Chapter 11 pt 2 Flashcards
wound closure
what is the ideal kind of suture to use
highest tensile strength and smallest diameter
what is inertness of suture tissue
doesn’t react with tissue
(not treated as foreign body)
what is the most inert suture you can put in body
relatively inert?
stainless steel
monofilament
what is an absorbable suture like
capable of being absorbed by tissue within giving period of time
should be completely absorbed by the time tissue no longer needs them
what is a nonabsorbable suture like
resists enzymatic digestion of absorption by tissue
permanent until removed
classifications of suture: elasticity and pliability
stretch and bindability, able to withstand movement
classifications of suture: barbed
anchors tissue, can’t back up
v-loc and stratafix
characteristics of monofilament suture
single thread (no bacteria)
doesn’t hold knots well
memory
doesn’t harbor bacteria
relatively inert
characteristics of multifilament suture
braided
capillarity
handle greater tensile strength
coated to pass through tissue easier
two classifications of suture material
natural
synthetic
natural suture material
made out of natural things
guts and silk
digested by body enzymes that attack suture strand and destroy it
tissue reaction: moderate
synthetic suture material
consists of polymer from petroleum based products
hydrolyzed the body
tissue reaction: minimum
factors affecting selection of suture
biological characteristics
healing characteristic of tissue
type of procedure
surgeon specific
MEMORIZE TABLE OF SUTURES IN BOOK
MEMORIZE TABLE OF SUTURES IN BOOK
what is suture size referred as
gauge
who bases what suture guage should be
USP (United States pharmacopeia)
the more Os the smaller the suture
suture size ranges
12-0 to #5
5” to 59” long
most common suture gauge range
4-0 to 1
what size is ortho fascia suture
0-1 g
what size is skin suture
3-0 to 4-0 g
what size are small vessel suture
6-0 to 7-0 g
what size are micro vascular sutures
11-0 to 9-0 g
what size are aorta dura suture
5-0 to 4-0 g
what size of suture is for microvascular and eyes
8-0 to 11-0
what is on the box if it comes with more than two needles
the number of needles Is written in red
anatomy of suture needle
eye (where swaged on), point, body
what causes the least amount of tissue damage
**swagged (eyeless) needles
*what are needle eye *
portion of needle where suture is attached
suture inserted into hollow end and crimped by manufacture
what is double armed needle eye
needle swaged into each end go suture strand
permanent or controlled release (pop off)
able to pull the needle off quickly
French eye needle
pulled through V area
quicker load but most damage
3 types of cutting type needle tips
conventional - triangle, for sclera + skin
reverse - upside down triangle for skin
side - opthalmic, pentagon shaped
what body parts are cutting needle points used for
sclera tendon and skin
what is the benefit of reverse cutting needle tip
more surface area, stronger clamp of skin together
what is the benefit of conventional needle point
less scarring
tapered needle point
round shaft, no cutting edge
delicate tissues (bowel)
Taper cut needle point ( ground point wire needle)
round body
only tip is tapered
vascular tissue or mesh grafts
blunt needle tip
round shaft ending in blunt tip (just dull tipped needle)
weak, pulp tissues- kidney liver
what is length of needle body determined by
the “bit”
deeper tissue (depth of bite) requires longer needle
what is shape of needle body determined by
determined by how it is used
what Is a ligature
a tie
what are ligatures used for
to occlude vessels for hemorrhage control or organ/ extremity removal
three forms of ligatures
precut
full length - cut to size
radiopaque reel
clamp-clamp-cut-tie
1st vascular clamp (Kelly)
2nd vascular clamp (Kelly)
tissue scissor (Metz)
suture tie
- multifilament
- monofilament
how close do you cut multifilament suture tie internal and external
internal: ⅛”
external: on knot for skin
how close do you cut monofilament suture tie internal and external
internal: ¼’
external: ⅛” on skin
what is the order after you cut the suture
remove clamp
suture scissor
suture tie
remove clamp
suture scissor
what is the realistic order of ligatures and suture cuts
clamp - Kelly, mixter
clam- kelly, mixter
cut (vessel) - Metz
tie - 2.0 silk
tie - 2.0 silk
cut - mayo
cut - mayo
what are the main sutures you use as ties
range?
chromic, plain gut, vicryl, silk
2-0 to 4-0
what is the most common instrument for a tie on a pass
tonsil
if shallow, right angle
what is a stick tie
suture ligature with suture needle attached
to occlude large vessels
prevents suture slippage
what do you do for suture preparation for procedures
look at DPC
talk with surgeon bout variations
open only as many as needed
counted and arranged on field
how are abdominal wounds closed
inner layer to outer
peritoneum
fascia
muscle
subcutaneous
subcuticular
skin
three ways to eliminate dead space
meticulous closure of tissue
pressure dressings
wound drains
what type of suture do you use for parietal peritoneum
3-0 absorbable
what provides the greatest support to abd cavity
fascia
what is the layer you ALWAYS HAVE to close
fascia
which two layers do not tolerate suture well
subcutaneous!
muscle
what suture is used for muscle
absorbable multifilament vicryl
what type of suture is used for vessel anastomosis
prolene
non absorbable
monofilament
double armed
taper
SYNTHETIC
suturing technique: primary
approximate would edges for first intention wound healing (side to side)
suturing technique: secondary
support primary suture line
three suture techniques
primary
secondary
endoscopic
what does the tech do during primary suturing
“follows” the suture necessary to maintain tension and keep suture our of surgeons way
contradictions with primary suture technique
not used to close tissue under a lot of tension
not used in presence of infection
what suture do you not use in an infection
multifilament
primary: continuous (running) simple technique
long straight incisions when wound edges easily evert
stitches equal distances apart
even tension
primary: continuous (running) locking (blanket) technique
suture is locked prior to placement of the next throw
increases wound edge eversion and reduces skin tension
primary: continuous (running) subcuticular technique
sutures placed in the sub cuticular in short lateral throws under epidermis
wound reinforced with sterile strips and derma bond
patients prone to keloids
primary: continuous (running) purse string technique
drawstring suture placed in a circular fashion around structure in a way that pulling on the suture ends tightens and closes an opening
constant strong internal pressure: appendectomy
primary: interrupted suture technique
used to close tissues under tension
used to close tissues that are infected
how are stitches placed on primary simple interrupted sutures
each string individually placed
how are stitches placed on a primary interrupted figure 8 stick tie
suture placed through vessel to prevent slippage , then wrapped around vessel
occlude large vessels
how are stitches placed on a primary interrupted figure 8 mattress
forms a figure 8 across wound, unidirectional pull
suture tendons
how are stitches placed on a primary interrupted vertical mattress
2 bit suture technique
when under a lot of tension
approximates well
used for deep wounds
how are stitches placed on a primary interrupted horizontal mattress
2 stitches placed parallel
used when under a lot of pressure
used for deep wounds
approximates well
five kinds of primary interrupted sutures
simple
figure of 8 (stick tie/ mattress)
vertical
horizontal
buried
how are primary interrupted buried sutures placed
knot is located under the layer to be closed an is not projecting outward
what are traction sutures
(retraction sutures)
retract a structure that may not be easily retracted with an instrument
nonabsorbable suture, cut out at end of procedure
- ends are clamped with a hemostat
secondary: retention suture
placed lateral to primary suture to reinforce (wider than primary)
large gauged, bigger than primary
bolsters
plastic rubber tubing that keeps retention sutures from cutting into the skin (padding)
- red rubber Cath keeps cost down
suture anchors
fixing tendons or ligaments to bone
eyelet for suture to pass through
adhesive skin closer strips
(steri strips)
used in epidermal layer when sub cuticular wound closure has been done for good cosmesis
