import subprocess, json, base64
from io import BytesIO
from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.oxml.ns import qn
from lxml import etree

# ── Colour palette ─────────────────────────────────────────────────────────────
NAVY     = RGBColor(0x0D, 0x2B, 0x55)   # deep navy - title bg
TEAL     = RGBColor(0x00, 0x7A, 0x87)   # teal accent
GOLD     = RGBColor(0xF0, 0xA5, 0x00)   # warm gold highlight
WHITE    = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_BG = RGBColor(0xF4, 0xF8, 0xFB)   # slide background
DARK_TXT = RGBColor(0x1A, 0x1A, 0x2E)
MID_GREY = RGBColor(0x55, 0x6B, 0x82)
TEAL_LIGHT = RGBColor(0xE0, 0xF5, 0xF7)

# ── Presentation setup ─────────────────────────────────────────────────────────
prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ── Helper: solid fill ─────────────────────────────────────────────────────────
def solid_fill(shape, color):
    fill = shape.fill
    fill.solid()
    fill.fore_color.rgb = color

# ── Helper: add textbox ────────────────────────────────────────────────────────
def tb(slide, x, y, w, h, text, size, bold=False, color=WHITE,
       align=PP_ALIGN.LEFT, wrap=True, italic=False):
    txb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf  = txb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.size  = Pt(size)
    r.font.bold  = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = "Calibri"
    return txb

# ── Helper: add rect ───────────────────────────────────────────────────────────
def rect(slide, x, y, w, h, color):
    s = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    solid_fill(s, color)
    s.line.fill.background()
    return s

# ── Helper: multi-paragraph textbox ───────────────────────────────────────────
def tb_bullets(slide, x, y, w, h, title, bullets, title_size=14,
               bullet_size=11, title_color=NAVY, bullet_color=DARK_TXT,
               bg_color=None, padding=0.15):
    if bg_color:
        rect(slide, x, y, w, h, bg_color)
    txb = slide.shapes.add_textbox(Inches(x+padding), Inches(y+padding),
                                   Inches(w-padding*2), Inches(h-padding*2))
    tf  = txb.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    # Title
    p = tf.paragraphs[0]
    r = p.add_run()
    r.text = title
    r.font.size  = Pt(title_size)
    r.font.bold  = True
    r.font.color.rgb = title_color
    r.font.name = "Calibri"
    # Bullets
    for b in bullets:
        p = tf.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size  = Pt(bullet_size)
        r.font.color.rgb = bullet_color
        r.font.name = "Calibri"
    return txb

# ── Helper: add image from URL ────────────────────────────────────────────────
def add_img_url(slide, url, x, y, w, h):
    try:
        result = json.loads(subprocess.check_output(
            ["python", "/tmp/skills/shared/scripts/fetch_images.py", url],
            timeout=30
        ))
        if result and result[0].get("base64"):
            fmt, b64 = result[0]["base64"].split(";base64,")
            raw = base64.b64decode(b64)
            slide.shapes.add_picture(BytesIO(raw), Inches(x), Inches(y),
                                     Inches(w), Inches(h))
            return True
    except Exception as e:
        print(f"Image load failed: {e}")
    return False

# ── Helper: slide header strip ────────────────────────────────────────────────
def header(slide, title_text, subtitle_text=None):
    rect(slide, 0, 0, 13.333, 7.5, LIGHT_BG)       # background
    rect(slide, 0, 0, 13.333, 1.05, NAVY)            # header bar
    rect(slide, 0, 0.95, 13.333, 0.06, GOLD)         # gold accent line
    tb(slide, 0.35, 0.12, 12.5, 0.75, title_text,
       28, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
    if subtitle_text:
        tb(slide, 0.35, 0.75, 12.5, 0.3, subtitle_text,
           12, color=GOLD, align=PP_ALIGN.LEFT, italic=True)

# ── SLIDE 1 – Title slide ─────────────────────────────────────────────────────
s1 = prs.slides.add_slide(blank)
rect(s1, 0, 0, 13.333, 7.5, NAVY)
# Decorative gold band
rect(s1, 0, 3.5, 13.333, 0.12, GOLD)
rect(s1, 0, 6.9, 13.333, 0.6, TEAL)
# Side teal strip
rect(s1, 0, 0, 0.18, 7.5, TEAL)
tb(s1, 0.5, 1.2, 12.0, 1.5,
   "STITCHING METHODS,\nTYPES & INSTRUMENTS",
   40, bold=True, color=WHITE, align=PP_ALIGN.LEFT)
tb(s1, 0.5, 3.7, 12.0, 0.6,
   "A Comprehensive Overview for Medical Students & Professionals",
   16, color=GOLD, align=PP_ALIGN.LEFT, italic=True)
tb(s1, 0.5, 4.45, 12.0, 0.55,
   "Covering: Suture Materials  |  Stitch Techniques  |  Wound Closure Methods  |  Surgical Instruments",
   13, color=RGBColor(0xB0, 0xC8, 0xE0), align=PP_ALIGN.LEFT)
# Bottom bar text
tb(s1, 0.5, 7.05, 8.0, 0.4, "Based on Tintinalli's Emergency Medicine & Dermatology 5e",
   10, color=WHITE, italic=True)

# ── SLIDE 2 – Overview / Table of Contents ────────────────────────────────────
s2 = prs.slides.add_slide(blank)
header(s2, "Table of Contents", "What we will cover today")

topics = [
    ("01", "Introduction to Wound Closure",      "Principles, goals, closure timing"),
    ("02", "Suture Materials",                    "Absorbable vs. non-absorbable, monofilament vs. braided"),
    ("03", "Basic Stitch Techniques",             "Simple interrupted, continuous, subcuticular"),
    ("04", "Advanced Stitch Techniques",          "Mattress, figure-of-eight, purse-string"),
    ("05", "Other Wound Closure Methods",         "Staples, tissue adhesives, steri-strips, staples"),
    ("06", "Surgical Instruments",                "Needle holders, forceps, scissors, scalpels"),
    ("07", "Choosing the Right Technique",        "Wound type decision table"),
    ("08", "Wound Healing & Complications",       "Healing phases, dehiscence, infection"),
]
cols = [(0.35, 3.6), (6.85, 6.1)]
for i, (num, title, desc) in enumerate(topics):
    col_x, col_w = cols[i // 4]
    row = i % 4
    y = 1.35 + row * 1.5
    bg = TEAL_LIGHT if i % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8)
    r_shape = rect(s2, col_x, y, col_w - 0.2, 1.3, bg)
    # Accent left strip
    acc = rect(s2, col_x, y, 0.18, 1.3, TEAL)
    tb(s2, col_x + 0.28, y + 0.08, 0.7, 0.4, num, 22, bold=True, color=TEAL)
    tb(s2, col_x + 1.0, y + 0.08, col_w - 1.4, 0.45, title, 13, bold=True, color=NAVY)
    tb(s2, col_x + 1.0, y + 0.52, col_w - 1.4, 0.6, desc, 10, color=MID_GREY)

# ── SLIDE 3 – Introduction to Wound Closure ───────────────────────────────────
s3 = prs.slides.add_slide(blank)
header(s3, "01 | Introduction to Wound Closure",
       "Principles of wound healing and closure timing")

rect(s3, 0.35, 1.25, 6.1, 5.85, TEAL_LIGHT)
left_bullets = [
    "Restore anatomical continuity and function",
    "Minimise infection and scarring",
    "Provide structural support during healing",
    "Achieve haemostasis at wound edges",
]
tb_bullets(s3, 0.5, 1.3, 5.9, 1.95,
           "Goals of Wound Closure",
           left_bullets, bg_color=None, title_color=TEAL, bullet_color=DARK_TXT)

timing_bullets = [
    "Primary closure: within 6 h (clean wounds)",
    "Delayed primary closure: 2–5 days post-op",
    "Secondary intention: heavily contaminated",
    "Tertiary (delayed primary): granulation then close",
]
tb_bullets(s3, 0.5, 3.4, 5.9, 2.2,
           "Closure Timing",
           timing_bullets, bg_color=None, title_color=TEAL, bullet_color=DARK_TXT)

tension_bullets = [
    "Static tension (at rest) vs. dynamic (with motion)",
    "High-tension wounds → deep dermal sutures first",
    "Undermine tissue to relieve skin tension",
    "Keloid-prone patients → tapes or adhesives preferred",
    "Small clean hand lacerations <2 cm may heal without sutures",
]
rect(s3, 6.75, 1.25, 6.2, 3.0, RGBColor(0xE8, 0xF0, 0xF8))
tb_bullets(s3, 6.9, 1.3, 6.0, 2.95,
           "Tension Considerations",
           tension_bullets, bg_color=None, title_color=NAVY, bullet_color=DARK_TXT)

method_bullets = [
    "Sutures (strongest, most precise)",
    "Staples (fastest, good for scalp/trunk)",
    "Tissue adhesives (low-tension facial wounds)",
    "Adhesive strips (Steri-Strips) – low tension only",
    "Wound clips (skin staples)",
]
rect(s3, 6.75, 4.45, 6.2, 2.65, TEAL_LIGHT)
tb_bullets(s3, 6.9, 4.5, 6.0, 2.55,
           "Wound Closure Methods",
           method_bullets, bg_color=None, title_color=TEAL, bullet_color=DARK_TXT)

# ── SLIDE 4 – Suture Materials Overview ──────────────────────────────────────
s4 = prs.slides.add_slide(blank)
header(s4, "02 | Suture Materials", "Classification and properties")

# 2-column layout
rect(s4, 0.35, 1.25, 6.1, 5.85, TEAL_LIGHT)
abs_bullets = [
    "Lose tensile strength within 60 days",
    "Natural: plain gut, chromic gut",
    "Synthetic: Vicryl (polyglactin 910), Monocryl\n  (poliglecaprone 25), PDS (polydioxanone)",
    "Uses: deep dermal, fascial, mucosal layers",
    "Monocryl – similar handling to nylon;\n  ideal for subcuticular closure",
    "PDS – long-lasting (180 days), used for fascia",
]
tb_bullets(s4, 0.5, 1.3, 5.9, 5.7,
           "ABSORBABLE SUTURES",
           abs_bullets, bg_color=None, title_color=TEAL,
           bullet_color=DARK_TXT, title_size=15)

rect(s4, 6.75, 1.25, 6.2, 5.85, RGBColor(0xE8, 0xF0, 0xF8))
nonabs_bullets = [
    "Retain tensile strength ≥60 days",
    "Natural: silk, linen (rarely used now)",
    "Synthetic: Nylon (ethilon), Prolene\n  (polypropylene), Polybutester",
    "Uses: skin closure, tendon repair, vascular",
    "Nylon / Prolene preferred – low tissue reactivity",
    "Polybutester: elastic – good when swelling\n  is anticipated",
    "Silk: excellent handling; causes tissue reaction",
]
tb_bullets(s4, 6.9, 1.3, 6.0, 5.7,
           "NON-ABSORBABLE SUTURES",
           nonabs_bullets, bg_color=None, title_color=NAVY,
           bullet_color=DARK_TXT, title_size=15)

# Gold divider label
rect(s4, 6.55, 1.25, 0.2, 5.85, GOLD)

# ── SLIDE 5 – Suture Structure (Mono vs Braided) ──────────────────────────────
s5 = prs.slides.add_slide(blank)
header(s5, "02 | Suture Structure", "Monofilament vs. Multifilament (Braided)")

cards = [
    ("MONOFILAMENT", TEAL, [
        "Single strand – smooth surface",
        "Low tissue drag and less bacterial\n  adherence (lower infection risk)",
        "Stiffer, harder to handle/knot",
        "Examples: Nylon, Prolene, Monocryl, PDS",
        "Preferred for vascular and skin closure",
        "Poor knot security → needs more throws",
    ]),
    ("BRAIDED / MULTIFILAMENT", NAVY, [
        "Multiple strands twisted or braided together",
        "Excellent handling and knot security",
        "Higher capillarity → wicks fluid/bacteria",
        "Higher tissue reactivity / inflammation",
        "Examples: Vicryl, Silk, Polyester (Ethibond)",
        "Useful for deep tissues, fascia, GI anastomosis",
    ]),
    ("PSEUDOMONOFILAMENT", TEAL, [
        "Coated braided sutures",
        "Handling of braided + surface of mono",
        "Examples: Coated Vicryl, Coated Prolene",
        "Reduce tissue drag of braided sutures",
        "Increasingly used in practice",
    ]),
    ("SIZING SYSTEM", NAVY, [
        "USP sizing: 11-0 (finest) → 5 (heaviest)",
        "More zeros = finer suture (e.g. 6-0 < 4-0)",
        "Face/eye: 5-0 to 7-0",
        "Skin general: 3-0 to 4-0",
        "Fascia / deep tissue: 0 to 2",
        "Choice based on tissue tensile strength",
    ]),
]
positions = [(0.35, 1.25), (6.85, 1.25), (0.35, 4.3), (6.85, 4.3)]
for idx, ((x, y), (title, color, bullets)) in enumerate(zip(positions, cards)):
    rect(s5, x, y, 6.1, 2.8, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    rect(s5, x, y, 6.1, 0.38, color)
    tb(s5, x + 0.15, y + 0.04, 5.8, 0.32, title, 13, bold=True, color=WHITE)
    txb = slide_shapes_text = s5.shapes.add_textbox(
        Inches(x+0.2), Inches(y+0.45), Inches(5.7), Inches(2.25))
    tf = slide_shapes_text.text_frame
    tf.word_wrap = True
    tf.margin_left = tf.margin_right = tf.margin_top = tf.margin_bottom = 0
    for b in bullets:
        p = tf.add_paragraph() if tf.paragraphs[0].text else tf.paragraphs[0]
        if tf.paragraphs[0].text:
            p = tf.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size = Pt(10.5)
        r.font.color.rgb = DARK_TXT
        r.font.name = "Calibri"

# ── SLIDE 6 – Basic Stitch Techniques ────────────────────────────────────────
s6 = prs.slides.add_slide(blank)
header(s6, "03 | Basic Stitch Techniques",
       "Fundamental suture patterns used in wound closure")

techniques = [
    ("Simple Interrupted", TEAL, [
        "Most versatile stitch – each bite tied separately",
        "Failure of one stitch does not compromise whole closure",
        "Allows selective tension adjustment",
        "Optimal for irregular lacerations",
        "Disadvantage: time-consuming",
    ]),
    ("Simple Continuous (Running)", NAVY, [
        "Single suture runs the length of the wound",
        "Faster than interrupted; shares tension evenly",
        "Risk: if suture breaks → entire closure fails",
        "Best for long linear lacerations",
        "Variants: running locked (haemostatic effect)",
    ]),
    ("Subcuticular (Intradermal)", TEAL, [
        "Runs horizontally within dermis",
        "No surface punctures → excellent cosmesis",
        "Absorbable: buried, not removed",
        "Non-absorbable: pulled out at follow-up",
        "Used for elective facial/cosmetic closures",
    ]),
    ("Deep Dermal (Buried Interrupted)", NAVY, [
        "Suture is buried with knot facing deep",
        "Relieves tension from skin surface layer",
        "Prevents surface suture from cutting through",
        "Used with absorbable sutures (Vicryl, Monocryl)",
        "Placed before skin closure in layered approach",
    ]),
]
xs = [0.35, 6.85, 0.35, 6.85]
ys = [1.25, 1.25, 4.3, 4.3]
for idx, (x, y, (title, color, bullets)) in enumerate(zip(xs, ys, techniques)):
    rect(s6, x, y, 6.1, 2.9, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    rect(s6, x, y, 6.1, 0.4, color)
    tb(s6, x + 0.15, y + 0.05, 5.8, 0.34, title, 13, bold=True, color=WHITE)
    txb2 = s6.shapes.add_textbox(
        Inches(x+0.2), Inches(y+0.48), Inches(5.7), Inches(2.3))
    tf2 = txb2.text_frame
    tf2.word_wrap = True
    tf2.margin_left = tf2.margin_right = tf2.margin_top = tf2.margin_bottom = 0
    for b in bullets:
        p = tf2.paragraphs[0] if not tf2.paragraphs[0].text else tf2.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size = Pt(10.5)
        r.font.color.rgb = DARK_TXT
        r.font.name = "Calibri"

# ── SLIDE 7 – Advanced Stitch Techniques ─────────────────────────────────────
s7 = prs.slides.add_slide(blank)
header(s7, "04 | Advanced Stitch Techniques",
       "Specialised patterns for challenging wound types")

adv_techniques = [
    ("Vertical Mattress", TEAL, [
        "Two throws: deep (tension) + superficial (eversion)",
        "Distributes tension at two levels of depth",
        "Excellent wound edge eversion → good cosmesis",
        "Shorthand variant: faster to place",
        "Used for high-tension wounds (back, scalp)",
    ]),
    ("Horizontal Mattress", NAVY, [
        "Needle enters/exits 0.5–1 cm from wound edge",
        "Parallel bites run horizontally across wound",
        "Strong – used for fascia, tendon repair",
        "Risk of edge ischaemia if too tight",
        "Good haemostasis at wound edges",
    ]),
    ("Figure-of-Eight", TEAL, [
        "Crosses diagonally – creates an 'X' pattern",
        "Combines tension distribution of both mattress types",
        "Used for fascial closure, muscle, tendon",
        "Strong mechanical hold; fewer knots needed",
        "Common in abdominal wall closure",
    ]),
    ("Purse-String Suture", NAVY, [
        "Continuous circular suture drawing edges together",
        "Used to invert appendix stump, ostomy creation",
        "Robotic surgery: vaginal cuff closure",
        "Creates a drawstring-like seal around opening",
        "Barbed sutures used for knotless variants",
    ]),
    ("Half-Buried Horizontal Mattress", TEAL, [
        "Preserves blood supply to flap tips",
        "Needle passes through dermis of tip (not epidermis)",
        "Avoids strangulation of flap tip vasculature",
        "Ideal for stellate lacerations and skin flaps",
        "Also used at corners of wound edges",
    ]),
    ("Continuous Locking (Running Locked)", NAVY, [
        "Running suture locked around itself at each pass",
        "Enhanced haemostatic effect vs. simple running",
        "Good for scalp lacerations (high vascularity)",
        "Maintains even tension throughout wound",
        "Should not be used in high-swelling areas",
    ]),
]
xs2 = [0.35, 4.75, 9.15, 0.35, 4.75, 9.15]
ys2 = [1.25, 1.25, 1.25, 4.3, 4.3, 4.3]
for idx, (x, y, (title, color, bullets)) in enumerate(zip(xs2, ys2, adv_techniques)):
    rect(s7, x, y, 3.9, 2.9, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    rect(s7, x, y, 3.9, 0.4, color)
    tb(s7, x + 0.12, y + 0.05, 3.7, 0.34, title, 11.5, bold=True, color=WHITE)
    txb3 = s7.shapes.add_textbox(
        Inches(x+0.15), Inches(y+0.48), Inches(3.6), Inches(2.3))
    tf3 = txb3.text_frame
    tf3.word_wrap = True
    tf3.margin_left = tf3.margin_right = tf3.margin_top = tf3.margin_bottom = 0
    for b in bullets:
        p = tf3.paragraphs[0] if not tf3.paragraphs[0].text else tf3.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size = Pt(9.5)
        r.font.color.rgb = DARK_TXT
        r.font.name = "Calibri"

# ── SLIDE 8 – Other Wound Closure Methods ────────────────────────────────────
s8 = prs.slides.add_slide(blank)
header(s8, "05 | Other Wound Closure Methods",
       "Staples, tissue adhesives, strips, and negative pressure")

other_methods = [
    ("Skin Staples", TEAL, [
        "Fastest closure method available",
        "Cost-effective for long linear lacerations",
        "Least precise wound approximation",
        "Best for: scalp, trunk, extremities",
        "Avoid on face – poor cosmetic result",
        "Removed at 5–10 days depending on site",
    ]),
    ("Tissue Adhesives (Glue)", NAVY, [
        "Cyanoacrylate polymers (Dermabond, Histocryl)",
        "Water-impermeable; low infection rate",
        "No removal required",
        "Best for small low-tension facial lacerations",
        "Not suitable for deep or high-tension wounds",
        "Meta-analysis: equal cosmesis to sutures",
    ]),
    ("Adhesive Skin Tapes (Steri-Strips)", TEAL, [
        "Minimal tissue trauma; no needles",
        "Reinforces wound after suture/adhesive closure",
        "Not suitable for high-tension, wet, or hairy areas",
        "Good for pretibial thin-skin lacerations",
        "Useful adjunct post-suture removal",
        "Patient preference: low anxiety",
    ]),
    ("Negative Pressure Wound Therapy", NAVY, [
        "Applied to open/contaminated wounds",
        "Promotes granulation tissue formation",
        "Reduces wound oedema and bacterial load",
        "Facilitates delayed primary closure",
        "Used when immediate closure is not possible",
        "Vacuum-assisted closure (VAC) device",
    ]),
]
xs3 = [0.35, 6.85, 0.35, 6.85]
ys3 = [1.25, 1.25, 4.35, 4.35]
for idx, (x, y, (title, color, bullets)) in enumerate(zip(xs3, ys3, other_methods)):
    rect(s8, x, y, 6.1, 2.85, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    rect(s8, x, y, 6.1, 0.4, color)
    tb(s8, x + 0.15, y + 0.05, 5.8, 0.34, title, 13, bold=True, color=WHITE)
    txb4 = s8.shapes.add_textbox(
        Inches(x+0.2), Inches(y+0.48), Inches(5.7), Inches(2.27))
    tf4 = txb4.text_frame
    tf4.word_wrap = True
    tf4.margin_left = tf4.margin_right = tf4.margin_top = tf4.margin_bottom = 0
    for b in bullets:
        p = tf4.paragraphs[0] if not tf4.paragraphs[0].text else tf4.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size = Pt(10.5)
        r.font.color.rgb = DARK_TXT
        r.font.name = "Calibri"

# ── SLIDE 9 – Surgical Instruments (with image) ───────────────────────────────
s9 = prs.slides.add_slide(blank)
header(s9, "06 | Surgical Instruments",
       "Essential tools for suturing and wound closure")

instruments = [
    ("Needle Holders", [
        "Mayo-Hegar: standard workhorse holder",
        "Webster: delicate; facial/dermatology work",
        "Stille Frimand Duo-Grip: ergonomic handle",
        "Castroviejo: ophthalmic/microsurgery",
        "Grip needle at 2/3 from tip; lock mechanism",
    ]),
    ("Tissue Forceps", [
        "Adson toothed: general skin handling",
        "Bishop-Harmon: ophthalmic/fine skin",
        "Castroviejo (0.9 mm): delicate facial work",
        "Plain (non-toothed): fragile/mucosal tissue",
        "Never crush tissue – grasp gently",
    ]),
    ("Scissors", [
        "Iris scissors (curved): general suture cutting",
        "Metzenbaum: blunt undermining scissors",
        "Supercut Shea: fine undermining",
        "Mayo: heavy fascial/suture scissors",
        "Suture scissors: dedicated for cutting thread",
    ]),
    ("Scalpels & Other", [
        "#15 blade: most common – gentle curve",
        "#10 blade: heavy tissue (back, thick dermis)",
        "#11 blade: stab incisions, drainage",
        "Skin hooks (single/double-pronged): gentle retraction",
        "Mosquito haemostats: control bleeding points",
    ]),
]
rect(s9, 0.35, 1.25, 8.15, 5.85, LIGHT_BG)
xs4 = [0.5, 4.3, 0.5, 4.3]
ys4 = [1.3, 1.3, 4.1, 4.1]
for idx, (x, y, (title, bullets)) in enumerate(zip(xs4, ys4, instruments)):
    c = TEAL if idx % 2 == 0 else NAVY
    rect(s9, x, y, 3.6, 2.65, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    rect(s9, x, y, 3.6, 0.38, c)
    tb(s9, x + 0.12, y + 0.04, 3.4, 0.32, title, 12, bold=True, color=WHITE)
    txb5 = s9.shapes.add_textbox(
        Inches(x+0.15), Inches(y+0.45), Inches(3.4), Inches(2.1))
    tf5 = txb5.text_frame
    tf5.word_wrap = True
    tf5.margin_left = tf5.margin_right = tf5.margin_top = tf5.margin_bottom = 0
    for b in bullets:
        p = tf5.paragraphs[0] if not tf5.paragraphs[0].text else tf5.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size = Pt(9.5)
        r.font.color.rgb = DARK_TXT
        r.font.name = "Calibri"

# Image panel on right
rect(s9, 8.65, 1.25, 4.3, 5.85, RGBColor(0xE8, 0xF0, 0xF8))
tb(s9, 8.75, 1.35, 4.1, 0.4, "NEEDLE HOLDERS", 11, bold=True, color=NAVY)
add_img_url(s9,
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_fb3f93d5556dbbbdcdb998188926b46df33f7a3396ec37d41524fa225593d75c.jpg",
    8.75, 1.8, 4.0, 2.6)
tb(s9, 8.75, 4.5, 4.1, 0.4, "SUTURING TECHNIQUE", 11, bold=True, color=NAVY)
add_img_url(s9,
    "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_78072f3a45877df87dd8d78aa699a3a3c7094a704f788253807b845e4faf9aaa.jpg",
    8.75, 4.95, 4.0, 2.0)

# ── SLIDE 10 – Decision Table ─────────────────────────────────────────────────
s10 = prs.slides.add_slide(blank)
header(s10, "07 | Choosing the Right Technique",
       "Wound type decision guide – based on Tintinalli's Emergency Medicine")

rect(s10, 0.35, 1.25, 12.65, 5.85, LIGHT_BG)

# Table header
rect(s10, 0.35, 1.25, 12.65, 0.5, NAVY)
cols_x = [0.45, 3.2, 5.85, 8.5, 10.95]
col_w_list = [2.65, 2.55, 2.55, 2.35, 2.05]
headers_ = ["Wound Type", "Recommended Stitch", "Suture Material", "Tension", "Notes"]
for x, w, h in zip(cols_x, col_w_list, headers_):
    tb(s10, x, 1.3, w, 0.4, h, 11, bold=True, color=WHITE)

rows = [
    ("Short linear (face)", "Simple interrupted", "5-0 / 6-0 Nylon", "Low", "Best cosmesis"),
    ("Long linear (trunk)", "Running / staples", "3-0 / 4-0 Nylon", "Low–moderate", "Fastest closure"),
    ("High-tension wound", "Vertical mattress\n+ deep dermal", "2-0 Vicryl deep;\n3-0 Nylon skin", "High", "Layer by layer"),
    ("Scalp laceration", "Staples / horizontal\nmattress", "3-0 Nylon", "Moderate", "Haemostatic"),
    ("Flap tip / corner", "Half-buried horiz.\nmattress", "4-0 / 5-0 Nylon", "Low–moderate", "Preserves vascularity"),
    ("Deep cavity / fascia", "Figure-of-eight\nor running PDS", "0 / 1 PDS", "High", "Long-lasting strength"),
    ("Skin graft / thin skin", "Adhesive tape /\ngentle interrupted", "4-0 / 5-0", "Very low", "Avoid strangulation"),
    ("Contaminated wound", "Leave open (secondary\nintention or delayed)", "VAC / packing", "N/A", "Primary closure avoided"),
]
row_colors = [TEAL_LIGHT, RGBColor(0xE8, 0xF0, 0xF8)]
for i, row in enumerate(rows):
    y = 1.85 + i * 0.62
    rect(s10, 0.35, y, 12.65, 0.60, row_colors[i % 2])
    if i % 2 == 0:
        rect(s10, 0.35, y, 0.08, 0.60, TEAL)
    for x, w, cell in zip(cols_x, col_w_list, row):
        tb(s10, x, y + 0.05, w, 0.52, cell, 9.5, color=DARK_TXT)

# ── SLIDE 11 – Needles ────────────────────────────────────────────────────────
s11 = prs.slides.add_slide(blank)
header(s11, "06b | Surgical Needles",
       "Types, geometry, and clinical selection")

needle_cards = [
    ("By Shape", TEAL, [
        "Straight (Keith): hand suturing, GI, skin",
        "1/4 circle: ophthalmic surgery",
        "3/8 circle: most common – superficial tissue",
        "1/2 circle: deep cavities, limited access",
        "5/8 circle: urological, orthopaedic",
        "Compound curve: pelvis, cardiovascular",
    ]),
    ("By Tip (Point) Type", NAVY, [
        "Round/Taper point: soft tissue, GI, vascular",
        "Cutting: skin and tough tissue – triangular tip",
        "Reverse cutting: preferred for skin (edge faces out)",
        "Blunt taper: friable tissue (liver, kidney)",
        "Trocar point: calcified / tough fascia",
        "Side-cutting (spatula): ophthalmic procedures",
    ]),
    ("By Attachment", TEAL, [
        "Swaged (atraumatic): suture factory-attached\n  – no eye, minimal trauma, single use",
        "Eyed needle: suture threaded manually,\n  double-strand passes through tissue",
        "Control-release: breaks free with gentle tug\n  – speeds interrupted suturing",
        "Swaged preferred in all modern surgery",
    ]),
    ("Needle Material & Coding", NAVY, [
        "Most needles: stainless steel alloy",
        "Size coded by wire gauge and chord length",
        "Ethibond: larger braided polyester needles",
        "Needle holder positioned at 2/3 from tip",
        "Never re-use needles – sharps safety protocol",
        "Blunt needles: reduce needle-stick injury",
    ]),
]
xs5 = [0.35, 6.85, 0.35, 6.85]
ys5 = [1.25, 1.25, 4.3, 4.3]
for idx, (x, y, (title, color, bullets)) in enumerate(zip(xs5, ys5, needle_cards)):
    rect(s11, x, y, 6.1, 2.85, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    rect(s11, x, y, 6.1, 0.4, color)
    tb(s11, x + 0.15, y + 0.05, 5.8, 0.34, title, 13, bold=True, color=WHITE)
    txb6 = s11.shapes.add_textbox(
        Inches(x+0.2), Inches(y+0.48), Inches(5.7), Inches(2.27))
    tf6 = txb6.text_frame
    tf6.word_wrap = True
    tf6.margin_left = tf6.margin_right = tf6.margin_top = tf6.margin_bottom = 0
    for b in bullets:
        p = tf6.paragraphs[0] if not tf6.paragraphs[0].text else tf6.add_paragraph()
        r = p.add_run()
        r.text = f"• {b}"
        r.font.size = Pt(10.5)
        r.font.color.rgb = DARK_TXT
        r.font.name = "Calibri"

# ── SLIDE 12 – Wound Healing & Complications ──────────────────────────────────
s12 = prs.slides.add_slide(blank)
header(s12, "08 | Wound Healing & Complications",
       "Phases of healing and common post-closure complications")

# Three healing phases
phases = [
    ("Phase 1\nHAEMOSTASIS\n0–24 hrs", TEAL,
     "Vasoconstriction → platelet plug → fibrin clot formation. Wound edges held by suture tension."),
    ("Phase 2\nINFLAMMATION\n1–4 days", NAVY,
     "Neutrophils then macrophages clean debris. Redness, swelling, warmth normal. Sutures should not be too tight."),
    ("Phase 3\nPROLIFERATION\n4–21 days", TEAL,
     "Fibroblasts deposit collagen. Angiogenesis occurs. Wound gains tensile strength – sutures can be removed."),
    ("Phase 4\nREMODELLING\n21 days – 2 yrs", NAVY,
     "Collagen reorganises. Scar matures and contracts. Final tensile strength reaches 80% of original tissue."),
]
for idx, (title, color, desc) in enumerate(phases):
    x = 0.35 + idx * 3.22
    rect(s12, x, 1.3, 3.1, 1.6, color)
    tb(s12, x + 0.1, 1.35, 2.9, 1.5, title, 12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
    # Arrow
    if idx < 3:
        tb(s12, x + 3.0, 1.9, 0.3, 0.6, "→", 20, bold=True, color=GOLD)
    rect(s12, x, 3.0, 3.1, 1.5, TEAL_LIGHT if idx % 2 == 0 else RGBColor(0xE8, 0xF0, 0xF8))
    txb7 = s12.shapes.add_textbox(
        Inches(x+0.15), Inches(3.05), Inches(2.85), Inches(1.4))
    tf7 = txb7.text_frame
    tf7.word_wrap = True
    tf7.margin_left = tf7.margin_right = tf7.margin_top = tf7.margin_bottom = 0
    p = tf7.paragraphs[0]
    r = p.add_run()
    r.text = desc
    r.font.size = Pt(9.5)
    r.font.color.rgb = DARK_TXT
    r.font.name = "Calibri"

# Complications row
rect(s12, 0.35, 4.7, 12.65, 2.4, RGBColor(0xFF, 0xF0, 0xE8))
rect(s12, 0.35, 4.7, 12.65, 0.4, GOLD)
tb(s12, 0.5, 4.74, 12.0, 0.34,
   "COMMON COMPLICATIONS OF SUTURED WOUNDS", 13, bold=True, color=DARK_TXT)

comps = [
    ("Wound Dehiscence", "Sutures too tight/loose; infection; poor technique; malnutrition"),
    ("Surgical Site Infection", "Contaminated wound; inadequate debridement; immunosuppression"),
    ("Suture Granuloma", "Foreign body reaction; non-absorbable suture in deep tissue"),
    ("Stitch Abscess", "Suture acts as a nidus; treat with removal of suture"),
    ("Scarring / Keloid", "Excess tension; genetic predisposition; dark skin phototypes"),
    ("Track Marks", "Sutures left in too long; tight stitches causing ischaemia"),
]
for ci, (ctitle, cdesc) in enumerate(comps):
    cx = 0.45 + ci * 2.15
    tb(s12, cx, 5.18, 2.0, 0.3, ctitle, 9, bold=True, color=NAVY)
    tb(s12, cx, 5.52, 2.0, 0.8, cdesc, 8.5, color=DARK_TXT)

# ── SLIDE 13 – Summary & Key Points ──────────────────────────────────────────
s13 = prs.slides.add_slide(blank)
rect(s13, 0, 0, 13.333, 7.5, NAVY)
rect(s13, 0, 0, 13.333, 1.05, TEAL)
rect(s13, 0, 0.95, 13.333, 0.06, GOLD)
tb(s13, 0.35, 0.12, 12.5, 0.75,
   "Summary & Key Take-Away Points",
   26, bold=True, color=WHITE, align=PP_ALIGN.LEFT)

key_points = [
    ("Suture Selection", "Match suture absorbability and size to tissue type and closure layer."),
    ("Technique Choice", "Consider wound tension, site, and cosmetic requirements."),
    ("Absorbable vs Non-Absorbable", "Absorbable for deep layers; non-absorbable (or slowly absorbable) for skin."),
    ("Monofilament Preferred", "Lower infection risk; better for contaminated or vascular wounds."),
    ("Instruments Matter", "Use appropriate needle holder size; delicate instruments for facial work."),
    ("Needle Geometry", "Reverse cutting for skin; round-body for soft internal tissues."),
    ("Timing Is Critical", "Primary closure safe within 6 hrs; contaminated wounds left open."),
    ("Complications Are Preventable", "Correct tension, layer closure, and sterile technique minimise risk."),
]
cols_kp = [(0.35, 5.85), (6.85, 6.1)]
for i, (kp_title, kp_desc) in enumerate(key_points):
    col_x = cols_kp[i // 4][0]
    col_w = cols_kp[i // 4][1]
    row = i % 4
    y = 1.2 + row * 1.5
    bg = RGBColor(0x0F, 0x3A, 0x6E) if i % 2 == 0 else RGBColor(0x0A, 0x4A, 0x5A)
    rect(s13, col_x, y, col_w - 0.2, 1.35, bg)
    rect(s13, col_x, y, 0.14, 1.35, GOLD)
    tb(s13, col_x + 0.25, y + 0.08, col_w - 0.55, 0.38, kp_title, 12, bold=True, color=GOLD)
    tb(s13, col_x + 0.25, y + 0.5, col_w - 0.55, 0.75, kp_desc, 10, color=RGBColor(0xCC, 0xDD, 0xEE))

tb(s13, 0.35, 7.12, 10.0, 0.3,
   "Sources: Tintinalli's Emergency Medicine | Dermatology 5e | Sabiston Textbook of Surgery | Campbell's Operative Orthopaedics",
   8.5, color=RGBColor(0x88, 0xAA, 0xCC), italic=True)

# ── Save ──────────────────────────────────────────────────────────────────────
out = "/tmp/workspace/stitching-pptx/Stitching_Methods_Types_Instruments.pptx"
buf = BytesIO()
prs.save(buf)
with open(out, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {out}")
print(f"Slides: {len(prs.slides)}")

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/stitching-pptx/build.py'