Intraoperative Procedures Flashcards
Goals of suturing
Stop bleeding
Close any dead space
Approximate the wound edges
Minimize scar formation
What determines selection of suture material?
Type of wound and incision that needs to be closed
What is used for peritoneum? Fascia
3-0 monocryl
Fascia: large absorbable suture like 0-vicryl
What is used for deep space/deep dermal sutures? Skin?
smaller absorbable such as 3-0 vicryl
Skin: subcutaneous suture, staples, or glue
What is used for superficial wounds and delicate tissues?
absorbable sutures such as polyglactin (ex vicryl) or polyglycolic acid ( ex dexon)
What type of suture is used for deeper tissues and those requiring prolonged support?
Non-absorbable sutures like nylon (ethilon) or propylene (prolene) are often used
If the wound is expected to heal rapidly and not require long-term support, what sort of sutures are preferred?
Absorbable
When are non-absorbable sutures used?
Prolonged support necessary, such as in cardiovascular or orthopedic surgeries
How does location of the wound require impact suture choice?
Some areas are more likely to harbor bacteria than others, so would prefer monofilament sutures such as nylon or polyprolene
Multifilament may be used in areas where more flexible suture required such as scalp
How does expected tension impact selection of suture?
High-tension areas may require stronger and more durable sutures, such as braided polyester (ethibond)
Low tension areas may be sutured with finer materials like polyglactin like vicryl
How is number associated with size of suture?
Small numbers - large diameter sutures
Size of suture needs to be appropriate for thickness of tissue being sutured
What should be done if patients have an allergy?
Adjust sutures accordingly such as not using silk
What are the 7 factors that influence suture selection?
Type of tissue
Healing characteristics
Location of wound
Expected tension
Size of suture
Biocompatibility and allergy
Cost and availability
What suture material may have allergies to it and what is the general reaction?
Silk, catgut, chromic gut, nickel, titanium/alloys, adhesives
Redness, itching, inflammation, swelling
What should be used to close the abdominal fascia in an open bowel resection? 4-0, 2-0, 0, or 5-0
0
What should be used when closing the skin of an incision following carpal tunnel repair? 0-vicryl, 2-0 monocryl, 6-0 catgut, 4-0 nylon
4-0 nylon (generally removed after a few days)
What should be used to close an incision on the scalp? 0-vicryl 2-0 silk 4-0 monocryl 4-0 prolene
4-0 prolene (purple and easy to see)
What should be used for a 12 year old male presenting to the ED with a 2 cm laceration just above his right eyebrow? 6-0 nylon, 2-0 nylon, 0 vicryl, 2-0 vicryl
6-0 nylon (vicryl is absorbable and we want non-absorbable and will be taken out)
What is the style of closure based on?
Wound size
Location
Amount of stress/tension the wound will undergo while healing
When are simple interrupted sutures placed?
Low tension lacerations and wounds
When placing simple interrupted sutures, what must you do?
Take care to ensure each stitch is of equal distance, depth, and tension to optimize wound healing and minimize scar formation
What is the most commonly used material for simple interrupted sutures?
Nonabsorbable - nylon or prolene
What is the benefit of the rule of halves?
Ensure tension evenly distributed along wound edges
Promotes better wound healing
Reduces risk of tissue of tissue ischemia or necrosis caused by excessive tension on the wound edges
Helps maintain and aesthetically pleasing outcome, particularly in cosmetically sensitive areas
When is a simple running/continuous stitch acceptable?
If wound very clean and easy to bring edges together, quicker and adequate
Technique of choice to help stop bleeding from skin edge
