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Surgical Recall > Chapters 6 & 7 - Sutures And Stitches, Surgical Knot Tying > Flashcards

Chapters 6 & 7 - Sutures And Stitches, Surgical Knot Tying Flashcards

1
Q

What is a suture?

A

Any strand of material used to ligate blood vessels or to approximate tissues

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2
Q

How are sutures sized?

A

By diameter; states as a number of 0’s; the higher the number of 0’s, the smaller the diameter

E.g. 2-0 suture has a larger diameter than a 5-0

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3
Q

Which is thicker, a 3-0 suture or a 1-0

A

1-0 suture

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4
Q

What are the two most basic suture types?

A

Absorbable and non-absorbable

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5
Q

What is an absorbable suture?

A

Suture that is completely broken down by the body (dissolving suture)

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6
Q

What is a nonabsorbable suture?

A

Suture is not broken down (permanent suture)

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7
Q

What are catgut sutures made of?

A

Purified collagen fibers from the intestines of health cows and sheep

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8
Q

What are the two types of gut sutures?

A

Plain and chromic

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9
Q

What is the difference between plain and chromic gut?

A

Chromic gut is treated with chromium salts (chromium trioxide), which results in more collagen crosslinks, making the suture more resistant to breakdown by the body

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10
Q

What is a vicryl suture?

A

Absorbable, braided, and multifilamentous copolymer of lactide and glycoside

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11
Q

How long does vicryl retain its strength?

A

60% at 2 weeks, 8% at 4 weeks

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12
Q

Should you every use purple-colored Vicryl for skin closure?

A

No, it may cause purple tattooing

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13
Q

What is a PDS suture?

A

Absorbable, monofilament polymer of polydioxanone (absorbable fishing line)

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14
Q

How long does PDS maintain its tensile strength?

A

70-74% at 2 weeks, 50-58% at 4 weeks, 25-41% at 6 weeks

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15
Q

How long does it take for PDS to complete absorption?

A

180 days (6 months)

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16
Q

What is silk?

A

Braided protein filaments spun by the silkworm larva; known as a nonabsorbable suture

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17
Q

What is Prolene?

A

Nonabsorbable suture used for vascular anastomoses, hernias, abdominal fascial closure

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18
Q

What is nylon?

A

Nonabsorbable “fishing line”

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19
Q

What is monocryl?

A

Absorbable monofilament

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20
Q

What kind of suture should be used for the biliary tract or the urinary tract?

A

Absorbable, otherwise the suture will end up as a Indus for stone formation

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21
Q

What are the three types of wound healing?

A
  1. Primary closure (intention)
  2. Secondary intention
  3. Tertiary intention (Delayed Primary Closure or DPC)
22
Q

What is primary intention?

A

When the edges of a clean wound are closed in some manner immediately (e.g. suture, Steri-Strips, staples)

23
Q

What is secondary intention?

A

When a wound is allowed to remain open and heal by granulation, epithelization, and contraction

Used for dirty wounds, otherwise an abscess can form

24
Q

What is tertiary intention?

A

When a wound is allowed to remain open for a time and then closed, allowing for debridement and other wound care to reduce bacterial counts prior to closure (i.e. delayed primary closure)

25
Q

What is another name for tertiary intention?

A

DPC (delayed primary closure)

26
Q

What is a taper-point needle?

A

Round body, leaves a round hole in tissue (spreads without cutting tissue)

Used to suture soft tissues other than skin (e.g. GI tract, muscle, nerve, peritoneum, fascia)

27
Q

What is a conventional cutting needle?

A

Triangular body with the sharp edge toward the inner circumference; leaves a triangular hole in tissue

Used for suturing of skin

28
Q

What is a simple interrupted stitch?

A

Each stitch is cut after the knot is complete, before starting the next stitch

29
Q

What is a vertical mattress stitch?

A

Simple stitch is made, the needle is reversed,and a small bit is taken from each wound edge

The knot ends up on one side of the wound

30
Q

What is the vertical mattress stitch also known as?

A

Far-far, near-near stitch; oriented perpendicular to wound

31
Q

What is a vertical mattress stitch used for?

A

Difficult-to-approximate skin edges; everts tissue well

32
Q

What is a simple running (continuous) stitch?

A

Stitches made in succession without knotting each stitch

33
Q

What is a subcuticular stitch?

A

Stitch (usually running) placed just underneath the epidermis, can be either absorbable or nonabsorbable (pull-out stitch if nonabsorbable)

34
Q

What is a pursestring suture?

A

Stitch that encircles a tube perforating a hollow viscus (e.g. gastrostomy tube), allowing a hole to be drawn tight and thus preventing leakage

35
Q

What is a gastrointestinal anastomosis (GIA) device?

A

Stapling device that lays two rows of small staples in a hemostatic row and automatically cuts between them

36
Q

What is a Lambert stitch?

A

It is a second layer in bowel anastomoses

37
Q

What is a Connell’s stitch?

A

The first mucosa-to-mucosa layer in an anastomosis; basically a running U stitch

38
Q

What is a suture ligature (a.k.a. “Stick tie”)?

A

Suture is anchored by passing it through the vessel on a needle before wrapping it around and occluding the vessel; prevents slippage of know-use on larger vessels

39
Q

What is a retention suture?

A

Large suture (#2) that is full thickness through the entire abdominal wall except for the peritoneum; used to buttress an abdominal wound at risk for dehiscence and evisceration

40
Q

What is a pop-off suture?

A

Suture that is not permanently swaged to the needle, allowing the surgeon to “pop off” the needle from the suture without cutting the suture

41
Q

What is the basic surgical knot?

A

Square knot

42
Q

What is the first knot that should be mastered?

A

Instrument knot

43
Q

What is a “surgeon’s knot”?

A

Double-wrap throw followed by single-square knot throws

44
Q

What are the guidelines for the number of minimal throws needed?

A

Depends on the suture material:
Silk - 3
Gut - 4
Vicryl, Devon, other braided synthetics - 4
Nylon, polyester, polypropylene, PDS, Maxon - 6

45
Q

How long should the ears of the knot be cut?

A

Some guidelines are:
Silk vessel ties = 1 to 2 mm
Abdominal fascia closure = 5 mm
Skin sutures, drain sutures = 5 to 10 mm (makes them easier to find and remove)

46
Q

When should skin sutures be removed?

A

As soon as the wound has healed enough to withstand expected mechanical trauma; any stitch left in more than ~10 days will leave a scar

Guidelines:
Face - 3 to 5 days
Extremities - 10 days
Joints - 10 to 14 days
Back - 14 days
Abdomen - 7 days
47
Q

How can strength be added to an incision during and after suture removal?

A

With Steri-strips

48
Q

In general, in which group of patients should skin sutures be left in longer than normal?

A

Patients on steroids

49
Q

How should the sutures be cut?

A

Use the tips of the scissors to avoid cutting other tissues; try to remove cut ends (less foreign material decreases infection risk)

Rest the scissor-hand on the non-scissor hand to steady

50
Q

How is an instrument knot tied?

A

Always start with a double wrap, known as a “surgeon’s knot”, and then use a single wrap, pulling the suture in opposite directions after every “throw”

51
Q

Does a student need to know a one-hand tie?

A

No; master the two-hand tie and instrument tie

52
Q

What is the basic position for the two hand tie?

A

“C” position, formed by the thumb and index finger; the suture will alternate over the thumb and then the index finger for each throw

Lead with the index finger first, then the thumb

Surgical Recall (6 decks)

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