Chapter 11 Flashcards
Hemostasis, Wound Closure, Wound Healing
1
Q
What does adhesion mean?
A
Attachment of two surfaces or structures that are normally separate
2
Q
What does anastomosis mean?
A
Pathological, surgical, or traumatic formation of an opening between two normally separate organs or spaces
3
Q
What does debridement mean?
A
Removal of devitalized tissue and contaminants
4
Q
What does approximated mean?
A
Returned to proximity; brought together sides or edges
5
Q
What does autologous mean?
A
From oneself
6
Q
What does capillarity mean?
A
The tendency of a liquid in a
capillary tube or absorbent material to rise or fall as a result of surface tension
7
Q
What are chronic wounds?
A
Wound that persists for an extended period of time
8
Q
What does cicatrix mean?
A
A scar
9
Q
What is collagen?
A
Protein that consists of bundles of reticular fibers that form the white, inelastic fibers of fascia, ligaments, and tendons
10
Q
What does compress mean?
A
To apply pressure
11
Q
What is dead space?
A
A space that remains in the tissues as a result of failure of proper closure of a surgical wound
12
Q
What is edema?
A
The abnormal accumulation of fluid in the interstitial spaces of tissues causing swelling
13
Q
What is elasticity?
A
The ability of tissue such a skin, lungs, or muscles to return to its normal shape after being pushed inward, stretched outward, or in some way manipulated
14
Q
What is evisceration?
A
Interruption of a closed wound or traumatic injury that exposes the viscera
15
Q
What does exudate mean?
A
Mass of cells and fluid that
has seeped out of blood vessels or an organ, especially in inflammation
16
Q
What does first intention mean?
A
Type of healing that occurs with primary union that is typical of an incision opened under ideal conditions; healing occurs from side to side, dead space has been eliminated, and the wound edges are accurately approximated
17
Q
What is the French-Eye Needle?
A
A type of needle in which the suture must be threaded by pulling the strand through a V-shaped area into the eye. Does most damage
18
Q
What does friable mean?
A
Easily torn or crumbled
19
Q
What does gangrene mean?
A
Necrosis of tissue usually due to ischemia and subsequent bacterial infection
20
Q
What is granulation?
A
Second intention wound healing in which the wound is left open to heal and the space is filled in from the bottom upward with granulation tissue
21
Q
A
22
Q
What is hemolysis?
A
The destruction of erythrocytes
23
Q
What is hemostasis?
A
The arrest of the escape of blood through natural or artificial means
24
Q
What is a hemostat?
A
An instrument used to grasp tissue on vessels, or clamp onto a vessel.
25
What is a herniation?
Abnormal protrusion of an organ or other body structure through an opening in a covering membrane or muscle
26
What does homologous mean?
From the same species
27
What is an immunosuppressed patient?
Patient whose immune system has decreased due to disease, or intentionally decreased with immunosuppressive drugs for organ transplant patients to prevent organ rejection
28
What does inert mean?
A substance, such as the aiming beam of a laser, that is inactive and has no effect on tissue
29
What is inflammation?
The body’s protective response to injury or tissue destruction
30
What is a laceration?
Cut or tear
30
What is a keloid?
Complication of wound healing resulting in hypertrophic scar formation
30
What is ischemia?
Lack of oxygenated blood supply to an area or organ of the body
31
What is dishinence?
Partial or total separation of a layer or layers of tissue after closure of the wound. Occurs 5-10 days postop in pts w friable tissue. Caused by abd distension, too much tension on the wound, improper suture type. Pt reports popping or tearing associated w coughing, vomiting, or straining. Can result in retrograde infection, peritonitis, or evisceration. Surgery may be required to correct.
32
What does ligated mean?
The placement of a suture tie around a vessel or other anatomical structure for the purpose of constriction (i.e., to control hemorrhage from a blood vessel)
33
What is memory?
The ability of a material to return to its former shape after being moved or manipulated
34
What is a monofilament suture?
Suture that is manufactured from one strand of natural or synthetic material
34
What is packing?
Sterile fine-mesh gauze that is loosely placed in a chronic wound or one that has been left open to heal by second intention
34
What does pliability mean?
The flexibility and/or how easily a material can be bent
34
What is a primary line suture?
Main suture that approximates the wound edges for first intention healing to occur
34
What does PTFE mean?
A synthetic coating used on certain types of nylon suture material to reduce the drag through tissue
34
What is an Rh (Rhesus) Factor?
Antigenic substance found in the erythrocytes in most people. Individuals with the factor are
termed Rh positive, whereas individuals lacking the factor are termed Rh negative. If blood given to an Rh- negative individual is Rh positive, hemolysis occurs, leading to anemia. Due to these factors, blood is carefully typed and cross-matched prior to being administered
34
What is the secondary suture line?
sutures placed to support and
ease the tension on the primary suture line, thus reinforcing the wound closure and obliterating any dead spaces. retention sutures. large-gauge, interrupted, nonabsorbable sutures placed lateral to a primary suture line for wound reinforcement. Bridges. plastic devices
34
What does serosanguinous mean?
Fluid that contains both blood and serum
35
What is a seroma?
Swelling within a tissue or organ caused by the localized accumulation of serum
35
What does swaged mean?
Strand of suture material with an eyeless needle attached by the manufacturer; the needle is continuous with the suture strand
35
What does synthetic mean?
Material that is man-made such as synthetic sutures
35
What is tensile strength?
Amount of pull or tension that a suture strand will withstand before breaking; expressed in pounds
35
What does third intention mean?
Healing that occurs when two granulated surfaces are approximated; also referred to as delayed primary closure
35
What does tissue reaction mean?
Abnormal response of tissue to foreign substances such as suture material
35
What are vessel loops?
Thin strips made of silicone that can be placed around a vessel, nerve, or duct for the purposes of retracting or isolating; the loops are colored for easy identification of the retracted structures. Nerves and ducts are yellow/white. Arteries are red. Veins are blue.
35
What is wound disruption?
General term for the various types of abnormal separation of a surgical wound such as dehiscence and evisceration
35
What does ideal wound healing consist of?
-Restoration of continuity
-Strength
-Function
-Appearance
36
What are some methods in which hemostasis is obtained?
-Clot formation
-Vessel Spasm
-Mechanical Pressure
-Ligation
-Applying hemostatic agents
-Thermally
37
What happens when a vascular injury occurs?
-Endothelial cells interact with platelets and clotting factors to form a blood clot
-Coagulation occurs (hemostatic process begins in order to stop the flow of blood
38
What are the steps of coagulation?
1. Brief vasoconstriction
2. Inflammation/vasodilation
3. Platelets adhere to subendothelium and forms plug
4. Platelets release ADP, serotonin, and epinephrine (makes more platelets adhere)
5. Plate aggregate (white cell thrombus) forms
6. Prothrombin + thromboplastin = thrombin. Thrombin + fibrogen = stable blood clot.
39
Why is blood loss measured intraoperatively?
Provides info to surgeon/anesthesia abt pt status and potential blood/auto transfusion. EBL is charted by circulator.
40
How is estimated blood loss determined?
-Calibrated suction canisters (EBL = Volume in canister - Irrigation fluid)
-Blood sponges (wet weight-predetermined weigh)
-Sponges can be visually assessed by surgeon
41
What are some factors that can affect hemostasis?
Congenital hemostatic factors: Hemophilia (clotting deficiency)
Acquired hemostatic factors:
-Liver disease
-Anticoagulant therapy (for DVT, PE, stroke)
-Aplastic anemia (bone marrow disorder)
-Drug therapy (Aspirin; should be stopped one week prior)
42
What are some methods of mechanical hemostasis?
Hemostatic instrument: compress walls of vessel
-Ligatures: Ties for ends of vessels. Synthetic v natural. Dissolvable v nodisolvable. Monofilament. Smallest diameter suture use as possible.
-Clips: Placed at end of vessel. Made of nonreactive metal (titanium, stainless steel). Dissolvable v permanent.
-Sponges: apply pressure and absorb extra fluid
-Pledgets: small squares of Teflon used as buttresses over suture line
-Bone wax: Sterile beeswax to seal edges of bone. Use sparingly. Knead prior to use
-Tourniquets
-SCDs
43
What are some methods of obtaining biological hemostasis?
-Fibrin Glue
-Bioglue
44
What is Fibrin Glue?
-A biological adhesive that produces fibrin to form a clot.
-Consists of fibrinogen/cryoprecipitate (syringe 1) derived from human plasma, calcium chloride/thrombin (syringe 2) and administer at the same time
-Can be liquid or spray.
-Used for approximating wound edges, fixating ocular implants, meddle ear reconstruction, tack down for surgical mech, and nerve/micro surgery anastomosis.
-One type is autologous of homologous plasma which should be warmed to 98.6 degrees.
-Another is pooled doned plasma which comes from many donors and cleaned but not FDA approved.
-Evicel/Tisseel should be refrigirated 24hrs before use
-Evarrest is the patch form which has a vicryl backing
45
What is Bioglue?
-Made of albumen and glutaraldyhyde
-Used to adhere tissue/tissue, tissue/graft, and graft/graft
-Creates flexible seal independent of body (used in CV cases)
46
What are some methods of obtaining thermal hemostasis?
-ESU
-Lasers
-Argon Plasma Coagulation: Argon gas w monopolar electrical energy. Little to no tissue adherence.
-Ultrasonic/Harmonic Scalpel
47
What are some methods of obtaining chemical hemostasis?
-Absorbable gelatin (Gelfoam®)
-Absorbable collagen (Avitene®)
-Microfibrillar collagen
-Oxidized cellulose (Nu-Knit®; Surgi-Cel®)
-Silver nitrate
-Epinephrine
-Thrombin
48
What is absorbable gelatin and what are some components of it? (Gelfoam, Gelfilm, Surgifoam)
-Composed of collagen (porcine)
-Power or foam
-Gelatin in placed over the bleeding area and fibrin is deposited
-Can be soaked in thrombin, epi, and saline (enhances flexibility)
-Prevents tissue adhesion
-Absorbed by body in 30 days
49
What is hemostatic matrix and what are some components of it? (Floseal, Surgiflo)
-Absorbable gelatin granules w topical thrombin
-Long, flexible tip for hard to reach bleeding areas (sponge should be used to press against matrix material for several minutes)
-Slightly expands for compression
-Excess is absorbed w suction and irrigation
50
What is microfibrillar collagen and what are some components of it? (Avitene, instat, superstat, collastat, helistat)
-Purified bovine collagen
-Comes in preloaded applicators or compact nonwoven sheets
-Must be kept dry
-4x4 to ensure adherence to wound
-Soluble
-Excess is removed to prevent adhesions
51
What is oxidized cellulose and what are some components of it? (Surgicel, Nu-Knit, Fibrillar, sNoW
-Plant waste high density pads or low density woven fabric
-Spread over large, oozing areas which turns into gel as it soaks up blood
-Held in place until bleeding stops
-Topical thrombin inactivates it
-Powder form is Arista
52
What is Silver Nitrate and what are some components of it?
-Used for cervical/nasal or burn tissue
-Comes in a stick or solution
-Not used on the face bc it temporarily blackens the area
53
What is epinephrine and what are some components of it (relating to hemostasis)
-A potent vasoconstrictor that is used w local agents or Gelfoam for hemostasis
-Absorbed rapidly but provides good hemostasis
-Contradicted in eyes, ears, nose, fingers, penis, and toes
54
What is thrombin and what are some components of it?
-An enzyme that results from activation of prothrombin
-Topical (NEVER injected)
-Bovine
-Can be sprayed, poured, or directly applied
-Can be soaked in Gelfoam pad or collagen/cottonoid sponge
-Should be discarded after 3 hours bc it loses patency
55
What are some factors of blood replacement?
-Used when blood loss is too great to be controlled by intraop hemostatic procedures
-Determined by surgeon and anesthesia
-Used especially in CV and prostate surgery
-Can be homologous which should be blood typed to prevent transfusion reactions
-Can be autologous which was previously donated by pt and obtained through autotransfusion (cell saver)
56
What are common blood components?
Whole blood: All components of blood; used to treat hemorrhage from trauma
Packed Red Blood Cells (PRBC's): RBC's from a unit of blood after most plasma is removed; Used to restore O2 carrying capacity
Fresh Frozen Plasma (FFP): Fluid component of blood containing clotting factors; Used to restore clotting factors I:4 ratio w RBC's
Platelets: Platelets from a unit of blood; Used to enhance blood's clotting ability when platelets are low.
57
How is blood typed?
Based on the presence/absence of A/B antigens and antibodies
A- A antigens, B antibodies
B- B antigens, A antibodies
O- No antigens, AB antibodies
AB- AB antigens, no antibodies
58
What is the Rh (Rhesus) Factor?
An antigenic factor found in the erythrocytes of most people. Positive has the factor, negative doesn't. If crossed, hemolysis occurs leading to anemia. This is a concern for the second child when the mom is negative and the child is positive bc mom makes antibodies and the baby's body thinks its a threat. This is stopped by a RhoGAM shot.
59
How should blood replacement components be handled?
-Obtained from a blood bank, signed, and brought to OR.
-If not used immediately, should be refrigerated at 1-6 degrees Celsius (33.8-42.8 F)
-Before administration, blood should be identified for proper type and pt by two ppl. Type, Rh factor, and MRN should match pt's wristband and chart. Double check MD order. Check expiration date. Check to make sure there are no clots
-If something is off, return to the blood bank
60
What is autotransfusion and how does it work?
Reinfusion of pts own blood.
-Can be donated prior to surgery or intraop
-Eliminates the danger of a mismatch or disease transmission
-If collected intraop, it is suctioned from wound or rung from sponges into a cell saver which filters and anticoagulants blood and infuses it via IV.
-Cell saver is contraindicated if blood exposed to collagen, gastric/enteric contents, amniotic fluid, cancer cells, PMMA, or infection
-If no cell saver, blood can be collected in bag containing anticoagulant and reinfused or can be collected in sterile blood canister and washed
61
What is a Hemolytic Transfusion Reaction?
-Caused from blood not being matched
-Can be fatal and must be treated ASAP
-S&S in conscious pt include fatigue, tachy, SOB, jaundice, pallor
-S&S for unconscious pt include general blood loss and lower O2 sats
-If suspected, transfusion should be stopped immediately. Sample should be sent to lab to r/o mismatch. Drug therapies should begin immediately (steroids). Urine output is monitored to r/o hypovolemia. Pt may need to undergo dialysis.
62
What is a wound and what are the different types?
Any tissue that has been damaged by surgical or traumatic means. Include intentional, unintentional,
incidental (iatrogenic-from treatment), and chronic (ulcers).
63
What are the different types of intentional wounds?
Chemical: chemical is placed on skin to denude or coagulate area (causes inflammation and reepithelialization). most commonly used in plastics
Occlusion banding: Ischemia by the means of banding
Surgical site incision: intentional cut through intact skin to expose underlying structures
Surgical site excision: Removal of tissue
64
How are unintentional wounds classified?
Traumatic injury: sudden onset injuries and can be blunt, penetrating, and burn
Closed wound: skin remains intact but underlying tissue suffers
Open wound: integrity of skin is damaged
Simple wound: skin is compromised but there is no loss or destruction and no foreign body
Complicated wound: tissue is lost or destroyed or there is foreign body
Clean wound: wound edges can be approximated and heals by first intention
Contaminated wound: dirty object damages skin and can become infected. debridement may be needed (I/D)
Delayed full thickness: full extent of tissues caused by industrial accidents including MVA's
-Injuries can be categorized by mechanism of injury. Abrasion, contusion, laceration, puncture, and thermal
65
What is the inflammatory process?
Body's response to injury. Can destroy, dilute, or wall off injured tissue. S&S are pain, heat, redness, swelling, loss of function. Damaged tissues release histamine which causes small vessels to dilate which increases blood flow.
66
How is the type of wound healing determined?
By type and condition of tissue
67
What is first intention wound healing (primary union)
When incision is opened under ideal conditions. Healing occurs side to side and dead space is removed. Wound edges are accurately approximated and there is minimal scarring. Wound tensile strength at 3 months is 70-80%.
68
What is Phase 1 of first intention would healing?
Lag/Inflammatory Phase: 3-5 days. There is inflammation present. Platelets aggregate to slow bleeding (scab is formed) preventing serous and serosanguinous drainage. Macrophages and neutrophils begin phagocytosis of foreign particles. Fibroblasts begin repair of nonepithelial tissue. There is no tensile strength.
69
What is Phase 2 of first intention wound healing?
Proliferation; postop-20 days. Fibroblasts multiply and bridge edges of wound by secreting collagen fibers that form fibers. Capillary network forms by day 3-5 and lymphatic network forms by day 10. There is 25-30% tensile strength.
70
What is phase 3 of first intention wound healing?
Maturation or differentiation: Day 14 to 12 months. Collagen fibers continue to interweave and increases tensile strength. Wound contraction from subcutaneous and dermal myofibroblasts is done within 21 days. Collagen density increases while formation of vessels decreases. A cicatrix forms.
71
What is second intention wound healing? (Granulation)
When a wound fails to heal by first intention. (large wounds that can't be approximated, infected tissue that breaks down tissue, or after removal of large amount of necrotic tissue). Would is left open to heal from deep to superficial. Granulation tissue forms in wound causing closure by contraction. Can form a weak scar that is prone to herniation or proud flesh which protrudes above the edges of the wound.
72
What is third intention wound healing? (Delayed primary closure)
Should be used in wounds that are contaminated or have devitalized tissue. Left open for 3 days to observe for infection. Pt is treated w antibiotics and wound is closed and allowed to heal by first intention. Occurs when two granulated surfaces are approximated.
73
What are some factors that influence wound healing?
Physical condition of the pt: Age, allergic responses, nutritional status, obesity, disease, smoking, immunocompromised
External Factors: Drug therapy, fluid and electrolyte balance, hematology, radiation exposure
Suturing Techniques: SSI, prevention of infection, and intraop tissue handling.
74
What are some possible complications of wound healing?
-Hematoma
-Dishinence
-Edema
-Evisceration
-Exudate
-Gangrene
-Granuloma
-Hemmorhage
-Infection
-Adhesion
-Herniation
-Fistula: abnormal tract between two epithelium-lined surfaces that is open at both ends
-Sinus Tract Formation: abnormal tract between two epithelium-lined surfaces that is open at one end only.
-Suture Complications
-Ischemia
-Keloid
-Seroma
-Wound tension
-Dead Space
75
What are some factors in preventing dishinence?
-Avoid long paramedian incisions but if you have to provide careful closure
-Use uninterrupted, nonabsorbable suture on fascia and provide careful closure
-Use special closing techniques on abd and secondary suture line
-Use interrupted, nonabsorbable suture on fascia or retention suture for deficient would healing. Treat systemic problems
-For already present infection, emphasize sterile technique, irrigate wound, close dead space, use monofilament suture. Leave wound open for second intention healing when necesary
76
What are some factors in preventing infection?
-Use scrupulous sterile technique
-Irrigate wound
-Close dead spaces
-Leave wound open for second intention healing if necessary
-Respond proactively to probable infective agents
-Debridge nonviable tissue
-Use hemostatic agents cautiously
-Drain wound properly
-Use proper suturing technique
-Use monofilament tissue
-Remove gross material
77
How does the CDC classify wounds?
Classified according to degree of microbial contamination. Helps to determine expected healing process. Subject to change.
Class I: Clean
Class II: Clean Contaminated
Class III: Contaminated
Class IV: Dirty
78
What is a Class I Wound?
-Primary closure
-No inflammation
-Closed wound drainage device is necessary
-Incision made under ideal conditions
-No break in sterile technique
-No entry to aerodigestive or GU tract.
-Examples include THA, craniotomy
79
What is a Class II Wound?
-Primary closure
-Open/mechanical drainage
-Minor break in sterile technique
-Controlled entry to aerodigestive or GU tract
-Ex includes appendectomy and cholecystectomy
80
What is a Class III Wound?
-Acute inflammation present
-Major break in sterile technique
-Open traumatic wound (less than 4 hours) w retained necrotic tissue
-Entry to aerodynamic and GU tract w major spillage
-Ex is penetrating fx
81
What is a Class IV Wound?
-Perforated organ
-Microbial contamination prior to procedure
-Open traumatic wound (More than 4 hours)
82
What is the goal of postop wound care?
To prevent infection and other complications. May include use of drains w different types of dressings.
83
What are wound drains?
Devices that remove unwanted fluids or gases from the wound. (JP, Hemovac)
84
What are some components of dressings?
-Applied using sterile technique in OR
-Changed if soiled or pt shows signs of infection
-Removed after 48 hours for nonchronic wound closures
-Contaminated wounds are left open and packed with fine mesh gauze.
-Packing is removed after 4-5 days
85
How are suture materials classified?
Classified according to design mean to support healing and hold tissue edges together. Tissue type varies so suture does too. Include inertness, elasticity/pliability, tensile strength, knot strength, barbed, absorbable/nonabsorbable, mono/multifilament, natural/synthetic, and size
86
What tensile strength and diameter is should be picked when choosing suture?
The highest tensile strength for the smallest diameter for tissue selected.
-To minimize tissue trauma
-Minimize the amount of foreign material placed into the body
87
What is inertness?
Means material does not react w tissues. Sutures are treated as foreign bodies and the longer they dwell, the more likely the tissues will react. Range in inertness w stainless steel being inert and monofilament being relatively.
88
What is tensile strength?
How much a strand can be stretched before breaking
89
What are some componenets of absorbable suture?
-Capable of being absorbed by tissue after a given amount of time
-Should be ideally absorbed by the time the tissue is stable (coincides w the time it takes tissue to heal)
90
What are some components of nonabsorbable suture?
-Resists enzymatic digestion and absorption of tissue
-Used when continued strength is necessary
-It is permanent until removed
91
What is barbed suture?
Barbs that extend from the surface of suture and renders it knotless. Includes V-lock and Stratafix
92
What are some components of monofilament suture?
-Made out a single thread like structure
-Relatively inert
-Doesn't harbor bacteria so can be used in infected tissue
-Little resistance when pulled through tissue
-Doesn't hold knots as well as multifilament
-Has a memory so needs more knots and is difficult to remember
93
What are some components of multifilament suture?
-Multiple thread like structures braided or twisted into a single strand
-Exhibits capillarity so should not be used in presence of infection.
-Has greater tensile strength, pliability, flexibility, and knot security
-Is coated to make it pass through tissue easier
94
What are some components of natural suture?
-Comes from naturally occurring substances including cellulose (plant fiber), animal by-products, and animal tissue which include guts and silk.
-Digested by body enzymes that attack the suture and destroy it
-Silk is nonabsorbable but it loses much of its tensile strength in a year and undetected in 2
-Guts are rapidly absorbed
-There is moderate tissue reaction
95
What are some components of synthetic suture?
-Made of polymer from petroleum based products
-Hydrolyzed by the body (water in tissue penetrates strand and break down the fibers)
-Minimum tissue damage (lease is prolene)
96
What are some factors that affect the selection of suture?
-Biological characteristics of suture material
-Healing characteristics of the tissue
-Type of procedure
-Surgeon's preference
-Condition of patient's tissue
-Nature of the disease process
97
What are some things that can modify patient tissue?
-Vitamins
-Proteins
-Dehydration
-Carbohydrates
-Vascularization
-Radiation therapy
-Metabolic factors
-Age of the patient
-Weight of the patient
-Incision relative to fiber direction
-Thickness of tissue at a given time
-Amount of devitalized tissue within a wound
-Edema or induration (hardening and thickening of tissue)
Some tissue is stronger and some heal faster. Fascia and skin are strong but slow healing. GI is weak but heals fast
98
What are some components of plain gut sutures?
Made from collagen from serosa of beef intestine or submucosa of sheep intestine.
Absorption rate: By enzymatic absorption process. 70 days.
Tensile Strength: 7-10 days.
Tissue Reaction: Moderate
Coating: None
Use: Ligating superficial blood vessels and subcutaneous
Color: Yellow
-Absorbed faster in presence of infection
-Not used on tissues under stress
-Not for CV or neuro
-Packaged in alcohol; avoid opening near wound
-Natural
-Monofilament
99
What are some components of Chromic gut suture?
Absorption rate: 90 days
Tensile strength: 10-14 days
Tissue reaction: moderate (less than plain gut)
Coating: None
Use: Ligating superficial blood vessels and subcutaneous
Color: beige or tan
-Can be treated w chromium to prolong absorption rate
-Not used on tissues under stress, neuro, or CV
-Packaged in alcohol
-Natural
-Monofilament
100
What are some components of Polydioxanone (PDS II)?
Polyester polymer suture
Absorption rate: By hydrolysis. Minimal until day 90. Complete after 6 months
Tensile Strength: 70% at two weeks, 50% at four, and 25% at six.
Tissue reaction: Minimal
Coating: None
Use: all soft tissue including ortho, GYN, eye, plastic, digestive, and peds CV
Color: clear, blue, violet
-Not for neuro, adult CV, microsurgery, and prosthetics
-Low affinity for microbes
-Pliable
-Good memory
-Synthetic
-Monofilament
101
What are some components of PDS Plus Antibacterial suture?
Absorption rate: by hydrolysis. 183-238 days
Tensile strength: 60-80% at two weeks, 40-70% at four weeks, 35-60% at six weeks
Tissue reaction: minimal
Coating: None
Use: all soft tissue including ortho, GYN, plastic, digestive, and peds CV
Color: undyed, violet
-Impregnated w antibiotic.
-Not for neuro, adult CV, microsurgery, and prosthetics
-Low affinity for microbes
-Pliable
-Good memory
-Synthetic
-Monofilament
102
What are some components of Poliglecaprone 25 (Monocryl)?
Copolymer of glycolide and epsilon-caprolactone suture
Absorption rate: 91-119 days
Tensile strength: undyed is 21 days, dyed is 28 days
Tissue reaction: Minimal
Coating: none
Use: soft tissue approximation or ligation
Color: undyed, violet
-Undyed should not be used of fascia
-Should not be used on CV, neuro, eye, and microsurgery
-Good knot security
-Good pliability
-Monofilament
-Synthetic
103
What are some components of Monocryl Plus Antibacterial suture?
Absorption rate: hydrolysis. 91-119 days.
Tensile Strength: 14 days
Tissue reaction: Minimal
Coating: None
Use: soft tissue approximation or ligation
Color: undyed, violet
-Impregnated w antibiotic
-Undyed should not be used of fascia
-Should not be used on CV, neuro, eye, and microsurgery
-Good knot security
-Good pliability
-Monofilament
-Synthetic
104
What are some components of Polyglyconate (Maxon)?
Copolymer of glycolic acid and trimethylene carbonate.
Absorption rate: 6mo
Tensile strength: 75% at 2 weeks, 65% at 3 weeks, and 50 at 4
Tissue reaction: Minimal
Coating: None
Use: Soft tissue approximation, peds CV, PV tissue
Color: Undyed, green
-Do not use on adult CV, neural, or microsurgery
-Synthetic
-Monofilament
105
What are some components of Biosyn suture?
Synthetic polyester consists of glycolide, dioxanone, trimethylene
Absorption rate: hydrolysis; 90-100 days.
Tensile Strength: 75% at 2 weeks, 40% at 3 weeks
Tissue reaction: Minimal
Coating: None
Use: soft tissue approximation, ligation, and eyes
Color: undyed, violet
-Good knot security
-Minimal memory
-Gradual encapsulation by fibrous CT
-Not for CV or neuro
-Synthetic
-Monofilament
106
What are some components of Caprosyn suture?
Absorption rate: hydrolysis; 56 days
Tensile Strength: 50-60% at 5 days, 20-30% at 10 days, none at 21 days
Tissue Reaction: minimal
Coating: None
Use: soft tissue approximation and ligation
suture color: undyed, violet
-good knot security
-rapid absorption
-not for eye, CV, neuro, and microsurgery
-monfilament
-synthetic
107
What are some components of vicryl (polyglactin 910)?
Copolymer of glycolide and lactic acid
Absorption rate: hydrolysis; 50-60 days (minimum 40 days)
Tensile Strength: 6-0 and larger is 75% at 2 weeks, and 50% at three weeks. 7-0 and smaller is 40% at 3 weeks.
Tissue Reaction: minimal
Use: Tissue that needs long term tensile strength but also need absorbable suture. Soft tissue approximation and ligation.
Color: violet
-Good knot security
-Uncoated monofilament can be used for eyes
-No memory
-Synthetic
-Multifilament
108
What are some components of coated Vicryl?
Absorption rate: 56-70 days (40 minimum)
Tensile strength: 75% at two weeks. 6-0 and larger 50% at 3 weeks. 4-0 an smaller 40% at 3 weeks.
Tissue reaction: Minimal
Coating: polyglactin 310 and calcium stearate which is absorbable, adherent, and lubricating.
Use: soft tissue approximation, ligation, and eye
Color: undyed, violet
-Also available in monofilament
-can be used in presence of infection
-avoid use for neuro and CV
-conjunctiva sutures should be removed within 7 days to avoid irritation.
-Synthetic
-Multifilament
109
What are some components of Vicryl plus?
Absorption rate: 56-70 days
Tensile Strength: 4 weeks
Tissue reaction: Minimal
Coating: yes
Use: soft tissue approximation, ligation. not for eye, CV, and neuro
Color: undyed, violet
-braided
-Synthetic
-Multifilament
110
What are some components of Dexon (polyglycolic acid) suture?
Homopolymer of glycolic acid.
Absorption rate: 30 days
Tensile strength: 50% at 21 days
Tissue reaction: minimal
Coating: may or may not be coated
Use: tissue where you want absorbable and good tensile strength. soft tissue approximation and ligation (including eyes)
Color: beige, green
-comes in monofilament and braided
-braided should not be used for neuro or CV
-synthetic
-monofilament
111
What are some components of polysorb suture?
copolymer of glycolide and lactide.
absorption rate: hydrolysis 56-70 days
tensile strength: 80% at two weeks, 30% at 3 weeks.
tissue reaction: minimal
coating: mixture of caprolactone/glycolide copolymer and calcium stearoyl lactylate
Use: soft tissue approximation, ligation, and eye
suture color: undyed, violet
-braided
-good knot security
-gradual encapsulation by CT
-not for CV and neuro
-synthetic
-monofilament
112
What are some components of Nylon suture (aka ethilon and dermalon)?
Tensile strength: degrades at 15-20% a year
Tissue reaction: minimal
coating: none
Use: soft tissue approximation and ligation. can be for eye, CV, neuro, and microsurgery
Color: undyed, blue, black, green
-Inert
-Memory makes it so there needs to be more throws in suture
-More pliable when wet
-Gradual encapsulation by CT
-Nonabsorbable
-Synthetic
-Monofilament
113
What are some components of supramid (nylon)?
Nonabsorbable
Tensile strength: Good
Reaction: minimal
coating: none
Use: soft tissue approximation, skin suture, plastics
Color: undyed, black
-Good knot security
-Good handling qualities
-Supramid Extra: cable-type suture made of many fine inner nylon fibers enclosed in smooth nylon outer shell
-synthetic
-monofilament
114
What are some components of Novafil (polybutester) suture?
Nonabsorbable
Tensile strength: excellent
Tissue reaction: minimal
Coating: none
Use: tissues that require long term tensile strength, running subcutaneous, vessel anastomosis
Color: Undyed, blue
-Great ability to stretch in response to given load
-Monofilament
-Synthetic
115
What are some components of Prolene (polypropylene) suture?
Nonabsorbable
Tensile strength: excellent
Tissue reaction: least reactive of synthetic materials
Coating: none
Use: frequently used in general, ortho, plastic, CV, and neuro cases. top choice for vessel anastomosis
Color: Clear, blue
-Useful in contaminated and infected wounds
-Does not adhere to sutures (pull-out suture)
-Commonly used as mesh for tissue reinforcement
-Monofilament
-Synthetic
116
What are some components of Polytetrafluoro-ethylene suture?
Nonabsorbable
Tensile strength: excellent
Tissue reaction: None
Coating: None
Use: soft tissue approximation, bone grafting, soft tissue implants, plastics
Color: White
-Good knot security
-Monofilament
-Synthetic
-Excellent handling
-No memory
117
What are some components of 316L stainless steel-chromium and nickel alloys suture?
Nonabsorbable
Tensile strength: indefinite
Tissue reaction: minimal
Coating: none
Use: abd wound closure, hernia repair, sternal closure, cerclage, tendon repair, bone repair, respiratory sutures, retention sutures
Color: silver
-Most inert
-Can be used in presence of infection
-Should not be used in presence of other types of metal protheses or implants
-Can be braided
-Can be twisted w wire twisters rather than tied
-Should be cut w wire cutters
-Should not be used if pt is allergic
-Synthetic
-Monofilament
118
What are some components of goretex suture?
Nonabsorbable
Tensile strength: Excellent
Tissue reaction: Minimal
Coating: None
Use: anastamosis of vascular grafts, mitral valve repair, chordae tendinae repair, carotid endarterectomy, hernia repairs, pelvic floor repairs, robotic surgery
Color: white
-Micropourous
-Offers benefits of mono and multifilament sutures
-Excellent handling
-Good knot security
-No memory
-Sizing is different from USP; sizing is prefix “CV” with number, CV-8 is smallest and CV-0 is largest
119
What are some components of surgical silk suture?
Absorption rate: very slow, not detected for 2 years so listed as nonabsorbent
Tensile strength: Loses most by a year
Tissue reaction: less than plain gut, more than synthetics
Coating: waxes or silicone
Use: serosa of GI tract and suture ligatures
Color: undyed, black
-Available twisted and braided
-do not use in presence of infection
-Contraindicated for use in urinary and bile tracts
-No memory
-Used dry
-Natural
-Multifilament
120
What are some components of Ethicon suture?
Nonabsorbable
Tensile strength: Excellent but declines over time
Tissue reaction: minimal
Coating: Polybuti-late; PTFE; and silicone coatings to reduce tissue drag
Use: soft tissue approximation when strength is needed. used in neuro, eye, and CV surgery
Color: undyed, black, green
-Excellent knot security
-Gradual encapsulation of CT
-Synthetic
-Multifilament
121
What are some components of Bralon (nylon) suture?
Absorption rate: Nonabsorbable
Tensile strength: Excellent
Tissue reaction: Minimal
Coating: Polybutylene
Use: Used w endostitch
Color: undyed, black
-braided
-Synthetic
-Multifilament
122
What are some components of Mersilene suture (Polyethylene terephthalate)?
Absorption rate: Nonabsorbable
Tensile strength: excellent
Tissue reaction: Minimal
Coating: none
Use: General soft tissue approximation and/or ligation; eye, CV, and neurologic surgery; respiratory tract
Color: Undyed, green
-Braided
-Gradual encapsulation by CT
-Excellent knot security
-10-0/11-0 used for eye
-Multifilament
-Synthetic
123
What are some components of ethibond? (Polyethylene terephthalate coated with polybutilate)
Absorption rate: nonabsorbable
Tensile strength: excellent
Tissue reaction: minimal
Coating: Polybutilate
Use: general soft tissue approximation, ligation, closing incisions of the heart, tendon repair, eye, and neurosurgery
Color: undyed, green
-Braided
-Gradual encapsulation by CT
-Multifilament
-Synthetic
124
What are some components of Dacron suture?
Made of polyester fibers
Absorption rate: nonabsorbable
Tensile strength: Excellent
Tissue reaction: minimal
Coating: can be coated
Use: soft tissue approximation, respiratory tract, and CV procedures
Color: undyed, green
-Good knot security
-Pliable
-Braided
-Uncoated will drag through tissue
-Multifilament
-Synthetic
125
What are some components of Ti-Cron suture?
Made of polyethylene terephthalate
Absorption rate: Nonabsorbable
Tensile strength: Excellent
Tissue reaction: Minimum
Coating: uncoated or w silicone
Use: soft tissue approximation, ligation, eye, CV, neuro
Color: White, blue
-Braided
-Excellent w prosthetic implants
-Good knot security
-No contraindications
-Gradual encapsulation by CT
-Multifilament
-Synthetic
126
What are some components of Tevdek suture?
Made of polyester.
Absorption rate: nonabsorbable
Tensile strength: Excellent
Coating: PTFE
Use: soft tissue approximation, ligation, eye, ortho, CV, neuro
Color: white, green
-Inert
-Good knot security
-Easily handled
-Multifilament
-Synthetic
127
What are some components of Polydek suture?
Nonabsorbable
Tensile strength: Excellent
Tissue reaction: Minimal
Coating: PTFE
Use: soft tissue approximation, ligation, eye, ortho, CV, and neuro
Color: white, green
-Inert
-Good knot security
-Easily handled
-Multifilament
-Synthetic
128
What are some components of fiberwire suture?
Nonabsorbable
Tensile strength: excellent
Tissue reaction: minimal
Coating: silicone
Use: ortho, soft tissue repair (rotator cuff)
Color: black
-Good knot security
-Braided
-Easily handled
-Multifilament
-Synthetic
129
What are some components of Stratafix suture?
Absorption rate: short term is 90-120 days, long term is 120-180 days
Tensile Strength: Short term 1-6 weeks, long term is 4-6 weeks
Tissue reaction: minimal
Coating: none
Use: soft tissue approximation, laparoscopic, and robotic procedures
Color: undyed, violet
-Knotless tissue control device
-Can be absorbable and nonabsorbable
-Spiral anchor provides hold in tissue
-Barbed
130
What are some components of V-loc suture?
Absorption rate: short term is 90-110 days, long term is 180
Tensile strength: short term is 1-6 weeks, long term is 4-6 weeks
Tissue reaction: minimal
Coating: none
Use: soft tissue approximation
Color: undyed, blue, green, violet
-Knotless tissue control device
-Can be absorbable and nonabsorbable
-Spiral anchor provides hold in tissue
-Barbed
131
How are sutures sized?
-Diameter of the suture is the gauge
-Starts at #5 and ends at 12-0 (the more 0's, the smaller)
-Length ranges from 5-59 inches
-Stainless steel suture is measured in Browne and Sharpe (B&S) commercial wire gauge
132
What size sutures are commonly used with certain tissues?
-Most common is 4-0 to 1
-0 to 1 is commonly used for ortho and abd fascia
-3-0 to 4-0 is common for skin
-4-0 to 5-0 is for aortic anastomosis and dura
-6-0 to 7-0 is common for small vessels
-8-0 to 11-0 is for microvascular and eye
133
How is tensile strength chosen?
The tensile strength of the suture should be equal to the tensile strength of the tissue. The smaller the suture, the weaker the tensile strength
134
How are sutures packaged?
Come in dispenser boxes with 1-3 dozen.
The box will have the lot number, surgical application, product code, needle point geometry, suture length and color, expiration date, shape and quantity of needles, and metric length and diameter
The primary suture package will have the product code, number, material, size, and needle type/number
135
What are some components of surgical needles?
-Used to insert suture material into tissue
-Available in variety of shapes, diameter, and sizes
-Made of steel and should be rigid enough to not bend or break when suturing
-Should be smooth and free of any burs and corrosion
-Described in terms of the: eye, body, and point
136
What are some components of needle eyes?
The portion of the needle where the suture is attached
Swaged (eyeless): causes least amount of tissue damage, the suture is inserted into the hollow end and crimped
Single (swaged): for interrupted or continuous suturing. suture completely fills the holes made by the needle
Double armed (swaged): needle is swaged to each end of the suture. for anastomosis of vessels
Permanant/Controlled Release/Pop off: quick pull for rapid, efficient placement of interrupted sutures
Closed: Hole in the body to load the suture; provides more variety but more damage
137
What are some different needle points?
Cutting: for tough tissue (sclera, tendons, skin). cuts the skin as it penetrates
Conventional: Three cutting edges,
triangle. Cuts in direction of pull
Reverse cutting: Upside down tri-angle. Flat edge on pull. Less tearing. Used on skin
Side cutting: For ophthalmic. Doesn’t penetrate deep. Separate tissue layers
Tapered: Round shaft w no cutting edge. Penetrates tissue w/o cutting. For delicate tissue
Taper cut (ground point wire): Starts cut at point. Round body. For vascular tissue or mesh grafts (penetrates w minimal damage)
Blunt: Round shaft with a blunt point. For weak, pulp tissues like the kidneys and the liver.
138
What symbols represent what points?
Circle (shaded): Taper point
Circle (not shaded): Blunt taper
Triangle: Cutting edge
Upside down triangle: Reverse cutting edge
Peace sign: Tapercut
Upside down trapezoid: Spatula curved
139
What are some components of needle bodies?
Between the strand and the point. Heavier tissues need heavier bodies. Shape determines how it is used. Length is determined by bite There are:
-Straight (Keith)
-1/4 circle
-3/8 circle (for micro, skin, and retention)
-1/2 circle
-5/8 circle
140
What are ligatures (ties)?
Used to occlude vessels or control hemorrhage during organ/extremity removal. Come in precut suture (18, 24, and 30"), Full length suture (54" for absorbable and 60" for nonabsorbable), and a radioopaque reel.
141
What is the order for applying ties?
Clamp-clamp-cut-tie
1. Vascular clamp
2. Vascular clamp
3. Tissue scissor
4. Suture tie
5. Remove clamp
6. Suture scissor
7. Suture tie
8. Remove clamp
9. Suture scissors
142
What are free ties?
Precut ties that are removed as single strands or cut to size by the CST and placed in the open hand of a surgeon. Ligatures can be placed around a kelly after being affixed to the vessel. After the first knot is thrown, the clamp is removed and the knot is secured w a surgeon's knot. Suture is then cut (1/4" for monofilament and 1/8" for multi)
143
What is a ligature reel?
Used to occlude superficial bleeders. Most common materials are chromic, plain gut, vicryl, and silk in 2-0, 3-0, and 4-0 which is indicated by the number of holes on the side of the reel. They are radioopaque and are included in the count to prevent loss. You should pull 2-3 inches so the surgeon does not have to find the suture.
144
What is an instrument tie (Tie on a pass)?
Ties are loaded onto a clamp to place on a vessel deep in the wound. (curved kelly, tonsil, right angle, adson)
145
What is a suture ligature (stick tie)?
Used to occlude large vessels in order to prevent slippage. They are sutures w swaged, atraumatic needles which is used to place a figure 8 stich after a kelly is clamped. The ends are brought around the clamp so the vessel is double ligated. 18" for superficial bleeders, 27" for deeper vessels. 2-0 and 3-0 are the common sizes but silk is common.
146
How should suture be prepped for the procedure?
-Look at DPC for routine sutures and consult the surgeon for any variations.
-Only open as many as needed (leftovers have to be thrown)
-Sutures are then counted and organized. Ligature reels should be on the mayo w extended end. Free ties should be opened w strands protruding for easy access. Long free ties can be organized in a towel roll. If hemorrhaging is expected, load stick ties and place on sharp zone of mayo.
-Preload sutures in order of use for routine procedures. Know procedure and listen to surgeon/assistants.
-Remaining suture can be left unopened in order of use on back table's sharp zone.
147
How is suture loaded?
-Needle holder is chosen based off of surgeon preference, size of needle, and depth of wound.
-Needle holder is then clamped 1/3 of the way from the swaged end (1/2 for tough tissue but never on swaged end bc it is weak)
-Modern suture packets allow CST to load w/o touching needle
148
What are some suturing handling techniques?
-Straighten monofilaments w a gentle pull.
-Do not pull plain/chromic gut (could fray)
-Nylon sutures should be drawn between gloves to remove memory
-Take care when straightening pop off needles
-Don't place tension on swage (weakest part)
-Avoid crimping suture w instruments
-Keep the guts away from heat and water (flammable and rapidly absorbable)
-Keep silk dry
-Don't bend stainless steel wires
149
How should suture be passed?
-Surgeon receives the needle holder with needle pointed towards chest. CST controls end of suture to prevent contamination and snagging. (forceps can be used to help).
-Surgeons places and CST receives from the neutral zone. Needles should be inspected before reuse.
-Sharps container should be used during case
-Needles are properly disposed of after the case.
150
How is suture cut?
Usually by CST w a straight mayo.
1. Use dominant hand. Place index on screw joint.
2. Scissors are slightly opened and the tip of one blade is placed on the suture, slid down to the knot and cut w the tips
-Ideally CST will see knot but not possible in deep wounds.
-Cut close to the knot unless surgeon says leave a longer tail
151
What is the order for closing the layers of the abdominal wall?
1. Peritoneum
2. Facia
3. Muscle
4. Subcutaneous
5. Subcuticular
6. Skin
152
What are some ways to eliminate dead space?
1. Meticulous closure/approximation of layers
2. Pressure dressings
3. Wound drains
153
How is the peritoneum closed?
Very fast healing. An absorbable 3-0 suture is frequently used but it is often closed with the fascia.
154
How is the fascia closed?
This provides the most strength and support in the abdomen, if other layers are not closed this one must. Heals very slow. Interrupted, heavy-gauge, nonabsorbable multifilament suture is preferred. If absorbable is used, it should have high tensile strength. Polypropylene surgical mesh may be sutured in for weak fascial layers.
155
How should muscle be closed?
They are rarely cut and usually retracted instead. Do not tolerate suture well. If they are needed, they are approximated with interrupted, loose, absorbable suture.
156
How should the subcutaneous layer be closed?
Fatty layer of tissue under the skin (aka SubQ/Hypodermis). Does not tolerate suture well. Some surgeons place a few interrupted sutures to prevent dead space (esp in obese pts). Plain gut is most common.
157
How is the subcuticular layer closed?
Tough layer of CT below the epidermis and above subQ. Closed to minimize scarring. Short, lateral stitches are placed either interrupted or continuous. Absorbable sutures are preferred. Steri strips are used in conjunction.
158
How is skin closed?
Interrupted or continuous monofilament, nonabsorbable sutures on a cutting needle, or with stainless steel staples (skin stapler). Polypropylene or nylon are preferred but staples are more inert. Wound will scar more.
159
How are vessels anastomosed?
With a non-absorbable, monofilament, double-armed, tapered, synthetic suture.
160
What is a continuous (running) suture?
A single strand of suture that places a series of stitches for closure of long incisions. Strand is tied at the beginning and end. Even tension should be distributed along the whole suture; this is achieved by an assistant "running/following" by holding lower quarter of suture taut. Contraindicated for infection and tissue under great stress.
161
What is a simple continuous suture?
For long, straight wounds where edges easily evert. Simple suture is placed and tied off then sutures are placed at equal distances. Final throw is not pulled all the way through since tie is done w the loop end of suture. CST follows.
162
What is a continuous locking (blanket) suture?
Suture is locked prior to placement of the next. First and last ties are the same. Suture is loop through opening and pulled into place before next throw. Results in increased edge eversion and reduces skin tension.
163
What is a subcuticular suture? (continuous)
A single suture technique is thrown at the ends of the wounds. Sutures are then placed in the subQ in short lateral throws. Wound is then reinforced w steri strips or dermabond. For pts prone to keloids.
164
What is a purse string suture? (continuous)
A drawstring suture is placed in a circular fashion and pulling on the ends tightens it. Usually for appendectomies or in the right atrium to introduce cannulas for cardiopulmonary bypass
165
What is an interrupted suture?
Used for tissues under tension (fascia/tendons) and infected tissues.
166
What are Halsted's Principles of Suture Technique?
-Interrupted sutures should be used to promote greater strength along the wound; each suture should be tied separately
-Interrupted sutures are a barrier to infection
-Sutures are as fine as is consistent with security. A suture stronger than the tissue in which it is placed is unnecessary.
-Sutures should be cut close to the knots. Long ends can increase tissue inflammation and irritation.
-A separate needle should be used for each skin stitch.
-Dead space in the wound is prevented
-Two fine sutures are used instead of one large suture.
-Silk material should not be used for infection.
-Undue tension should not be placed on the tissue by the suture to avoid strangulation of the blood supply.
167
What is a simple interrupted suture?
Each stitch is individually placed, cut, and tied for the length of wound. Wound edges are approximated and everted.
168
What is a Figure of 8 Stick Tie suture? (Interrupted)
Tissue or vessel to be tied is held in a hemostat. The first throw is a surgeon’s knot. Suture is then passed back and forth through the tissue around the two sides of the clamp in a figure-8 fashion and the suture is tied. Used to occlude large vessels and prevent slippage.
169
What is a figure of 8 Mattress Suture? (Interrupted)
A mattress stitch that forms a figure 8 around the wound. Usually horizontal. Eases tension on wound w unidirectional pull. Used to suture tendons.
170
What is an interrupted vertical mattress suture? (Interrupted)
Two bite suture technique. First bite is placed close to the wound edges, second is places slightly behind and deeper. Needle comes out the side the first bite was placed. Used for deep wounds and provides excellent eversion and approximation.
171
What is a horizontal mattress suture? (Interrupted)
Two bite technique. Stiches are placed parallel on each side of the wound. First bite is a simple suture, second bite is parallel to the first and travels across wound edge to the same side as first bite. Used for deep wounds and skin approximation.
172
What is a buried suture? (Interrupted)
Knot is under the layer being closed and does not project out. Can be done at the beginning or ending knot of a continuous suture.
173
What are traction sutures?
Used to retract a structure that can't be easily retracted retractors (tongue, myocardium). Nonabsorbable suture is placed through or around the structure and a hemostat clamps the ends and pulls them out of the operative site.
174
What is a retention suture?
Large gauge, nonabsorbable sutures placed lateral to primary line suture for wound reinforcement. May be placed through all layers of tissue. Used when surgeon thinks wound will not heal properly or slowly. Prevents wound disruption from pressure.
175
What are the two methods of endoscopic suturing?
Extracorporeal: Creating knot outside of body before introducing instruments through trocar. Common method is forming extracorporeal slip locking knots with subsequent transfer of the knot to the tissue site
Intracorporeal: Instruments are introduced to internally suture and knot. (Endostitch, Endoloop)
176
What are bolsters?
Plastic, rubber tubing, or cotton that keeps retention sutures from cutting into skin. Red rubber catheter cut up keeps the costs down.
177
What are suture anchors?
Used for fixing tendons/ligaments to bone. Contains a screw which can be made of metal or an absorbable material. Contains an eyelet for the suture to pass through.
178
What are adhesive skin closure tapes (Steri Strips)
Strips made of nylon or polypropylene to reinforce a wound where subcutaneous tissue is closed. May require mastisol. Available in 1/4, 1/8, and 1/2" widths.
179
What are atrial/venous cannulas?
Used to introduce an indwelling catheter. Atrial can be used to get ABGs, monitor arterial BP, and introduce angioplasty/diagnostic catheters over guidewires. Angio-cath is used to introduce fluids/meds (IVs)
180
What are heparin needles?
Attached to the syringe to irrigate open arteries with saline-heparin solution.
181
What are irrigation needles?
Small diameter cannulated tubes attached to a plastic needle hub for placement on a syringe. Available straight and angled, nondisposable and disposable, and in various lengths. Used in eye and microsurgery
182
What are biopsy needles?
Used to obtain tissue samples for bx. Sometimes guided w CT or fluoroscopy. There are different types.
Dorsey: cerebral tissue through a burr hole
Chiba: lung tissue through the chest wall
Franklin-Silverman: trap door for liver or other organs
Tue-cut: a cutting canula to facilitate insertion into tissue. a stylet allows multiple samples to be taken. Usually 14-18 gauge and is 3-6". Some brands allow a leur lip syringe for aspiration when the Stylet is removed.
-Bx needles attached to syringe can aspirate fluid from a cyst or abscess. Very small can obtain breast lesions, lymph nodes, and other shallow tissues.
183
What are spinal needles/cannulas?
3-4" long w a sharp, beveled stylet within a metal cannula. Usually used to introduce anesthetic agents into the epidural or subdural space or to obtain cerebral spinal fluid.
184
What is the wound/surgical zipper?
Noninvasive, atraumatic device for skin closure. Combines a zipper and two lateral adhesive strips. Adhesive strips are placed on each side of the incision. When zipper is closed it approximates the edges. Zipper should be 3-4 inches longer than the wound. Eliminates needle holes, sharps injuries, and is faster.
185
What is cyanoacrylate? (Demabond)
Synthetic adhesive dispensed in a pencil-like button or a small brush. Takes 2 minutes to dry. Provides a strong, flexible wound closure and naturally wears off in 7 to 10 days. Contraindicated for infections pts allergic to cyanoacrylate or formaldehyde.
186
What are bridges?
Plastic devices that bridge the closed incision. Retention suture ends are brought up through holes on each end of the bridge and tied at the middle. A circular tightening device on the bridge allows tension to be adjusted on the retention sutures
187
What are button and lead shots?
Tendon sutures may be pulled through buttonholes and tied over a button to prevent tissue damage. Split lead shots may be clamped onto the ends of subcuticular sutures after skin closure.
188
What is umbilical tape?
Used to retract and isolate bowel, vessels, nerves, and ducts. Usually packaged with two strands in a pink packet and is best used moistened with saline and loaded onto a hemostat
189
What is negative pressure wound therapy?
Look at ch 10 cards
190
What are some components of staples?
-Made of stainless steel, titanium and absorbable polysorb.
-Designed to form a noncrushing B shape to allow blood to pass through the lines of staples preventing tissue necrosis and promoting healing
191
What is the difference between disposable and nondisposable staplers?
Reusable:
-not as accurate as disposable.
-loaded by CST preop.
-disassembled and cleaned
Nonreusable:
-Preassembled, packaged, and sterilized by the manufacturer.
-Has integral or reloadable color-coded staple cartridges so a new one is not needed every time the staple is fired.
192
What are the advantages and disadvantages of staples?
Advantages:
-less reactive
-accelerated healing
-reduced OR time
-efficient leak-proof line (airtight)
-placement through a trocar
Disadvantages:
-Cost
-Precision. Errors are not easily reversed
193
What can staples be used for?
-Biopsy
-Ligation
-Resection
-Skin closure
-Anastomosis
-Facial closure
-Division of tissue
-Closure of organs
194
What are some components of the skin stapler?
Used to approximate skin during closure. Come with 5-35 wide and regular staples. Surgeon everts and approximates the tissue w Adsons w teeth and fires staple. Can also be used for fascia.
195
What is the linear stapler (transverse anastomosis-TA)?
Used for the digestive and thoracic cavity. Contains two straight, staggered parallel rows of staples. Comes in variety of lengths. Jaws are placed at the level of transection, stapler is closed, safety mechanism is removed, and staple is activated. Scalpel is used to sever distal tissue.
196
What are some components of the Linear Cutter (Gastrointestinal Anastomosis)?
Staples and transects the tissue. Delivers double staple lines with a knife blade that passes through the two lines. Used for GI procedures w an endoscopic version (EndoGIA)
197
What are Ligating Clips?
Used to occlude small structures like vessels and ducts which is then divided w scissors or a scalpel. Ligaclip applier is disposable. Hemoclip applier is reusable. Clips can be stainless steel, titanium, tanatalum, and absorbable.
198
What are Linear Dissecting Staplers/Ligating Dividing Stapler?
Ejects two ligating clips side by side then divides the tissue between. Used for GI or division of the greater omentum. Rarely used due to only one clip security.
199
What are Intraluminal/Circular Staplers?
Used to anastomose tubular structures in GI tract. Fires a double row of circular staples and then trims the lumen with a knife located within the head of the stapler. Used during resection and reanastomosis of the distal colon or rectum
200
What are some components of mesh and fabrics?
Bridge for tissues that cannot be brought together without placing a great deal of tension on the tissues (fascia repairs). Lattice like structure allows CT to proliferate within the mesh, creating a strong bridge for native tissues.
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What are some advantages of mesh?
-Pliable
-Easy to cut to create the correct size
-Easy to suture into place
-Porous: allow fibrous tissue to grow, strengthening the tissues.
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What are some synthetic meshes?
Polypropylene mesh (Prolene ® mesh): relatively inert material that can be used w infection. excellent elasticity and high tensile strength.
Polyglactin 910 mesh (Vicryl ® Mesh): absorbable material that provides temporary support
Polytetrafluoroethylene (PTFE) mesh (Gore-Tex ® soft tissue patch): This is a soft, flexible material that is not absorbable and should not be used w infection.
Stainless steel mesh: This material is rigid and hard to apply, resulting in discomfort for the patient. most inert of the mesh materials and can be used in the presence of infection or during second intention healing.
Polyester fiber mesh (Mersilene ® mesh): least inert. do not use w infection
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What are some components of biological materials?
Include fascia lata from cow or pts own thigh and in-grown mesh from porcine small intestine submucosa. The mesh facilitates complete tissue remodeling. Mesh is replaced w body’s own tissue, creating permanent repair w/o long-term presence of a foreign body. Maintains tensile strength.
