LA Suture Materials & Patterns (10) Flashcards
Dr. Devine
T/F: The strength of the wound is more dependent on the tissue’s ability to hold the suture than the suture material itself
TRUE
When are sutures with high stiffness chosen?
for abdominal closure, herniorraphy, prosthesis
What happens if you use oversized suture?
it will weaken your closure due to excessive tissue reaction
What is better than increasing suture size for wounds under tension?
increasing the number of sutures (or using tension relieving suture pattern)
Which parts of the body heal relatively fast? Slow?
fast: internal organs and SQ - few days
slow: fascia - a few weeks
How does skin heal? When does it seal?
based on quality of apposition
seals within 1 day
What is needed for suture absorption when using absorbable suture?
inflammatory response (tissue reaction)
What are the most common needle selections?
3/8 or 1/2 circle
T/F: You normally use a needle where you can reach across both sides of the skin with it
TRUE
What effect does a taper point needle have? Which kind of tissue?
round needle shaft does not enlarge hole as it passes through
delicate tissue
What effect does a reverse cutting needle have? Which kind of tissue?
cutting edge on the convex (outer) side - stronger than conventional cutting
skin, fibrous tissue
LA instrument? Purpose?
Buhner needle - used to purse string prolapses
LA instrument? Purpose?
S needle
- used to close cow skin and replaces needle drivers
- use suture on a reel
What needle was probably used for this?
buehner needle
Instrument? Purpose?
S needle - closing ruminant skin
What is the weakest point in the suture pattern?
a knot
What is a square knot?
two simple throws that are reversed
Which suture material in LA needs 4 throws to be secure?
2-0 PDS or nylon
Which suture material in LA needs 5 throws to be secure?
larger suture #2 or #3 vicryl
How do you suture fascia in LA?
bites are 15 mm away from the cut edge
close using vicryl or PDS
size 2-7
What is commonly used in cattle for fascia suturing?
catgut - cheap
What do you suture in LA for delicate tissues (SQ, GI organs?)
PDS, vicryl, monocryl
typically 2-0
What suture patterns do you use for the LA GI tract normally?
Lembert
simple continuous oversewn with a Cushings
How do you suture contaminated wounds in horses?
monofilament!
nonabsorbable suture - inert
elastic allows for tissue swelling
What suture do you use in farm animals to reduce cost?
- chromic cat gut
- suture on a reel
When do you remove sutures in the skin?
10-14 days
Do this
When do you use skin staplers in LA?
wounds with no tension - appose wound edges
What are inverting suture patterns? Which organs?
invert the tissue edges to help make a seal - suture does NOT come out the tissue edge
uterus, GI tract, urinary bladder
What are suture patterns that invert?
utrecht, Cushing, lembert
Where are Utrecht patterns used for in LA?
on the uterus
Suture pattern?
utrecht
When are Cushing suture patterns commonly used?
on GI, urinary bladder - often combined with a simple continuous first
Suture pattern?
cushing
When are Lembert suture patterns commonly used?
also for GI or urinary bladder
- interrupted or continuous
don’t accidentally invert a lot of tissue in - could lead to obstruction
How should you make an incision line regarding skin tension lines?
parallel
A horse has a puncture wound cranial to its cubital joint. What direction would the incision be?
incision vertical - in this case
How do you suture wounds under tension?
- use limb immobilization
- add more sutures
- use tension-relieving techniques
NOT BIGGER SUTURE
What are some other tension-relieving techniques?
- release incisions
- walking sutures
- can use stent, combo patterns
What does this show?
closing the primary wound and leave the relief incisions to heal by second intention
What are walking sutures?
using your suture to “pull” the skin over the top of the defect
- obliterate dead space, no closer than 2-3 cm apart
What do stents do?
distribute tension more evenly along suture to prevent pull-through
What are the characteristics a vertical mattress suture pattern?
- less impingement of blood supply compared to horizontal mattress
- good apposition but some eversion
- bites perpendicular to cut edge
What are the characteristics of a horizontal mattress suture pattern?
- strong tension relieving - will not tear through but tends to impede blood supply
- most eversion possible
can be continuous
What are the characteristics a near-far-far-near suture pattern?
- excellent apposition and tension relief
- interrupted only
- most suture in wound
What are the characteristics a ford interlocking suture pattern?
- mild tension relieving
- reduces suture disruption in one part breaks
- good apposition
What is this?
mesh for large defects
What are the differences in suturing LA than in small animal?
thicker skin
need tightness on skin sutures
more surgeon’s
NO PDS II on linea alba
Practice
