10. Sutures and Hand Ties

Question 1

What is a suture?

Answer 1

a stitch or series of stitches made to secure the edges of a surgical or accidental wound in application
Noun > material used to close a wound
Verb > to suture, the application of a stick or stitches

Question 2

What is the function of sutures?

Answer 2

to hold tissues in apposition while healing takes place
selection of suture type and size determined by: purpose of suture, its biological properties in the tissue, type and condition of tissue it will be used on

Question 3

What are surgical needles needles?

Answer 3

descrubed by shape and point
shape: the portion of a circle represented by the entire needle
Ex. Curved: varying degrees of curvature found (3/8th circle, half circle)
Double curved - LA surgery
body means the configuration of the cross-section - described as round, triangular or flat

Question 4

What is the taper-point?

Answer 4

Taper needles may be used for all tissue closures except skin
A circle that tapers off

Question 5

What is a cutting needle?

Answer 5

taper cut, reverse cutting, cutting edge, triaangle shaped

Question 6

Where are sutures attached to the needle?

Answer 6

Swaged on refers to the suture material being attached directly to the needle w/o the use of an eye
The eyes are a further description of the character of the needle - french or closed

Question 7

What is the purpose of suture materials? when might it be required?

Answer 7

purpose: to hold together and support wound edges until would can heal sufficiently
when: intentional sx incision, to ligate vessels, ligament tendon or muscle repair, wound closure
Must know terminology

Question 8

What are ideal characteristics of suture material?

Answer 8

tensile strength - amount of force in psi that suture can withstand as an untied fiber b4 it breaks
Memory - ability or tendency of the suture to return to its original packaged form
Flexibility - ease at which suture is manipulated
capillarity - ability to suture to allow microbes to wick to the interirior of the strand
Absorbability - absorbable vs not
Structure - multifilament/braided vs monofilament
Knot security - some hold better than others, braided generally has better knot security
Color - some sutures are dyed, which makes them easier to see on the patient

Question 9

What should we consider when selecting an ideal suture material?

Answer 9

no knot slippage, high tensile strength, absorbable, minimal tissue reactivity, be easy to handle, inexpensive, surgeon preference bc of patient size, area of placement, healing potential of tissue, cosmetic appearance

Question 10

What is a ligature?

Answer 10

A loop of suture material around the blood vessel - when tied properly, func to occlude lumen of vessel
A transfixion ligature

Question 11

How do we classify suture materials?

Answer 11

Absorbable or non-absorbable
Natural or synthetic fibrers
Multifilament or monofilament

Question 12

How are absorbably sutures broken down?

Answer 12

Phagocytosis - leukocytes are released and travel yo the site of concern (incision) to ingest and destroy foregin suture material
Hydrolysis - the chemical compound in the suture is decomposed as it is exposed to water

Question 13

How fast do absorbable surures absorb?

Answer 13

Can be as quick as 7 d
Rate is influenced by inflam, infection qnd vascularity of tissue

Question 14

How long do non absorbable sutures remain in the body?

Answer 14

At least 2yr
Have high tensile strength and most have low tissue reactivity

Question 15

What is the differrnce between monofilament vs multifilatment

Answer 15

Multifilament/braided - has 2+ strands braided together to form single strand of suture
Monofilament - single solid strand of suture material
Tends to have less tissue drag or friction than braided

Question 16

Give an example of metallic suture material

Answer 16

Stainless steel (suture wire, staples)

Question 17

What are stainless steal sutures?

Answer 17

Inert and non-corrosive
No capillary ability = not support infection
Difficult to handle - kinks easily, knots difficult to secure
Non-elastic - may strangulate tissue
Cut ends may irritate tissues and tear gloves
Where stainless steel sutures are indicated, monofil is better than multifil

Question 18

How do we size our sutures?

Answer 18

Numerical scale - “ought”
Numerical 0 = ought or zero
Higher # = smaller suture (4-0 (four-ought) is smaller than 2-0 (two-ought)
Whole numbers = bigger the # bigger the suture ex 4 is bigger than 4-0

Question 19

How is suture material packaged?

Answer 19

Single-use pre sterilized via gamma radiation = long expiry dates
Opened on an as-needed basis aseptically onto sx field
Unused suture packs can ve saved for non-sterile suturing
OR - can be mounted on a muliuse reel or “cassette” by manufactuerer - economical but greater potential for contamination than individually packaged products

Question 20

What are some suture related responsibilities of vet techs?

Answer 20

loading needle holder
cutting the cutures once the vet has completed the sutre placement - absorbable (cut leaving only 1/8-1/4 inch of suture beyond knot), non absorbable (cut so suture ends extends about 1/2” beyond the knot to facilitate suture removal
Running the suture when surgeon is on continuous pattern
Recognize suture patterns - so identify if suture line is compromised

Question 21

How are suture patterns categorized?

Answer 21

how they appose the tissue - appositional, everything, inverting
Tissue layer where they are placed - SQ, Subcuticular, skin
Method of placement - continuous, interrupted

Question 22

What is the subcutaneous

Answer 22

placed in the SQ tissue layer
Brings skin edges into apposition; does not close skin - dec dead space in a wound but still requires skin to be sutured

Question 23

What is subcuticular suturing?

Answer 23

placed just under the skin
External sutures unnecessary

Question 24

What is simple continuous suturing?

Answer 24

knot at either end of suture line w/ continuous suture btw
employed in SQ space, muscle layers, linea alba, any area where a relatively air-tight, fluid tight apposition is needed

Question 25

What is ford interlocking suturing?

Answer 25

used in LA sx, creates a very strong suture line

Question 26

What is simple interrupted suturing

Answer 26

Most common, quick, easy and versatile
Used to close skin, linea alba, muscle layers, SQ space, secure implants like penrose drain
must ensure edges remain in apposition by avoiding excessive tension
disadvantage - time consuming and more “foreign” suture material in wound

Question 27

What is the cruciate suturing pattern?

Answer 27

once placed, it results in an X over the wound

Question 28

What is the horizontal mattress suture pattern?

Answer 28

time consuming but ideal in areas of tension
If pulled fighting will = everting pattern

Question 29

What is the vertical mattress suturing pattern?

Answer 29

needle passes thru tissue i a “far far near near” pattern
used in areas of tension
time consuming
advan over horizontal mattress is that fer incidences of unintentional eversion of wound edges

Question 30

How do we monitor for wound care

Answer 30

swelling, inc redness, gaping of the incision, discharge, pain
keep incision clean and dry!
Minimize activity, provide barrier to prevent licking/scratching
non-absorbably sutures are generally removed 10-14 days following sx - ensure incision has healed b4 removing sutures

Question 31

How do we remove sutures?

Answer 31

w/ scissors and thumb tissue forceps
removal 10-14d after surgery
ensure healing first (no gaps, drainage, redness, or swelling)

Question 32

How do we remove interrupted sutures?

Answer 32

use thumb forceps to grab one of suture ends (tags) and gently apply tension away from the wound
PLace the hooked blade of the suture removal scissors besides the knot
with one quick motion, cut the suture and pull it out of the skin
Continue until all sutures have been removed
can be very uncomfortable for patient
depending on amount of overgrowth, patient may require sedation

Question 33

What are the properties of metal clips and staples?

Answer 33

= to stainless steel
quick and easy to apply
Disposable
may inc scarring if left in for too long
relatively inexpensive
used for ligating sm vessels (versa clips) and skin closures (staples)
Expensive sophisticated instruments available for GI anastomosis

Question 34

How do we remove continuous sutures?

Answer 34

using thumb forceps, grab the free end of suture at one end of the suture line
using the hook blade of suture scissors, cut the suture just next to the knot
snip every 3rd or 4th stitch and pull these short pieces out
remove last stitch as you would for interrupted pattern

Question 35

Why dont we just pull the entire continuous suture line through? Why do we have to cut it into short pieces?

Answer 35

Patient comfort + prevent contamination as we are pulling suture through a healing wound