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Y3 - Surg Skills > 2. Layered Closure and Intro to Suturing > Flashcards

2. Layered Closure and Intro to Suturing Flashcards

1
Q

what are the surgical layers of closure?

A

(Reverse of surgical layers of dissection)

  • Bone
  • Periosteum
  • Deep fascia
  • Superficial fascia
  • Skin
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2
Q

what hardware might you find in the 5th dissection layer?

A

Recall: 5th layer of closure is BONE

  • nothing (triple arthrodesis)
  • K-wires
  • steinman pins
  • cerclage wire
  • screws
  • plates
  • staples
  • external fixation
  • etc
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3
Q

what would you use for closure of the JOINT CAPSULE?

which layer is this in?

A
  • Use:
    • usually a larger, absorbable suture w/
      • (2-0 or 3-0 vicryl)
    • interrupted cruciate-style suture
  • Joint capsule is found in the periosteum (4th layer)
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4
Q

what would you use for closure of the PERIOSTEUM?

which layer is this in?

A
  • Use:
    • usually larger, absorbable suture w/ interrupted, cruciate-style (same as joint capsule), OR
      • (2-0 or 3-0 vicryl)
    • running (locking vs non-locking) w/ larger absorbable suture
      • (2-0 or 3-0 vicryl)
  • Periosteum is found in the 4th layer
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5
Q

list the ABSORBABLE SUTURE material?

A
  • Natural
    • Pig collagen, sheep intestine, cow intestine, or cat gut
    • May be chromic
  • Synthetic
    • Vicryl (Polyglactin 910) - Vicryl Rapid, Vicryl Plus, Triclosan
    • Dexon (Polyglyolic acid)
    • PDS (Polydiaxonone)
    • Maxon (Polyglyconate)
    • Monocril (Poliglecaprone)
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6
Q

list the NON-ABSORBABLE suture materials

A
  • Natural
    • Silk
    • Cotton/Linen
  • Synthetic
    • Nylon (Ethilon, Surgilon)
    • Polypropylene (Prolene, Surgilene)
    • Polyester (Ethibond, Dacron)
    • Fiberwire (Polyethylene multifilament core w/ braided polyester jacket)
    • Stainless steel
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7
Q

list the NATURAL suture materials

A
  • Absorbable
    • Pig collagen, sheep intestine, cow intestine, or cat gut
    • May be chromic
  • Non-absorbable
    • Silk
    • Cotton/Linen
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8
Q

list the SYNTHETIC suture materials

A
  • Absorbable
    • Vicryl (Polyglactin 910) - Vicryl Rapid, Vicryl Plus, Triclosan
    • Dexon (Polyglyolic acid)
    • PDS (Polydiaxonone)
    • Maxon (Polyglyconate)
    • Monocril (Poliglecaprone)
  • Non-absorbable
    • Nylon (Ethilon, Surgilon)
    • Polypropylene (Prolene, Surgilene)
    • Polyester (Ethibond, Dacron)
    • Fiberwire (Polyethylene multifilament core w/ braided polyester jacket)
    • Stainless steel
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9
Q

list the MONOFILAMENT suture materials

A
  • Absorbable
    • PDS
    • Maxon
    • Monocril
  • Non-absorbable
    • Nylon (both)
    • Polypropylene
    • Stainless steel (both)
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10
Q

list the BRAIDED/ MULTIFILAMENT suture materials

A
  • Absorbable
    • Vicryl
    • Dexon
  • Non-absorbable
    • Nylon (both)
    • Polyester
    • Fiberwire
    • Stainless steel (both)
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11
Q

Per Prism pg 79, what should you use for CAPSULE CLOSURE

(in general)

A

2-0 or 3-0 Vicryl

with cruciate stitch

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12
Q

Per Prism pg 79, what should you use for

SUBCUTANEOUS TISSUE CLOSURE?

A

3-0 or 4-0 Vicryl

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13
Q

Per Prism pg 79, what should you use to close SKIN?

A

4-0 Nylon or Prolene

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14
Q

When can skin sutures be removed? Why?

A
  • 10-14 days
  • Because at this point, the TENSILE STRENGTH of the wound equals the tensile strength of the suture
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15
Q

INTERRUPTED suture:

define, pros, cons

A

define: the individual stitches are not connected.

  • MC used technique in wound closure
  • Pros:
    • easy to place
    • high tensile strength
    • individual sutures can be removed (e.g in cases of infection) w/o jeopardising the closure.
  • Cons:
    • require a relatively long time to be placed
    • as each suture requires its own knot, are at a greater risk of inducing infection.
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16
Q

RUNNING suture:

define, pros, cons

A

Define: the stitches are continuous and connected along the wound.

  • Pros:
    • tends to be faster, particularly for long wounds.
  • Cons
    • wound is at greater risk of dehiscence if the suture material breaks
17
Q

what are the questions you should consider when deciding between

interrupted and running suture techniques?

A
  • how many knots do you want to throw?
  • how long is the incision?
  • what type of movement will take place along the incision?
  • do you have to take out the sutures?
    • absorbable/ non-absorbable;
18
Q

what are the 4 primary types of interrupted suture

A
  • simple
  • horizontal mattress
  • cruciate (aka figure of 8)
  • vertical mattress
19
Q

what type of suture material would you use for ACHILLES repair?

A

usually a 1-0 vicryl

20
Q

what type of suture material would you use for SKIN CLOSURE?

A

3-0 or 4-0 vicryl

21
Q

what techinque and suture material(s)

should be used for closing 3rd layer (DEEP FASCIA)?

A
  • usually interrupted cruciate-style with 2-0 or 3-0 vicryl, OR
  • running (locking vs. non-locking) with 2-0 or 3-0 vicryl
22
Q

what techinque and suture material(s)

should be used for closing 2nd layer (SUPERFICIAL FASCIA)?

A

Usually a buried, interrupted, smaller diameter ABSORBABLE suture technique

(usually 3-0 or 4-0 vicryl)

may also be running

23
Q

what techinque and suture material(s)

should be used for closing 1st layer (SKIN)?

A
  • interrupted suture technique with non-absorbable suture
  • running subcuticular w/ either absorbable or non-absorbable
  • skin staples
  • dermabond (MC skin glue)
24
Q

describe the RUNNING SUBCUTICULAR suture technique

A

(running technique of skin)

  • non-absorbable suture w/ a “bridge”
  • absorbable suture w/o a bridge

Other

  • W/IN THE DERMIS and closes skin
  • knot the ends or leave unknotted
  • re-enforce with simple sutures at the ends
25
Q

list some names of sutures we didn’t learn but may later in trauma/ recon classes?

A
  • apical stitch
  • allgower-donati technique
  • trauma stitch
  • far-near-near-far technique (holds a lot more tension than other techniques)
26
Q

what are the 4 appropriate places for a suture needle to be?

A
  1. suture pack
  2. IN the needle driver
  3. sharps container
  4. bury the needle into the “skin” of practice board

In essence, the needle point cannot be exposed

27
Q

home base is the half-way point between what?

A
  • part 1: throwing your suture
  • part 2: tying a surgeon’s knot
28
Q

describe the steps of the SURGEON’S KNOT

A
  • Step 1: cross your hands –> slip knot or simple knot
    • (with one loop or two loops)
  • Step 2: uncross your hands –> square knot
    • (with one loop initially is a square knot; two loops is a surgeon’s or friction knot)
  • Step 3: cross your hands –> surgeon’s knot

Essentially lying 3 knots on top of each other

29
Q

what is the problem with the SIMPLE /SLIP knot?

A

not very stable, loose

30
Q

how can you maintain tension until you complete the square knot?

A

square knot is the functional unit;

you need to generate a square knot so it will not loosen

*you can increase the number of “throws” or “loops” to generate tension

31
Q

what are the 3 different techniques to creating a surgeon’s knot?

A
  • with an instrument
  • with ONE-HAND technique
  • with TWO-HAND technique

Y3 - Surg Skills (6 decks)

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