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33 Cards in this Set
- Front
- Back
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Characteristics of an ideal suture: |
- sterile - versatile - predictable performance - favorable absorption profile - easy to handle and tie w/ secure knots - minimally reactive in tissue - resistant to infection - non-capillary, non-allergenic, non-carcinogenic |
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monofilament |
synthetic polymers extruded into a single fiber Pros: low friction passing thru tissues, do not harbor/wick bacteria Cons: poor handling, poor knot security |
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multifilament |
composed of numerous natural or synthetic fibers that are braided or twisted together Pros: easier to handle, better knot security Cons: more tissue friction, may harbor/wick bacteria |
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absorbable |
composed of materials that are digested by tissues of the body (hydrolysis, enzymatic degradation, phagocytosis)
rate of breakdown varies w/ material uses: buried sutures, skin sutures that can't be removed |
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non-absorbable sutures |
made from materials that are unaffected by biologic activities of the body (remain unless removed) uses: skin closure, procedures requiring long-term strength (-pexies, cardiac sx, ortho) |
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Vicryl |
synthetic, absorbable, multifilament retains tensile strength for 2-3 weeks. complete resorption in 56-70 days. Pros: easy to handle, minimal tissue reaction Cons: can harbor/wick bacteria, loses strength in urine Uses: ST closure, vessel ligation; DON'T use for bowel or skin |
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Monocryl |
synthetic, absorbable, monofilament retains tensile strength for 10-14 days. completely absorbed in 90-120 days. Pros: little tissue drag, pliable, doesn't harbor/wick bacteria Cons: more difficult to handle and poorer knot security than multifilaments Uses: ST closure, hollow organs, vessel ligation |
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PDS |
synthetic, absorbable, monofilament retains tensile strength for 6+ weeks. fully absorbed in 180-210 days. Pros: long retention of tensile strength, doesn't harbor/wick bacteria, little tissue drag, pliable Cons: tensile strength/absorption time excessive for general sx Uses: closure of slow healing tissues (fascial closures), general use in healing compromised pts |
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Ethilon |
synthetic, non-absorbable, monofilament
retains strength for many years. very slowly hydrolyzed. Pros: strong, minimal inflammatory rxn, elastic Cons: larger sizes are stiff/springy, poor knot security Uses: skin closure |
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Prolene |
synthetic, non-absorbable, monofilament Pros: minimal tissue rxn, little tissue drag, does not degrade/retains strength for up to 2 years Cons: none Uses: skin closure, linea alba closure in healing compromised pts, applications requiring long-term strength w/ minimal tissue rxn (-pexies, cardiac sx) |
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Supramid |
synthetic, non-absorbable, multifilament type of nylon Pros: inexpensive, good knot security, little tissue drag Cons: difficult to handle in larger sizes Uses: skin closure, -pexies in cows |
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instrument tie |
Pros: easy, reliable, faster than hand ties, uses less suture material, good for slippery materials, good for placement of deep ligatures Cons: ligatures more likely to slip, less tactile feedback than hand ties |
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two-hand tie
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Pros: easier than one-hand tie, more likely to result in square throws, less likely to slip
Cons: takes longer, harder to use in a cavity |
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friction knots |
Uses: prevent slippage of first throw of a ligature, ligation |
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interrupted patterns
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Pros: precise adjustment of tension along line, good alignment in irregularly shaped wounds, minimal interference w/ blood supply, minimal consequence when one knot fails Cons: time consuming, poor suture economy, more foreign material in wound |
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continuous patterns |
Pros: faster, tension evenly dist along closure, better air/water-tight seal, less foreign material in wound Cons: less precise control of wound approximation and tension, more compromise of blood supply at edges, knot failure can disrupt the entire line |
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appositional patterns |
edge to edge closure provides best anatomical approximation of the disrupted tissue planes preferred for most closures |
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inversion |
rolling the edges inward provides good leak resistance. BUT delayed healing, risk of stricture formation used primarily for closure of viscera w/ lrg lumen size (esp high bacterial pop), closure of organs w/ questionable viability |
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eversion
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rolling the edges outward used primarily for skin closures |
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simple interrupted
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- full thickness bites on each side, easy, secure anatomical closures, precise tension adjustment, minimal alteration in blood flow, excess tension may cause inversion
Uses: general closure of skin, SQ, fascia; viscera, vessels, nerves |
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interrupted intradermal/subcuticular |
- simple interrupted that incorp. only the dermis or dermis/SQ, time consuming Uses: closure of skin or skin/SQ, buried knots so pt can't chew suture |
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cruciate
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- two bites tied diagonally to form an "x", faster and stronger closure than simple interrupted, resists tension, prevents eversion Uses: skin, fascia |
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simple continuous |
- faster than interrupted, provides good apposition, better air/water tight seal, better suture economy, more difficult to adjust tension, not as strong as simple interrupted, line can fail completely if knot fails Uses: skin, SQ, fascia, GIT and UGT, blood vessels |
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continuous intradermal & subcuticular |
- continuous and buried, incorp. just dermis or dermis/SQ, good apposition, weaker than skin sutures, no sutures to remove, sutures protected from chewing/licking Uses: closure of skin/SQ (often w/ tissue glue or tape closures) |
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lockstitch (blanket, ford interlocking) |
- mod. simple continuous w/ each bite locked, more secure if knot fails, harder to remove Uses: skin in LAs |
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full thickness patterns for viscera
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simple interrupted, Gambee, Connell
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seromuscular patterns for viscera |
incorp. only serosa and muscular layers Lembert, Cushing |
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Connell |
- inverting, continuous, full-thickness - strong, leak-resistant, delayed healing, contribute to strictures, may wick contents due to mucosal penetration Uses: first layer of closure of viscera w/ lrg lumens |
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Cushing |
- inverting, continuous, seromuscular - weaker than full thickness, does not wick contents Uses: second or oversew layer |
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Lembert |
- inverting, interrupted or continuous, seromuscular - weaker than full-thickness patterns, doesn't wick contents Uses: second or oversew layer |
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vertical mattress |
- everting, interrupted - appositional or everting depending on tension, stronger in tissues under tension, less likely to occlude blood supply at wound edges than horizontal mattress Uses: dissipate wound tension - as primary skin closure, as widely spaced sutures for tension relief, as stent sutures |
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horizontal mattress |
- used somewhat interchangeably w/ vertical mattress to relieve tension, compromise blood flow more at wound edges Uses: interrupted or continuous as sole skin closure, widely spaced for tension relief, as stent sutures |
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pulley mattress sutures |
- provide tension relief and edge apposition Uses: closure of wounds under extreme tension, closure of linea |
