2. Layered Closure and Intro to Suturing Flashcards
what are the surgical layers of closure?
(Reverse of surgical layers of dissection)
- Bone
- Periosteum
- Deep fascia
- Superficial fascia
- Skin
what hardware might you find in the 5th dissection layer?
Recall: 5th layer of closure is BONE
- nothing (triple arthrodesis)
- K-wires
- steinman pins
- cerclage wire
- screws
- plates
- staples
- external fixation
- etc
what would you use for closure of the JOINT CAPSULE?
which layer is this in?
- Use:
- usually a larger, absorbable suture w/
- (2-0 or 3-0 vicryl)
- interrupted cruciate-style suture
- usually a larger, absorbable suture w/
- Joint capsule is found in the periosteum (4th layer)
what would you use for closure of the PERIOSTEUM?
which layer is this in?
- 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)
- usually larger, absorbable suture w/ interrupted, cruciate-style (same as joint capsule), OR
- Periosteum is found in the 4th layer
list the ABSORBABLE SUTURE material?
- 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)
list the NON-ABSORBABLE suture materials
- Natural
- Silk
- Cotton/Linen
- Synthetic
- Nylon (Ethilon, Surgilon)
- Polypropylene (Prolene, Surgilene)
- Polyester (Ethibond, Dacron)
- Fiberwire (Polyethylene multifilament core w/ braided polyester jacket)
- Stainless steel
list the NATURAL suture materials
- Absorbable
- Pig collagen, sheep intestine, cow intestine, or cat gut
- May be chromic
- Non-absorbable
- Silk
- Cotton/Linen
list the SYNTHETIC suture materials
- 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
list the MONOFILAMENT suture materials
- Absorbable
- PDS
- Maxon
- Monocril
- Non-absorbable
- Nylon (both)
- Polypropylene
- Stainless steel (both)
list the BRAIDED/ MULTIFILAMENT suture materials
- Absorbable
- Vicryl
- Dexon
- Non-absorbable
- Nylon (both)
- Polyester
- Fiberwire
- Stainless steel (both)
Per Prism pg 79, what should you use for CAPSULE CLOSURE
(in general)
2-0 or 3-0 Vicryl
with cruciate stitch
Per Prism pg 79, what should you use for
SUBCUTANEOUS TISSUE CLOSURE?
3-0 or 4-0 Vicryl
Per Prism pg 79, what should you use to close SKIN?
4-0 Nylon or Prolene
When can skin sutures be removed? Why?
- 10-14 days
- Because at this point, the TENSILE STRENGTH of the wound equals the tensile strength of the suture
INTERRUPTED suture:
define, pros, cons
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.
RUNNING suture:
define, pros, cons
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
what are the questions you should consider when deciding between
interrupted and running suture techniques?
- 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;
what are the 4 primary types of interrupted suture
- simple
- horizontal mattress
- cruciate (aka figure of 8)
- vertical mattress
what type of suture material would you use for ACHILLES repair?
usually a 1-0 vicryl
what type of suture material would you use for SKIN CLOSURE?
3-0 or 4-0 vicryl
what techinque and suture material(s)
should be used for closing 3rd layer (DEEP FASCIA)?
- usually interrupted cruciate-style with 2-0 or 3-0 vicryl, OR
- running (locking vs. non-locking) with 2-0 or 3-0 vicryl
what techinque and suture material(s)
should be used for closing 2nd layer (SUPERFICIAL FASCIA)?
Usually a buried, interrupted, smaller diameter ABSORBABLE suture technique
(usually 3-0 or 4-0 vicryl)
may also be running
what techinque and suture material(s)
should be used for closing 1st layer (SKIN)?
- interrupted suture technique with non-absorbable suture
- running subcuticular w/ either absorbable or non-absorbable
- skin staples
- dermabond (MC skin glue)
describe the RUNNING SUBCUTICULAR suture technique
(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
list some names of sutures we didn’t learn but may later in trauma/ recon classes?
- apical stitch
- allgower-donati technique
- trauma stitch
- far-near-near-far technique (holds a lot more tension than other techniques)
what are the 4 appropriate places for a suture needle to be?
- suture pack
- IN the needle driver
- sharps container
- bury the needle into the “skin” of practice board
In essence, the needle point cannot be exposed
home base is the half-way point between what?
- part 1: throwing your suture
- part 2: tying a surgeon’s knot
describe the steps of the SURGEON’S KNOT
- 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
what is the problem with the SIMPLE /SLIP knot?
not very stable, loose
how can you maintain tension until you complete the square knot?
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
what are the 3 different techniques to creating a surgeon’s knot?
- with an instrument
- with ONE-HAND technique
- with TWO-HAND technique
