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129 Cards in this Set
- Front
- Back
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In general how far from the wound edge should sutures be placed? How far apart should sutures be placed?
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5 mm for both
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What is the goal of suture placement?
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Maximum wound holding with minimal interruption of blood supply
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What are the 4 categories of suture patterns?
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1) Simple or mattress
2) Interrupted or continuous 3) Appositional, inverting or everting 4) Tension- relieving |
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What is a simple suture pattern? Mattress suture pattern?
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Simple: single passage on each side, then tied
Mattress: two passages on each side then tied |
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What is an interrupted suture pattern? Continuous suture pattern?
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Interrupted: knots are tied following each suture passage
Continuous: series of connected suture passages w/ 1 knot on each end of suture line |
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What are the 4 general advantages of interrupted suture patterns?
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1) Ease of placement
2) Adjustable tension 3) Loss of knot (Suture) less disastrous 4) Strength, tissue mobility |
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What is general disadvantage of interrupted suture patterns?
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More time and material
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What are the 5 general advantages of continuous suture patterns?
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1) Speed of placement
2) Less suture material 3) Ease of removal 4) Better 'seal' 5) Distributes forces evenly and may be stronger than interrupted patterns |
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What is a general disadvantage of continuous suture patterns?
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Loss of knots or suture breakage more disastrous
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What is an appositional suture pattern?
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Edges of incision are apposed or even with each other
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What is an inverting suture pattern? Everting suture pattern?
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Inverting: Edges of incision roll inwards
Everting: edges of incision roll outwards |
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What are 6 types of appositional suture patterns?
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1) Simple interrupted
2) Simple continuous 3) Intradermal/ subcuticular 4) Cruciate (interrupted) 5) Ford-interlocking (continuous) 6) Gambee (interrupted) |
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When is a simple interrupted appositional suture pattern used? What locations?
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Widely used and versatile
-Skin, fascia, bowel (hollow viscus), mucosa |
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What is a simple continuous suture pattern?
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Series of 'connected' simple interrupted sutures
-Needle placement directly across incision -External suture crosses over wound on diagonal |
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How do you tie off a simple continuous suture?
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Ended by tying across to last raised loop
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What are the applications of a simple continuous suture pattern?
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Sucutaneous, fascia, peritoneum, pleura, bowel, bladder
-Can be used as 1st layer in hollow viscus and oversewn with inverting pattern |
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Are simple continuous or simple interrupted sutures more cosmetic for skin?
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Simple interrupted are more cosmetic
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If a simple continuous suture pattern if used subcutaneously, the knots are often _____.
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Buried
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When burying a knot where does the passage of the needle start?
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Passage starts deep to dermis in subcutaneous
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How do you bury a knot?
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-Start deep to dermis in Subcut
- Passed out below dermis (upside down) -Over to opposite side in deep to to dermis -2 ends tied |
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What is an intradermal suture?
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An alternative skin closure (AKA subcuticular)
-Avoids external skin sutures |
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How do you do an intradermal suture pattern?
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-Horizontal passage through dermis
-Bury knot on either end |
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Should absorbable or non-absorbable suture for be used for an intradermal suture pattern?
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Absorbable suture
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True or false. Subcuticular means the same as subcutaneous.
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NO, subcuticular is at the base of the skin
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What are 2 locations that cruciate sutures are used at?
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Skin, body wall closure
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What type of a suture pattern is a cruciate?
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Series of 2 simple interrupted bites tied
-External portion forms "X" (cruciate) |
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A cruciate is a form of a ______ suture.
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Mattress suture
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What type of a suture is a Ford Interlocking suture?
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Modified simple continuous
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How do you do a Ford interlocking Suture?
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Each passage linked to previous passage
-Brought up through loop created |
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How do you end a For Interlocking suture?
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In simple fashion or by reversing needle and tying to loop
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What are the applications for a Ford Interlocking suture?
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Skin (often in cattle, less in other species)
-Use when better apposition is desired or the suture is under more "stress" |
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What type of a suture pattern is a Gambee?
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Simple interrupted in hollow viscus (intestine)
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How do you do a gambee suture pattern?
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Bite on each side passes into serosa through muscularis and submucosa, into lumen, then passes back through mucosa, submucosa and muscularis (on same side)
-NOT back out serosa like vertical mattress -may crush edges |
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What are 6 commonly used inverting suture patterns used in intestinal surgery?
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1) Lembert
2) Halsted 3) Cushing 4) Connell 5) Parker-kerr 6) Pursestring |
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What are 2 types of Lembert patterns?
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Interrupted or continuous
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What are the applications of Lembert suture patterns?
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Closing or oversew of hollow viscus (intestine)
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How do you do a Lembert suture pattern?
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Bite on each side passes into serosa, through muscularis and deep to submucosa (holding layer), then passes back out (not into lumen)
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What type of a suture pattern is a Halsted?
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Basically an interrupted mattress in Lembert fashion
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Cushing and Connell sutures are both _______ patterns.
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Continuous patterns
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What is the applicaiton for Cushing and Connell sutures?
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Closing or oversew of hollow viscus (intestine)
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What is the difference b/w a Cushing and Connell suture pattern?
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Both: needle passes into serosa, through muscularis and into submucosa
*Cushing Does not penetrate lume *Connell penetrates lumen (L=lumen) |
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What is the application of a Parker-Kerr oversew?
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Used to invert a stump of hollow viscus (intestine)
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How do you do a Parker-Kerr oversew?
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1st layer: Cushing suture over clamp (forceps-clamping stump)
-Clamps withdrawn as suture tightened 2nd Layer: Lembert placed over the top |
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What is the application of a purse string suture?
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Invert hollow viscus (intestine) or around drain tube to hold in place (bladder)
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Why shouldn't a purse string suture be used for intestinal stump closure?
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May not seal completely so not the best for intestinal stump closure
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What are 4 tension relieving suture patterns?
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1) Vertical mattress
2) Horizontal mattress 3) Near-far-far near 4) Stent |
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What type of a pattern is a vertical mattress, continuous or interrupted? Appositional, everting, or inverting?
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Interrupted
-appositional to everting |
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What are 2 advantages of a vertical mattress?
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1) * Combats tension
2) Minimal alteration in blood supply (similar to simple interrupted) |
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What are 2 applications (locations) for a vertical mattress?
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Skin, fascia
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Is a vertical mattress an interrupted or continuous pattern? Apposition, everting, inverting?
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Interrupted pattern
Appositional to everting |
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What are 3 advantages of a horizontal mattress?
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1) *Combats tension
2) Uses less suture than simple interrupted 3) Fast |
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What are 2 disadvantages of a horizontal mattress?
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1) Eversion
2) May reduce blood supply to edges |
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What are 3 applications for a horizontal mattress suture pattern?
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Skin, fascia, muscle
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Are near-far-far-near sutures continuous or interrupted?
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Interrupted pattern
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What are 2 advantages of a near-far-far-near suture pattern?
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1) Excellent (Strongest) for tension and apposition
2) Far suture holds against tension, near apposes |
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What are 3 disadvantages of a near-far-far-near suture pattern?
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1) Extra time required
2) Interruption of blood flow 3) Extra material in wound |
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What are 2 applications (locations) of a near-far-far-near suture pattern?
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Skin, fascia
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What is a stent?
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Sterile towel or gauze sutured over incision to absorb fluid, protect incision, and relieve skin tension
-Remove or replace if becomes wet or soiled |
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**What are 7 important suture characteristics?
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1) Tensile strength
2) Absorbable VS non-absorbable 3) Monofilament VS multifilament 4) Composition: natural vs synthetic 5) Handling 6) Tissue reaction to suture 7) Knot security |
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*What is tensile strength?
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How much pull a suture can take before it breaks
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Does absorbable or non-absorbable suture have longer lasting tensile strength?
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Non-absorbable
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Compare the healing rates of skin, intestines and tendons.
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Skin & intestines heal quicker than tendons
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What are the characteristics of absorbable suture?
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Rapid degradation and loss of tensile strength within 60 days
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What are 2 ways that absorbable suture is broken down?
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1) Hydrolysis
2) Enzymatic |
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How is catgut broken down?
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Protease degradation
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How is synthetic absorbable suture broken down?
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Hydrolysis
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How long does non-absorbable suture retain its tensile strength?
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> 60 days
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What are the 4 fates of absorbable suture in the system?
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1. Breakdown
2. Phagocytosis 3. Metabolism 4. Excretion -Tissue macrophages ingest suture breakdown product in bloodstream and are taken to the liver and spleen for further processing before being excreted |
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What are the 2 fates of non-absorbable suture material?
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1) Encapsulation
2) Extrusion Non-absorbabe suture is surrounded by fibrous connective tissue and either remains in the body or is extruded to a chronic |
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What is monofilament suture? What does the design allow for?
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Suture that consists of a single suture filament. Design allows for the smooth suture passage through tissue
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What is multifilament suture?
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Braided sutures that are constructed by twisting or braiding a number of strands together.
-Braids are known for their strength and superior handling properties |
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What are the 3 absorbable multifilament sutures?
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1) Gut (cat gut)
2) Polyglactin 910 (vicryl) 3) Polyglycolic acid (Dexon) |
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What are the 4 absorbable monofilament sutures?
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1) Polydioxanone (PDS)
2) Polyglyconate (Maxon) 3) Poliglecaprone 25 (Monocryl) 4) Glycomer 631 (Biosyn) |
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How is cat gut (gut) broken down?
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By enzymatic degradation & phagocytosis
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What is the advantage of cat gut?
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Cost
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What are 2 disadvantages of cat gut?
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Unpredictable absorption
Loss of strength by 7d |
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What is cat gut used for?
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Limited- not used much
-Cow uterus, flank muscles |
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How are braided synthetic multifilament (absorbable) sutures broken down?
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Hydrolysis
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What is an advantage of braided synthetic multifilament suture?
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strength and handling
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What are 3 disadvantages of braided synthetic multifilament suture?
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1) Early loss of strength
2) Tissue drag 3) Dexon (PGA) worse in urine |
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What are 4 uses for braided synthetic multifilament (Vicryl, Dexon, cat gut) suture?
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1) Buried suture
-Anything but skin 2) Subcutaneous 3) GI 4) Fascia |
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How are monofilament synthetic absorbable sutures (e.g. maxon) broken down?
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Hydrolysis
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What are 2 advantages of monofilalment synthetic suture (maxon)?
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1) Strength and less drag (monofilament)
2) Slower absorption is both advantage and disadvantage |
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What are 2 disadvantages of absorbable monofilament synthetic sutures (Maxon, PDS, monocryl, biosyn)?
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1) Stiffness (handling)
2) Monocryl loses strength faster (loses 50% after 7 d) |
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What are 3 uses for monofilament synthetic absorbable sutures?
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1) Buried suture (anything but skin)
2) SubQ, GI, fascia, muscle etc 3) Contaminated wounds |
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How long does it take most synthetic absorbable sutures to lose 50% of their tensile strength?
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14-21 days
-Except for 28-56 days for PDS -7 days for monocryl |
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The choice of the absorbable suture used should be based on what 4 things?
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1) Tissue involved (+ environment)
2) Expected healing 3) Handling characteristics 4) Preference, availability, cost |
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What are 4 types of non-absorbable multifilament suture?
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1) Polyester (Mersilene, Ethibond)
2) Polymerized caprolectam (Supramid) 3) Surgical steel (Flexon) 4) Silk |
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What are 4 types of non-absorbable monofilament suture?
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1) Nylon (ethilon, dermalon)
2) Polypropylene (Prolene, dermilene) 3) Polybutester (Novafil) 4) Surgical steel |
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What are 2 advantages of non-absorbable multifilament synthetic sutures?
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1) Medium to good handling
2) Medium to good knot security |
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What are 2 disadvantages of non-absorbable multifilament synthetic suture?
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1) Capillary action
2) Not good for contaminated wounds |
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What are 2 uses of non-absorbable multifilament synthetic suture?
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1) Skin
2) Laryngeal surgery- horses -Ethibond |
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What are the 2 advantages of stainless steel (non-absorbable multifilament synthetic) suture?
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1) Strongest
2) Most inert |
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What are 3 disadvantages of stainless steel (non-absorbable multifilament synthetic) suture?
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1) Poor handling
2) Cuts tissue 3) Repeated bending will break |
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What is stainless steel suture used for?
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Not used much unless need superior strength
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What suture is a non-absorbable natural multifilament?
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Silk
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What are 2 advantages of silk suture?
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Excellent handling
Ophthalmology |
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What are 2 disadvantages of silk suture?
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1) Highly reactive- may potentiate infection
2) Loses 80% of tensile strength in 8 days, although slowly absorbed |
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What are 3 clinical uses of silk suture?
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1) Ligatures
2) Ophthalmology 3) Plastic surgery |
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What are 4 advantages of non-absorbable monofilament synthetic sutures?
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1) Minimal reactivity
2) Non-capillary 3) Good in contaminated/ infected tissue 4) Medium to good handling |
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What is a disadvantage of monofilament synthetic (non-absorbable) suture?
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Medium to poor knot security
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What are 3 uses of non-absorbable monofilament synthetic sutures?
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1) Skin-commonly used
2) Fascia 3) Contaminated wounds |
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What are the 2 "criteria" for suture selection?
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1) Suture should be at least as strong as tissue
-Fascia > skin>bowel>bladder 2) Suture not needed once healed -Healing strength (time and degree) somewhat difficult to predict |
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Should absorbable or non-absorbable suture be used on viscera? why?
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Absorbable, viscera heals rapidly
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What type of suture should be used on fascia, absorbable or non-absorbable?
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Slowly-absorbed absorbable (mostly used)
Non-absorbable (special circumstances) |
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Do monofilament or multifilament suture resist infection better? Synthetic or natural?
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*monofilament > multifilament
*synthetic > natural |
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The selection of suture size is based on what 4 things?
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1) Needed tissue strength
2) Strength of suture 3) Minimum needed to maintain strength until healed 4) Minimize material in wound |
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How is suture size measured?
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-USP ("O"- ought)
"0"= .35 mm -Metric, size in 0.1 mm units |
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Do monofilament or multifilament suture resist infection better? Synthetic or natural?
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*monofilament > multifilament
*synthetic > natural |
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What is the range of USP suture sizes?
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10-0 (smallest) to #7 (largest)
Most used: range from 3-0 to #3 |
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The selection of suture size is based on what 4 things?
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1) Needed tissue strength
2) Strength of suture 3) Minimum needed to maintain strength until healed 4) Minimize material in wound |
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What are 4 types of needles?
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1) Taper- for friable tissues
2) Cutting- for rough tissues 3) Tapercut- doesn't damage tissues 4) Reverse cutting (edge on convex surface) |
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How is suture size measured?
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-USP ("O"- ought)
"0"= .35 mm -Metric, size in 0.1 mm units |
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What is the range of USP suture sizes?
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10-0 (smallest) to #7 (largest)
Most used: range from 3-0 to #3 |
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What are 4 types of needles?
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1) Taper- for friable tissues
2) cutting for rough tissues 3) Tapercut- doesn't damage tissues 4) Reverse cutting (edge on convex surface) |
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You have a horse present with a wire cut over the dorsum of the tarsus of a horse. The wound is contaminated and the incident happened 4 hours ago. What are the issues that you are dealing with when trying to decide what type of suture to use?
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1) High tension area
2) Motion over joint 3) Contaminated wound 4) Extensor tendon, skin |
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How do you suture an extensor tendon together?
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3 loop pulley or leave alone to heal by second intension
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What suture should be used for a 3 loop pulley suture pattern used on the extensor tendon?
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Long-lasting monofilament
-PDS |
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You have a horse present with a wire cut over the dorsum of the tarsus of a horse. The wound is contaminated and the incident happened 4 hours ago. What suture pattern should be used on the skin? What type of sutures?
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Near-far-far-near (superior tension relief)
Interrupted sutures in b/w to appose skin Nonabsorbable monofilament (nylon or polypropylene) |
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You have a non-contaminated, surgical wound over the hip following a tumor removal. What are 4 possible issues with suture selection?
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1) Moderate tension
2) Dead space 3) Motion area 4) Non-contaminated/infected wound |
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You have a non-contaminated, surgical wound over the hip following a tumor removal. What type of suture should be used to suture the fascia? Suture pattern?
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Absorbable synthetic (select from most available)
Pattern: simple interrupted or mattress |
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You have a non-contaminated, surgical wound over the hip following a tumor removal. What type of suture should be used on the skin? Suture pattern?
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Absorbable intradermal +/-
Non-absorbable simple interrupted cruciate mattress |
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You have a grossly-contaminated (road rash) open wound over forepaw. What are 4 issues to consider when deciding on a suture?
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1) Contaminated/infected
2) Tissue loss= tension 3) Friable tissues 4) Motion area |
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You have a non-contaminated, surgical wound over the hip following a tumor removal. What type of suture are you going to use to suture the tendons? Suture pattern?
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Prolonged strength needed:
-Non-absorbable (not infected) -Long-lasting absorbable (PDS) -Pulley type pattern |
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You have a non-contaminated, surgical wound over the hip following a tumor removal. What kind of suture should be used on the fascia? Suture pattern?
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Delayed healing, combat tension:
-Longer lasting absorbable (maxon, PDS) -Mattress or pulley sutures (horizontal mattress (friable tissues) |
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You have a non-contaminated, surgical wound over the hip following a tumor removal.
What type of suture should be used on the skin? Suture pattern? |
Delayed healing, friable and under tension:
-Longer lasting absorbable (intradermal) -but friable - Non-absorbable inert (infection): nylon, polypropylene -Mattress (horizontal) w/ simple interrupted |
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An animal has colonic carcinomia, and resection and anastomosis is performed. What are 4 issues that need to be considered for suture selection?
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1) Large bowel
-High potential for contamination 2) Terminal colon/rectum -Potential for vascular compromise 3) Potential tension w/ large resection 4) Potential contaminated area |
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An animal has colonic carcinomia, and resection and anastomosis is performed.
What type of suture should be used? |
Monofilament suture
-Or absorbable if braided, but potential delayed wound healing bc of vascular compromise |
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An animal has colonic carcinomia, and resection and anastomosis is performed. What type of suture should be performed?
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Tension so use a double layer closure
-Inversion second layer |
