Laceration Repair 572

Front 1

What kind of suture would you use for a laceration of the pelvic muscles?

Back 1

2-O

Front 2

What kind of suture would you use for a laceration of the vaginal mucosa?

Back 2

3-0

Front 3

What kind of suture would you use for lateral wall lacerations?

Back 3

2-O

Front 4

What kind of suture would you use for a laceration of the subcutaneous layer?

Back 4

3-O

Front 5

What kind of suture would you use for subcuticular stitches?

Back 5

3-O

Front 6

What kind of suture would you use for a laceration of the periurethral area?

Back 6

3-O

Front 7

What kind of suture would you use for lacerations of the clitoris, labia, or some periurethral areas?

Back 7

4-O

Front 8

What are the supplies you need when setting up for a laceration repair?

Back 8

*Adequate lighting
*Proper position of the patient
*4-0 to 2-0 chromic or vicryl suture
*Needle driver
*Forceps
*Suture scissors
*4 x 4’s
*1% lidocaine
*Small gauge needle
*Syringe

Front 9

How would you provide aseptic technique when setting up for a laceration repair?

Back 9

Change gloves if necessary

Place drape to provide a non-contaminated field

Front 10

What accommodations should you make regarding anesthesia for a laceration repair?

Back 10

*Does the patient have epidural anesthesia?
*Consider a bolus if needed
*Attempt local anesthesia with 1% lidocaine without epi
*Pudendal anesthesia if local inadequate

Front 11

What are the differences between larger gauge and smaller gauge suture?

Back 11

*Larger gauge = finer suture and weaker tensile strength
*Smaller gauge = heavier suture and stronger tensile strength

Front 12

What is 2-O suture used for?

Back 12

*Deep interrupted stitches of the pelvic muscles
*Lateral wall lacerations

Front 13

What is 3-O suture used for?

Back 13

*Vaginal mucosa
*subcutaneous stitches
*subcuticular stitches
*periurethral lacerations

Front 14

What is 4-O suture used for?

Back 14

*Clitoral lacerations
*labial lacerations
*periurethreal lacerations

Front 15

What is chromic catgut made from, how does it work/tensile strength, and instructions related to absorption?

Back 15

*Made from sheep intestine with chromic salts to prolong tensile strength
*Tissue inflammation reaction
*Tensile strength maintained for 10-14 days
*Complete absorption in 10-40 days may vary per patient factors (enzymatic degradation)

Front 16

What is polygactin otherwise called, what is it made of, how does it compare to catgut, and instructions related to absorption?

Back 16

*Vicryl, or Polysorb
*Synthetic
*Vicryl :Tensile strength 65% in 14 days, 40% in 21 days, 10% in 35 days, complete absorption by 70 days
*Polysorb: 80% in 21 days, 30% in 14 days, complete absorption by 56-70 days
*Less associated with discomfort compared to chromic suture
*occasionally requires removal because of its longer life

Front 17

What are the three kinds of needles?

Back 17

*Taper point
*Cutting
*Curved

Front 18

Describe a taper point needle

Back 18

Taper point (round needle): penetrates and passes through tissues by stretching without cutting. A sharp tip at the point flattens to an oval/rectanglular shape.

Front 19

Describe a cutting needle

Back 19

Cutting: designed for penetration through dense, irregular, and relatively thick tissues. The point cuts a pathway through tissue an is ideal for skin sutures, not for obstetric lacerations.

Front 20

Describe a curved needle

Back 20

Curved: predictable path through issue and requires less space for maneuvering than a straight needle. Semicircle provides an even distribution of tension. Common size- ½ inch for repair of muscle, mucosa, subcuticular. Smaller for clitoral or other smaller areas.

Front 21

What are the four stitches commonly used in obstetric laceration repair?

Back 21

*Blanket
-Vaginal mucosa
-Continuous locked
-Running
*Deep interrupted
-Deep muscle repair
-Crown stitch
-Continuous unlocked
*Subcutaneous layer
-Mattress
-Subcuticular

Front 22

Describe key points of a perineal muscle repair

Back 22

*Repaired with Vicryl 3-0 or 2-0
*Close each muscle body with interrupted stitches
-Bulbocavernosus located immediately below introitus
(Crown stitch can be used)
*Transverse perineal muscle located above external anal sphincter

Front 23

Describe key points of a vaginal laceration repair

Back 23

*Repaired with chromic or Vicryl 3-0
*Anchor Suture 1 cm above apex of vaginal Laceration
*Use blanket stitch (continuous locked) to close vaginal mucosa
*Locking Suture is recommended (used for hemostasis)
*Each pass should include
1. Vaginal mucosa
2. Vaginal fascia (important for vaginal support)
*Continue Blanket Suture up to hymenal ring
-May be tied off proximal to hymenal ring or
-May be passed under hymenal ring to perineum
-May be used for closing perineal skin

Front 24

When suturing is complete, what steps should you take to assess and finish the procedure?

Back 24

*Check hemostasis
*Is the vaginal surface bleeding?
*Add interrupted sutures as needed
*Is the laceration oozing blood?
*Apply direct pressure to area of bleeding until it stops
*Cleanse with warm water or saline

Front 25

List and define the complications that can occur with vaginal and perineal laceration repair and what tear or technique problem they are associated with

Back 25

*Chronic perineal pain including dyspareunia
-Associated with perineal skin closure
*Urinary and fecal incontinence
-Associated with third and fourth degree tears
*Anal fissure
-Associated with fourth degree tears
*Hematoma / infection
-Associated with dead space, poor approximation of sutures

Front 26

Define a blanket suture and what it looks like

Back 26

a suturing technique that loops each stitch over the previous one to create a succession of loops along one side and stitches across the incision. Also called
continuous lock stitch.

Front 27

Describe and define a continuous unlocked stitch

Back 27

*Used with the subcutaneous layer
*A suture in which an uninterrupted length of suture material is used to close an incision or laceration.

Front 28

Define and describe a mattress stitch

Back 28

*Used for subcuticular
*a continuous suture that is applied back and forth through the tissues in the same vertical plane but at a different depth, or in the same horizontal plane but at the same depth.

Front 29

Define and describe a deep interrupted suture

Back 29

*interrupted suture:one in which each stitch is made with a separate piece of material.
*Deep Interrupted: deep muscle repair, crown stitch
*The basic interrupted suture used to close dead space. Notice that the knot is buried in the deeper tissues.