: 0.35, fontSize: 11, bold: true, color: C.teal, margin: 0 });

  const steps = [
    "Begin exactly like a simple running suture — interrupted stitch at wound apex",
    "After each pass through tissue, thread needle BACK THROUGH the previous loop before making the next pass",
    "Each stitch is thereby LOCKED in place — cannot slide or creep along wound",
    "Continue locking each successive loop down the length of the wound",
    "Surface shows a visible chain-link / herringbone pattern",
    "End with a loop and tie",
  ];
  steps.forEach((st, i) => {
    s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.28 + i * 0.52, w: 0.42, h: 0.26, fill: { color: C.midblue } });
    s.addText(String(i + 1), { x: 0.35, y: 1.28 + i * 0.52, w: 0.42, h: 0.26, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(st, { x: 0.86, y: 1.27 + i * 0.52, w: 5.0, h: 0.48, fontSize: 9.5, color: "333333", margin: 0, wrap: true, valign: "middle" });
  });

  card(s, 0.25, 4.3, 5.7, 0.65, C.navy);
  s.addText("Locking = STRONGER than simple running but LESS FORGIVING — cannot loosen once locked", {
    x: 0.4, y: 4.35, w: 5.4, h: 0.55, fontSize: 10, color: C.white, valign: "middle", margin: 0, italic: true, wrap: true
  });

  card(s, 6.1, 0.75, 3.65, 2.0, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 0.75, w: 0.08, h: 2.0, fill: { color: C.midblue } });
  s.addText("WHEN PREFERRED", { x: 6.25, y: 0.8, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.midblue, margin: 0 });
  const indics = ["SCALP lacerations (classic site)", "Moderate tension wounds", "Well-vascularized wounds needing hemostasis", "Sites without tendency for inversion"];
  indics.forEach((ind, i) => {
    s.addText("▸ " + ind, { x: 6.25, y: 1.22 + i * 0.33, w: 3.38, h: 0.33, fontSize: 9, color: "333333", margin: 0, wrap: true });
  });

  card(s, 6.1, 2.9, 3.65, 2.1, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 2.9, w: 0.08, h: 2.1, fill: { color: C.red } });
  s.addText("SPECIFIC RISKS", { x: 6.25, y: 2.95, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.red, margin: 0 });
  const caut = ["Wound edge NECROSIS if tied too tight", "Worsens inversion — avoid on inverted wounds", "Postoperative swelling has NO accommodation", "Suture cannot be loosened once locked"];
  caut.forEach((c, i) => {
    s.addText("⚠ " + c, { x: 6.25, y: 3.38 + i * 0.38, w: 3.38, h: 0.38, fontSize: 9, color: C.red, margin: 0, wrap: true });
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 10 — SUBCUTICULAR (INTRADERMAL) SUTURE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "6.  Running Subcuticular (Intradermal) Suture", C.teal);
  addFooter(s);

  card(s, 0.25, 0.75, 5.7, 4.25, C.white);
  s.addText("TECHNIQUE", { x: 0.38, y: 0.8, w: 5.4, h: 0.35, fontSize: 11, bold: true, color: C.teal, margin: 0 });

  const steps = [
    "Needle enters skin at apex of wound — exits HORIZONTALLY into superficial dermis (does NOT pass through skin surface to outside)",
    "Needle passes horizontally WITHIN the dermis — alternating small bites on each side of wound (L then R then L...)",
    "Each bite stays just beneath the epidermis — entire suture runs INSIDE the skin",
    "Suture exits at far apex of wound with a tail (or is buried with an absorbable knot)",
    "Non-absorbable (Prolene): both tails out at each apex — pull out for removal",
    "Absorbable (Monocryl/PDS): buried entirely — dissolves in situ, no removal needed",
  ];
  steps.forEach((st, i) => {
    s.addShape(pres.shapes.ELLIPSE, { x: 0.35, y: 1.28 + i * 0.55, w: 0.28, h: 0.28, fill: { color: C.green } });
    s.addText(String(i + 1), { x: 0.35, y: 1.28 + i * 0.55, w: 0.28, h: 0.28, fontSize: 9, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(st, { x: 0.72, y: 1.27 + i * 0.55, w: 5.1, h: 0.5, fontSize: 9.5, color: "333333", margin: 0, wrap: true, valign: "middle" });
  });

  card(s, 6.1, 0.75, 3.65, 2.6, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 0.75, w: 0.08, h: 2.6, fill: { color: C.green } });
  s.addText("WHEN PREFERRED", { x: 6.25, y: 0.8, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.green, margin: 0 });
  const indics = [
    "Cosmetically sensitive areas — face, neck, breast, abdomen",
    "Sutures needed >5–7 days (no track marks)",
    "Patients prone to keloid/hypertrophic scar",
    "When suture removal is not feasible (absorbable version)",
    "Paediatric patients — avoids painful removal",
    "Clean surgical incisions after layered deep closure",
    "Anywhere a fine linear scar is the priority",
  ];
  indics.forEach((ind, i) => {
    s.addText("▸ " + ind, { x: 6.25, y: 1.22 + i * 0.28, w: 3.38, h: 0.28, fontSize: 8.5, color: "333333", margin: 0, wrap: true });
  });

  card(s, 6.1, 3.5, 3.65, 1.47, C.white);
  s.addShape(pres.shapes.RECTANGLE, { x: 6.1, y: 3.5, w: 0.08, h: 1.47, fill: { color: C.red } });
  s.addText("LIMITATIONS", { x: 6.25, y: 3.55, w: 3.38, h: 0.35, fontSize: 10, bold: true, color: C.red, margin: 0 });
  const lim = ["NO structural support on its own", "Deep buried sutures MANDATORY first", "Cannot adjust individual points", "Breakage = entire wound may open"];
  lim.forEach((l, i) => {
    s.addText("✗ " + l, { x: 6.25, y: 3.97 + i * 0.27, w: 3.38, h: 0.27, fontSize: 9, color: C.red, margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 11 — MASTER COMPARISON TABLE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Master Comparison — All Suture Types", C.dark);
  addFooter(s);

  const headers = ["Feature", "Simple Interrupted", "Vertical Mattress", "Horizontal Mattress", "Simple Running", "Locking Running", "Subcuticular"];
  const rows = [
    ["Knots",         "Many",         "One per stitch", "One per stitch", "2 total",        "2 total",        "2 (or buried)"],
    ["Speed",         "Moderate",     "Slow",           "Moderate",       "Fast",            "Moderate",       "Slow"],
    ["Eversion",      "✔ Moderate",   "✔✔ Excellent",  "✔ Moderate",     "Poor alone",      "Poor",           "Depends on deep"],
    ["Tension",       "Low-Moderate", "Moderate-High",  "High",           "Low",             "Moderate",       "Minimal"],
    ["Hemostasis",    "Minimal",      "Minimal",        "✔ Good",         "Moderate",        "✔ Good",         "None"],
    ["Track marks",   "Yes",          "High risk",      "Yes",            "Possible",        "Possible",       "None"],
    ["Failure risk",  "Isolated",     "Isolated",       "Isolated",       "Total wound",     "Total wound",    "Total wound"],
    ["Over joints?",  "✔ Yes",        "✔ Yes",          "✔ Yes",          "✗ No",            "✗ No",           "✗ No"],
    ["Best site",     "Any wound",    "Neck/Back/Hand", "Scalp/Joints",   "Long incisions",  "Scalp",          "Face/Cosmetic"],
  ];

  const colW = [1.45, 1.38, 1.38, 1.38, 1.38, 1.38, 1.25];
  const startX = 0.1;
  let startY = 0.72;
  const rowH = 0.42;
  const headerColors = [C.dark, C.navy, C.midblue, C.teal, C.teal, C.teal, C.green];

  // Header row
  let cx = startX;
  headers.forEach((h, i) => {
    s.addShape(pres.shapes.RECTANGLE, { x: cx, y: startY, w: colW[i], h: 0.38, fill: { color: headerColors[i] } });
    s.addText(h, { x: cx, y: startY, w: colW[i], h: 0.38, fontSize: 8, bold: true, color: C.white, align: "center", valign: "middle", margin: 2 });
    cx += colW[i];
  });
  startY += 0.38;

  rows.forEach((row, ri) => {
    cx = startX;
    const bgColor = ri % 2 === 0 ? C.white : C.lgrey;
    row.forEach((cell, ci) => {
      s.addShape(pres.shapes.RECTANGLE, { x: cx, y: startY, w: colW[ci], h: rowH, fill: { color: ci === 0 ? "D6E4F0" : bgColor }, line: { color: "CCCCCC", width: 0.3 } });
      const isWarning = cell.includes("✗") || cell.includes("Total wound") || cell.includes("High risk");
      const isGood = cell.includes("✔") || cell.includes("None");
      const cellColor = isWarning ? C.red : (isGood ? C.green : "333333");
      s.addText(cell, { x: cx, y: startY, w: colW[ci], h: rowH, fontSize: ci === 0 ? 8.5 : 8, bold: ci === 0, color: ci === 0 ? C.navy : cellColor, align: "center", valign: "middle", margin: 2, wrap: true });
      cx += colW[ci];
    });
    startY += rowH;
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 12 — SUTURE MATERIAL SELECTION
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Suture Material Selection by Anatomic Site", C.navy);
  addFooter(s);

  const data = [
    { site: "Eyelids", size: "6-0", type: "Prolene / Nylon", timing: "5–7 days" },
    { site: "Face & Ears", size: "5-0", type: "Prolene / Nylon", timing: "5–7 days" },
    { site: "Neck", size: "4-0 / 5-0", type: "Nylon / Monocryl (subcuticular)", timing: "7 days" },
    { site: "Scalp", size: "3-0 / 4-0", type: "Nylon or Staples", timing: "7–14 days" },
    { site: "Trunk / Extremities", size: "3-0 / 4-0", type: "Nylon / Prolene", timing: "10–14 days*" },
    { site: "Deep Dermal (buried)", size: "3-0 / 4-0", type: "Vicryl / Monocryl / PDS", timing: "Absorbable — no removal" },
    { site: "Subcuticular", size: "3-0 / 4-0", type: "Monocryl (absorbable) or Prolene", timing: "Absorbable or pull-out" },
  ];

  const colLabels = ["Anatomic Site", "Suture Size", "Recommended Material", "Removal Timing"];
  const colX = [0.25, 2.55, 4.65, 7.7];
  const colW2 = [2.2, 2.0, 3.0, 2.0];

  colLabels.forEach((h, i) => {
    s.addShape(pres.shapes.RECTANGLE, { x: colX[i], y: 0.72, w: colW2[i], h: 0.38, fill: { color: C.navy } });
    s.addText(h, { x: colX[i], y: 0.72, w: colW2[i], h: 0.38, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", margin: 2 });
  });

  data.forEach((row, ri) => {
    const bg = ri % 2 === 0 ? C.white : C.lgrey;
    const y = 1.1 + ri * 0.46;
    const cells = [row.site, row.size, row.type, row.timing];
    cells.forEach((cell, ci) => {
      s.addShape(pres.shapes.RECTANGLE, { x: colX[ci], y, w: colW2[ci], h: 0.44, fill: { color: ci === 0 ? C.skyblue : bg }, line: { color: "CCCCCC", width: 0.3 } });
      s.addText(cell, { x: colX[ci], y, w: colW2[ci], h: 0.44, fontSize: ci === 0 ? 10 : 9.5, bold: ci === 0, color: ci === 0 ? C.navy : "333333", align: "center", valign: "middle", margin: 2, wrap: true });
    });
  });

  card(s, 0.25, 4.4, 9.5, 0.58, C.lgrey);
  s.addText("* High-tension sites or poor wound healing may require sutures to remain longer. Suture size notation: smaller number = larger diameter = greater strength (3-0 > 4-0 > 5-0 > 6-0)", {
    x: 0.4, y: 4.45, w: 9.2, h: 0.48, fontSize: 9, color: C.grey, margin: 0, italic: true, wrap: true
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 13 — CLINICAL DECISION GUIDE
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  lightSlide(s);
  addHeader(s, "Clinical Decision Guide — Which Suture to Use?", C.teal);
  addFooter(s);

  const decisions = [
    { q: "General / any wound", ans: "Simple Interrupted", color: C.navy },
    { q: "Infected / contaminated wound", ans: "Simple Interrupted  (selective removal possible)", color: C.red },
    { q: "Edges tend to INVERT (posterior neck, concave surface)", ans: "Vertical Mattress", color: C.midblue },
    { q: "Gaping wound over joint or high tension", ans: "Horizontal Mattress", color: C.teal },
    { q: "Fragile / thin skin, elderly, steroids", ans: "Horizontal Mattress  (broad tension distribution)", color: C.teal },
    { q: "Skin flap tip / corner repair", ans: "Half-buried (Gillies Corner) Stitch", color: C.midblue },
    { q: "Long clean incision — deep sutures placed", ans: "Simple Continuous Running", color: C.green },
    { q: "Scalp laceration — hemostasis needed", ans: "Running Locking (Interlocking)", color: C.green },
    { q: "Cosmetic closure — no track marks", ans: "Subcuticular (Intradermal)", color: C.green },
    { q: "Paediatric patient — avoid removal", ans: "Subcuticular with absorbable Monocryl", color: C.green },
  ];

  decisions.forEach((d, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.25 + col * 4.9;
    const y = 0.78 + row * 0.9;
    card(s, x, y, 4.6, 0.82, C.white);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 0.07, h: 0.82, fill: { color: d.color } });
    s.addText("IF: " + d.q, { x: x + 0.18, y: y + 0.04, w: 4.32, h: 0.32, fontSize: 8.5, color: C.grey, margin: 0, italic: true, wrap: true });
    s.addText("→ " + d.ans, { x: x + 0.18, y: y + 0.44, w: 4.32, h: 0.34, fontSize: 9.5, bold: true, color: d.color, margin: 0, wrap: true });
  });
}

// ══════════════════════════════════════════════════════════
// SLIDE 14 — KEY TEACHING POINTS / SUMMARY
// ══════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.dark };
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.accent } });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.18, y: 0, w: 9.82, h: 0.06, fill: { color: C.teal } });

  s.addText("KEY TEACHING POINTS", {
    x: 0.4, y: 0.12, w: 9.2, h: 0.52, fontSize: 26, bold: true, color: C.white, charSpacing: 4, margin: 0
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.4, y: 0.7, w: 3, h: 0.04, fill: { color: C.accent } });

  const points = [
    { num: "01", text: "EVERSION is always the goal — wound edges contract. An everted wound heals flat; an inverted wound heals depressed and more visible." },
    { num: "02", text: "Always close DEAD SPACE with deep buried sutures FIRST before placing any surface suture (interrupted or continuous)." },
    { num: "03", text: "VERTICAL MATTRESS = eversion + tension in one stitch. Best for posterior neck, back, concave surfaces." },
    { num: "04", text: "HORIZONTAL MATTRESS = tension relief + hemostasis + fragile skin. Risk of ischemia if too tight." },
    { num: "05", text: "CONTINUOUS SUTURES — one break or infection = entire wound may dehisce. NEVER use over joints." },
    { num: "06", text: "SUBCUTICULAR suture provides NO structural support — it is purely for cosmesis. Deep closure must be complete first." },
    { num: "07", text: "Remove sutures on time: Face 5–7 days · Neck 7 days · Scalp 7–14 days · Trunk/limbs 10–14 days." },
  ];

  points.forEach((p, i) => {
    const col = i < 4 ? 0 : 1;
    const row = i < 4 ? i : i - 4;
    const x = 0.4 + col * 4.8;
    const y = 0.9 + row * 1.05;
    s.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.5, h: 0.92, fill: { color: "172A3F" }, rectRadius: 0.07 });
    s.addShape(pres.shapes.RECTANGLE, { x: x, y: y, w: 0.55, h: 0.92, fill: { color: C.teal } });
    s.addText(p.num, { x: x, y, w: 0.55, h: 0.92, fontSize: 15, bold: true, color: C.white, align: "center", valign: "middle", margin: 0 });
    s.addText(p.text, { x: x + 0.65, y: y + 0.08, w: 3.75, h: 0.78, fontSize: 8.5, color: "CCDDEE", margin: 0, wrap: true, valign: "middle" });
  });
  // Last point full width
  const lastIdx = 6;
  const col = 1, row = 3;
  // already placed above in loop

  s.addText("Wound Closure: Suture Types & Techniques  |  Surgery Seminar", {
    x: 0.4, y: 5.35, w: 9.2, h: 0.22, fontSize: 9, color: C.grey, margin: 0
  });
}

// ─── WRITE FILE ──────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/wound-closure-ppt/Wound_Closure_Suture_Types.pptx" })
  .then(() => console.log("SUCCESS: Wound_Closure_Suture_Types.pptx written"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

Running Command

cd /home/daytona/workspace/wound-closure-ppt && node generate.js 2>&1

Reading File

Running Command

node -e "const p = require('pptxgenjs'); const pr = new p(); console.log(Object.keys(pr.shapes).filter(k => k.toLowerCase().includes('ellip') || k.toLowerCase().includes('oval') || k.toLowerCase().includes('circle')))"

Running Command

sed -i 's/pres\.shapes\.ELLIPSE/pres.shapes.OVAL/g' /home/daytona/workspace/wound-closure-ppt/generate.js && echo "Done"

Running Command

grep -n "ELLIPSE" /home/daytona/workspace/wound-closure-ppt/generate.js

Editing File

~/wound-closure-ppt/generate.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/wound-closure-ppt/generate.js'

Editing File

~/wound-closure-ppt/generate.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/wound-closure-ppt/generate.js'

Editing File

~/wound-closure-ppt/generate.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/wound-closure-ppt/generate.js'

Editing File

~/wound-closure-ppt/generate.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/wound-closure-ppt/generate.js'

Running Command

cd /home/daytona/workspace/wound-closure-ppt && node generate.js 2>&1

Running Command

ls -lh /home/daytona/workspace/wound-closure-ppt/Wound_Closure_Suture_Types.pptx

Your presentation is ready!

Wound Closure Suture Types

Presentation · PPTX

What's inside (14 slides):

Slide	Content
1	Title slide - dark navy design with topic overview badges
2	Principles of Wound Closure - 6 core principles (eversion, dead space, tension, layering, material, timing)
3	Interrupted Sutures Overview - advantages, disadvantages, when to use
4	Simple Interrupted - step-by-step technique, indications, key points
5	Vertical Mattress - Far-Far/Near-Near steps, when preferred, cautions
6	Horizontal Mattress - technique, indications (scalp, joints, fragile skin), ischemia warnings
7	Continuous Sutures Overview - advantages vs. risks, critical rule
8	Simple Running Suture - technique, when preferred, do-not-use situations
9	Locking (Interlocking) Suture - technique, scalp indications, necrosis risk
10	Subcuticular Suture - technique, absorbable vs. non-absorbable, cosmetic indications
11	Master Comparison Table - all 6 types compared across 9 parameters
12	Suture Material Selection - size, material type, removal timing by anatomic site
13	Clinical Decision Guide - 10 clinical scenarios mapped to correct suture choice
14	Key Teaching Points - dark summary slide with 7 numbered takeaways

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