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20 Cards in this Set
- Front
- Back
interrupted
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each suture has its own knot
distance from wound edge = thickness of tissue offset the knot appositional common uses: skin, SQ, GIT |
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continuous
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knots only at each end
suture line perpendicular to incision material advances forward on wound surface quick to place appositional common uses: SQ and linea alba |
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advantages of interrupted pattern
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each suture is separate entity
adjust tension along wound easy to place failure of one knot usually unconsequential |
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disadvantages of interrupted suture
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more time to place
more foreign material poor suture economy |
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cruciate mattress suture
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easiest of mattress sutures
appositional avoids ischemia and eversion half number of knots as simple interrupted common uses: skin |
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horizontal mattress
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two simple interrupted placed in opposite directions
(visible suture is parallel to incision) difficult to place properly appositional if too tight, can cause marked eversion |
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vertical mattress
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suture perpendicular to incision
resists tension better than horizontal 2 vertical mattress joined together = Halstead suture common uses: skin, fascia in high tension areas |
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advantages of continuous suture
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fewer knots
less foreign material quicker better seal better suture economy |
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disadvantages to continuous suture
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less control of wound tension and apposition
disastrous if suture breaks down handle suture material very carefully |
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ford interlocking (blanket stitch)
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passage of suture material through tissue is partially locked
greater security if broken uses a lot of suture material common uses: skin, long wounds on ventral midline, LA |
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intradermal (subcuticular)
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continuous horizontal mattress pattern
no need to remove suture appositional excellent cosmetic result buried knots at each end not for high tension wounds |
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buried knots
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knots in subcuticular tissue
prevents wicking of bacteria from surface prevents irritation of skin |
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lembert suture
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inverted continuous vertical mattress
bite taken through serosa, muscularis, and submucosa used to close hollow viscera |
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Cushing
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inverting continuous horizontal mattress
bites are parallel to incision (lembert perpendicular) |
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connell
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inverting continuous horizontal mattress
bite penetrates lumen first layer of a two layer closure |
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parker kerr
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modified cushing/lembert
used to close the stump of hollow viscus (hardly used because cases excessive tissue eversion |
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purse string
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circular variation of lembert
uses: closure of hollow stump, securing tubes and catheters, placed around the anus during perineal surgery |
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tendon sutures
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resist tension caused by weight bearing
used to suture ends of tendon or attach tendon to bone 1. three loop pulley 2. bunnell 3. far near near far |
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skin staple
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fast
evert wound edges 8mm apart expensive |
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tissue adhesives
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cyanoacrylates
non-absorbable synthetic adhesives apply to dry wound strong, flexible wound bio inert closure of skin incisions bad: toxic degradation products, persistence can lead to granulation/fistula |