EXAM I Basic Suturing Skills Flashcards
the needle holder is not a ___
hemostat
the beaks of the needle holder have a ___ texture to allow a secure grip of the needle
cross-hatched
what is the proper handling of the needle holder?
thumb and ring finger are inserted through the rings. the index finger is held along the length of the needle holder to steady and direct it. the second finger aids in controlling the locking mechanism.
what is another name for tissue forceps?
adsens
tissue proceps can have pickups with or without ___
teeth
tooth forceps allow tissue to be held more delicately
grasping tissue too tight with tissue forceps can cause what?
the tissue to be crushed
tissue forceps are handled in a ___ fashion
pen grip
the most common suture scissors are the ___ scissors
Dean
suture scissors are held in the same fashion as ___
the needle holder; this provides proper stabilization
what are the most common types of suture needles?
3/8 circle or 1/2 circle cutting needles
allow easy passage of needle through tough mucoperiosteium
the needle is held approximately ___ of the distance between the tip and the base of the needle, suing the tips of the needle holder for best control
2/3
as the suture diameter gets smaller, the number gets ___
larger
think of it like needle gauges - the large the “gauge number”, the smaller the diameter
so a 4-0 suture is going to have a larger diameter than a 7-0 suture
what size suture is commonly used for suturing oral mucosa? which sizes are used for suturing on the face?
- 3-0 for oral mucosa
- 5-0 and 6-0 for the face
braided sutures are also called ___, and non-braided sutures are also called ___
- multi
- mono
what classification of suture material causes a tissue reaction due to enzymatic degradation?
natural
what are 3 examples of natural suture materials?
catgut, chromic gut, silk
all ___ suture materials are absorbable, but only some ___ materials are absorbable
- natural
- synthetic
___ suture materials provide temporary wound support
absorbable
how does absorption of natural vs synthetic suture materials occur? which one causes less tissue reaction?
- by enzymatic degradation in natural materials, and by hydrolysis in synthetic materials
- hydrolysis causes less tissue reaction than enzymatic degradation
what are 4 examples of absorbable suture materials?
catgut, chromic gut (these two are both natural), vicryl, and monocryl (these two are both synthetic)
___ suture material is a single strand
monofilament
monofilament suture materials help avoid ___
infection
this is because it is a single strand and is resistant to harboring microorganisms
___ suture materials provide less resistance to passage through tissue due to their smooth surface
monofilament
why are monofilament suture materials harder to tie?
due to more memory-poor knot security
they are also difficult to handle
what are 3 examples of monofilament suture materials?
polypropylene (prolene), monocryl, and nylon
are synthetic suture materials stronger or weaker than natural ones?
stronger
what are 2 examples of synthetic suture materials?
vicryl and monocryl
nonabsorbable suture materials provide longer ___ and are primarily used on ___ or ___
- mechanical support
- skin or internal ligature
nonabsorbable suture materials should be removed after ___ days on the face and in the mouth
5-7
what are 2 examples of nonabsorbable suture materials?
prolene and nylon
___ suture materials are braided
multifilament
multifilament suture materials have greater ___ and ___
tensile strength and flexibility
they are easier to handle and tie better than monofilaments
multifilament suture materials can introduce pathogens due to ___
increased capillarity that may act as a tract for introduction of pathogens
of multifilament and monofilament suture materials, which provides more tissue reaction?
multifilament
what are 2 examples of multifilament suture materials?
silk and vicryl
which suture is a natural, absorbable, multifilament?
silk
which suture is a synthetic, absorbable, monofilament?
monocryl
which suture is a synthetic, absorbable, multifilament?
vicryl
which sutures are nonabsorbable monofilaments (2)?
prolene (polypropylene) and nylon
which suture is natural, lasts for 5-7 days, and is used for mucosal closures?
gut
which suture is natural, lasts 10-14 days, and is used in mucosa and perineal?
chromic gut
which suture is braided, lasts 28 days, and is used for mucosal closures?
vicryl
proper suturing technique involves the needle entering the tissue at least ___mm from the edge of the flap and at a ___ degree angle, rotating the wrist following the curvatures of the needle
- 3
- 90
once the needle has entered tissue on one flap, it should enter the opposing flap at the same ___ and come out of the tissue at the same ___ from the tissue edge.
- depth
- distance
once the needle and suture material has been correctly insterted into both flaps of tissue, the suture is pulled through the tissue until a short tail of ___cm is left
2
what should you never do when demonstrating proper suturing techniques?
you should never blindly pass the needle through both sides of the tissue without visualizing the needle depth
what can you use when suturing on skin to help evert tissue?
tissue forceps
this aids in penetrating the tissue at a right angle and it can also help visualize depth before making the pass through the opposing tissue
why is it important to make sure the suture is symmetrical on both sides in regards to distance from the edge of the tissue and depth of the suture?
it allows for proper approximation and healing
what is a common mistake made when tying off a suture?
you want to pull on the needle end of the suture only when cinching down on the FIRST knot so that your suture tail doesn’t get any longer
what is a good rule of thumb for how many knots to make? why is this a good rule to follow?
- do as many knots as the size of the suture
- for example, if you are using a 3-0, do 3 knots; 4-0, do 4 knots, etc.
- this will help prevent unraveling, especially monofilament sutures such as prolene, nylon, or monocryl
what can happen if you tighten sutures too tight?
it can cause ischemia
you only want them tight enough to approximate the wound edge
in general, you want to cut sutures leaving a ___mm tail. what are some exceptions?
- 2-3
- if suturing on the face in a place with hair, leave tails longer for ease of removal
- you can also cut the tails shorter if they are in an irritating spot like the labial mucosa
T or F:
when tying off a suture, you should wrap the suture around the needle drivers twice, lay the knot down and tighten it, then repeat the same step but wrap the suture around the needle drivers in the opposite direction and only once
true
you want to alternate the direction you wrap the suture around the needle drivers each time you make a knot
after the initial knot, where the suture is wrapped around the needle drivers twice, you just want to wrap it a single time for the rest of the knots
what are 8 types of suture knots?
- simple interrupted
- simple continuous or running
- continuous locking
- horizontal mattress
- vertical mattress
- figure eight
- deep interrupted
- running subcuticular
what is the most common closure performed?
simple interrupted
what are two advantages of the simple interrupted suture?
- allows adjustment of tension throughout the suture line
- failure of one knot is often inconsequential
what are two disadvantages of the simple interrupted suture?
- more time needed to tie individual knots
- more suture wasted
which suture can be placed very quickly and is best in short lacerations with no tension?
the simple continuous suture aka running suture
the simple continuous suture helps with ___
hemostasis
in a simple continuous suture, what happens if one knot fails?
the entire closure is compromised
what situation is the simple continuous suture contraindicated and why?
in infected tissues as infection can propogate along the suture line
the continuous locking suture has similar concerns with knot security and integrity of closure as what other suture?
simple continuous suture
the continuous locking suture is used in wounds closed with ___ tension
moderate
the ___ suture is helpful in obtaining hemostasis but has a greater risk of tissue strangulation
continuous locking suture
which suture is indicated for fragile tissue?
horizontal mattress suture
what are the advantages of the horizontal mattress suture?
- distributes tension over a wider area
- helps evert skin edges
- used for fragile tissues
- commonly used intraorally
the ___ suture tends to leave small “railroad” scars
horizontal mattress suture
what is the horizontal mattress suture used for?
closure of angle skin flaps or wounds
the ___ suture is used for maximal edge eversion (used on tissues that tend to invert)
vertical mattress suture
the vertical mattress suture minimizes ___ in deeper tissues
deadspace
how does the vertical mattress suture help minimize tension?
by approximating both deep and superficial tissues
which suture tends to cause more scarring?
the vertical mattress suture
what are the instructions for the placement of the vertical mattress suture?
far-far-near-near
with intraoral suturing, you want to suture from ___ tissue to ___ tissue
mobile (usually buccal or facial) to attached tissue
when doing intraoral sutures, what is necessary to do to keep the needle holder oriented correctly?
suture backhand
not suturing backhand is a common mistake
in intraoral sutures, where should the knots be placed and why?
keep knots on the buccal or facial to prevent tongue irritation and longevity of the suture
the ___ suture can be used for re-approximating papillas or mucosa. if it is difficult to penetrate the lingual tissue from the buccal, and ___ suture can be used to pass the suture through the lingual tissue
- simple interrupted
- modified figure eight interrupted suture
which sutures are commonly used following full mouth extraction and alveoplasty, and where is a good place to tie off?
- simple continuous or continuous locking
- the midline on both sides
the ___ suture decreases the amount of sutures placed and slightly compresses the wound together and everts tissue
horizontal mattress
in an extraction case, the ___ suture is placed over the top of the socket to aid in hemostasis. it helps to maintain a piece of oxidized cellulose in the tooth socket.
figure eight
when suturing a 3rd molar envelope incision, where should you always suture first to approximate tissues to correct anatomical position (good landmark)? the ___ and ___ can be sutured if necessary
- distal papilla of the 2nd molar
- the distal incision and the mesial papilla of the 2nd molar can be sutured if necessary
what is the correct technique when suturing a 3-cornered flap?
- slightly elevate the non-flap side of the incision using a periosteal elevator, freeing the margin to facilitate passage of the needle through the tissue
- first suture is placed across the papilla where the vertical release incision was made (easy identifiable landmark makes the remaining sutures easy to place)
what type of suture is this?
simple interrupted suture
what type of suture is this?
simple continuous suture
what type of suture is this?
continuous locking suture
what type of suture is this?
horizontal mattress suture
what type of suture is this?
vertical mattress suture
what type of suture is this?
figure eight
