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Intro to Surgery > Lecture 5 - Basic Suture Patterns, Hand Ties, & Electrocautery > Flashcards

Lecture 5 - Basic Suture Patterns, Hand Ties, & Electrocautery Flashcards

1
Q

What are some reasons why you would use different suture patterns for different situations?

A
  1. Purpose of the procedure
  2. Strength of tissues
  3. Degree of tension
  4. Healing properties of the tissues
  5. Risk of complications
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2
Q

What are some classifications of suture patterns?

A
  1. Effect on wound margin (appositional vs. inverting vs. everting)
  2. Tension-relieving
  3. Placement (interrupted vs. continuous)
  4. Misc. patterns/techniques
  5. By tissue type (subcuticular/intradermal, SQ, skin, tendon)
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3
Q

_____ patterns are avoided in the skin.

A

Inverting

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4
Q

Inverting patterns are used to close _____.

A

hollow viscera

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5
Q

_____ patterns work nearly everywhere.

A

Appositional

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6
Q

Everting patterns can be used in _____.

A

the skin

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7
Q

In an interrupted pattern, every suture has a _____.

A

knot

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8
Q

Why are interrupted patterns more secure than continuous?

A

A single knot can fail while others are still in place

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9
Q

With interrupted patterns, it is easier to _____.

A

adjust tension

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10
Q

What are some disadvantages of interrupted suture patterns?

A

There is more foreign material in the wound;

They are slower to perform

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11
Q

Where are the knots located in continous suture patterns?

A

Single knot at beginning and end

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12
Q

What are some advantages of continuous patterns?

A
  1. Less foreign material
  2. Better seal
  3. Distributes tension evenly
  4. Quicker
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13
Q

What are some disadvantages of continuous patterns?

A
  1. Failure of knot or suture could lead to complete dehiscence
  2. Less able to adjust tension or apposition
  3. Bulkier knot at end (end + loop)
  4. Can create purse-string effect
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14
Q

What are the 7 appositional suture patterns?

A
  1. Simple interrupted
  2. Simple continuous
  3. Buried intradermal
  4. Continuous horizonal/intradermal
  5. Cruciate
  6. Ford interlocking
  7. Modified Gambee
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15
Q

What are the 7 inverting suture patterns?

A
  1. Lembert
  2. Cushing
  3. Connell
  4. Utrecht
  5. Halstead
  6. Parker-Kerr
  7. Purse-string
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16
Q

What are the 3 types of everting patterns?

A
  1. Horizontal mattress
  2. Vertical mattress
  3. Skin staples
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17
Q

What is the goal of appositional patterns?

A

To bring tissues into close approximation

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18
Q

What are some locations where a simple interrupted pattern can be used?

A

skin, linea, SQ, viscera

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19
Q

What are some advantages of a simple interrupted pattern?

A
  1. Secure
  2. Can adjust tension
  3. Disruption of one knot doesn’t compromise entirety
  4. Easy
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20
Q

What are some disadvantages of a simple interrupted pattern?

A
  1. Slow
  2. More foreign material
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21
Q

When would you use a modified Gambee pattern?

A

intestinal anastomosis

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22
Q

In a modified Gambee, why do we use additional submucosal purchase?

A

To minimize mucosal eversion

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23
Q

What is an advantage of a modified Gambee pattern?

A

Less wicking of GI contents

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24
Q

What are some disadvantages of using a modified Gambee pattern?

A

More tissue manipulation, slower

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25
Q

Where would you use a simple continuous pattern?

A

Intradermally, SQ, linea, fascia, viscera, vasculature

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26
Q

Where might you want to avoid using a simple continuous pattern?

A

in the skin (maybe)

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27
Q

What are some advantages to using a simple continuous pattern?

A
  1. Creates a seal
  2. Fast
  3. Easy
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28
Q

What are some disadvantages to using a simple continuous pattern?

A
  1. Excess tension leads to eversion/puckering
  2. Can cause strangulation
  3. Not as strong
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29
Q

Where would you use an interrupted intradermal/subcuticular pattern?

A

SQ, fascia, holding layer

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30
Q

An interrupted intradermal/subcuticular pattern is basically a _____ with the knot _____ or _____.

A

simple interrupted, deep, buried

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31
Q

Where would you use a continuous intradermal pattern?

A

Skin

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32
Q

A continuous intradermal pattern is basically a modified _____.

A

running horizontal mattress

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33
Q

What are some advantages of using a continuous intradermal pattern?

A
  1. Quick
  2. Easy
  3. Cosmetic
  4. No suture removal required
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34
Q

What are some disadvantages to using a continous intradermal pattern?

A
  1. Not as strong as skin sutures
  2. Expertise/practice required for proper knot burial
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35
Q

Where should you use a Ford interlocking pattern?

A

Thick skin

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36
Q

A Ford interlocking pattern is basically a modified _____ with each pass partially _____.

A

simple continuous, locked

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37
Q

What are some advantages to using a Ford interlocking pattern?

A
  1. Even tension distribution
  2. Fast
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38
Q

What are some disadvantages to using a Ford interlocking pattern?

A
  1. Microcirculatory compromise
  2. Nor very exact apposition
  3. Expertise/practice in ending the pattern is required
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39
Q

Where would you use a cruciate pattern?

A

Skin, muscle, fascia

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40
Q

How often is the wound crossed for each knot in a cruciate pattern?

A

2x

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41
Q

What are some advantages of using a cruciate pattern?

A
  1. Resists tension
  2. Stronger than simple interrupted
  3. Fast
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42
Q

What are some disadvantages to using a cruciate pattern?

A
  1. Less effective exact apposition
  2. Difficult to place evenly
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43
Q

Where would you use a lembert pattern?

A

Hollow viscera, joint capsule imbrication

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44
Q

A lembert pattern can be _____ or _____.

A

continuous, interrupted

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45
Q

How are bites of a lembert pattern taken?

A

perpendicular

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46
Q

T/F: A Lembert pattern does not penetrate the lumen

A

True

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47
Q

What is an advantage to using a Lembert pattern?

A

good seal

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48
Q

What is the pattern used in a Lembert (how is the suture placed)?

A

Inverting; Placed far-near, near-far

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49
Q

Where would you use a Halstead pattern?

A

hollow viscera

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50
Q

A Halstead pattern is basically 2 _____ together.

A

interrupted Lemberts

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51
Q

A Halstead pattern is basically a modified _____ and _____ together.

A

Lembert, horizontal mattress

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52
Q

T/F: Halstead pattern does not penetrate the lumen

A

True

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53
Q

How are bites in a Halstead pattern placed?

A

perpendicular

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54
Q

What is an advantage of using a Halstead pattern?

A

good seal

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55
Q

What is a disadvantage of using a Halstead pattern?

A

Could cause microcirculatory compromise

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56
Q

Where would you use a Cushing pattern?

A

hollow viscera

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57
Q

How are bites taken in a Cushing pattern?

A

parallel

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58
Q

T/F: A Cushing pattern penetrates the lumen

A

False

59
Q

What is an advantage of using a Cushing pattern?

A

Good seal

60
Q

What is the most common inverting pattern in small animals?

A

Cushing

61
Q

Where should you use a Connell pattern?

A

Hollow viscera

62
Q

How are bites taken in a Connell pattern?

A

parallel

63
Q

T/F: Connell pattern penetrates the lumen

A

True

64
Q

What is an advantage of using a Connell pattern?

A

good seal

65
Q

What is a disadvantage of using a Connell pattern?

A

May wick GI contents

66
Q

Where would you use a Utrecht pattern?

A

Hollow viscera (uterus in large animal)

67
Q

How are bites taken in a Utrecht pattern?

A

Diagonal ~45°

68
Q

T/F: A Utrecht pattern does not penetrate the lumen

A

True

69
Q

What is an advantage of using a Utrecht pattern?

A

Good seal

70
Q

Where would you use a Parker-Kerr pattern?

A

viceral stumps

71
Q

A Parker-Kerr pattern is a _____ pattern sewn over a _____ and _____ as the _____ is removed.

A

Cushing, clamp, tightened, clamp

72
Q

What is done in a Parker-Kerr pattern after the clamp is removed?

A

oversewn with a second layer

73
Q

What is a purse-string pattern used for?

A

To secure -ostomy tubes, temporarily close anus or treat prolapse

74
Q

A purse-string pattern is basically a continuous _____.

A

Lembert

75
Q

How is a purse-string pattern placed?

A

In a circular fashion

76
Q

What happens to the tissue in a purse-string pattern when the suture is pulled tight?

A

it inverts

77
Q

What is a disadvantage of using a purse-string pattern?

A

Can cause microcirculatory damage

78
Q

Where would you use a horizontal mattress pattern?

A

Areas of tension or friable tissue, muscle, fascia, tendon

79
Q

What does a horizontal mattress pattern form when complete?

A

square

80
Q

Horizontal mattress sutures can be _____ or _____.

A

interrupted, continuous

81
Q

What is a disadvantage of using a horizontal mattress pattern?

A

Can cause local tissue ischemia

82
Q

What would you use skin staples instead of?

A

nylon skin sutures

83
Q

What is an advantage of using skin staples?

A

Fast

84
Q

What are some disadvantages to using skin staples?

A
  1. More painful to remove
  2. Can flip and imbed into tissues
  3. Need special staple remover
85
Q

Skin staples have a tendency to _____ in animals.

A

evert

86
Q

Skin staples must _____ during placement.

A

appose tissues gently

87
Q

How are skin staples placed?

A

Line up arrow on stapler with incision, use downward pressure while clamping handle

88
Q

What are the 2 types of hand ties?

A

one-handed and two-handed

89
Q

When should you use hand ties?

A

In hard to reach areas, deep in cavities

90
Q

What are some advantages to using hand ties?

A

faster, more secure

91
Q

What are some disadvantages to using hand ties?

A

Requires more suture, need PRACTICE!

92
Q

Where are one-handed ties used and what is a disadvantage?

A

Used in confined areas;

Less tension control

93
Q

What is an advantage of using a two-handed tie?

A

better control and accuracy

94
Q

What are some advantages to using inatrument ties?

A
  1. Wastes less suture
  2. Fast
95
Q

Generally speaking, what is electrosurgery/electrocautery?

A

Atraumatic use of electromagnetic energy to coagulate blood vessels, cut, dissect, and ablate tissues.

96
Q

What is electrosurgery, specifically?

A

Passage of electrical current from instrument through tissues using alternating current.

97
Q

What is electrocautery, specifically?

A

Uses heat generated bu direct electric current into a metal wire or probe

98
Q

What are 3 characteristics of an electrical current?

A
  1. Takes path of least resistance
  2. Seeks ground
  3. Requires a complete circuit
99
Q

What is the circuit used in electrocautery?

A

Generator –> active electrode –> patient –> inactive electrode (grounding pad)

100
Q

What is an electrical current?

A

Waveforms transmitted by the generator

101
Q

What type of electrical current does cutting use?

A

continuous

102
Q

What type of electrical current does coagulation use?

A

intermittent

103
Q

What does tissue effects by electrocautery depend on?

A
  1. Surgical unit power (watts)
  2. Length of exposure
  3. Volume of tissue treated
  4. Contact type of electrode
  5. Density
  6. Tissue impedance
104
Q

What are the high resistance tissues?

A

bone, scar tissue, adipose

105
Q

What are the low resistance tissues?

A

muscle, vasculature

106
Q

What is the tissue effect at 250°C?

A

Tissue carbonization from dehydration

107
Q

What is the tissue effect at 100°C?

A

Cell wall rupture

108
Q

What is the tissue effect at 90°C?

A

Tissue dessication

109
Q

What is the tissue effect at 70°C?

A

Protein denaturing

110
Q

What is the tissue effect at 50°C?

A

Enzymatic activity inactivated

111
Q

What is the tissue effect at 40°C?

A

Inflammation and edema

112
Q

What is fulguration coagulation?

A

Holding electrode away from tissue using coagulation mode with gap from electrode to tissue

113
Q

What is dessication coagulation?

A

Direct contact electrode and tissue in coagulation mode

114
Q

What is coaptive coagulation?

A

Lumen of vessel is occluded by metal instrument and wall is coagulated

115
Q

In monopolar electrocautery, where does the current pass through?

A

Via hand-held electrode, through patient to grounding pad

116
Q

In monopolar electrocautery, the field must be _____.

A

dry

117
Q

In monopolar electrocautery, an _____ is created on tissue.

A

eschar/coagulum

118
Q

In monopolar electrocautery, there is direct contact or indirect via _____.

A

instrument arc

119
Q

In monopolar electrocautery, what size ground plate should be used?

A

Largest plate with good contact

120
Q

In monopolar electrocautery, vessels _____ in size are coagulated.

A

>2mm

121
Q

In monopolar electrocautery, you can cut for _____ or other tissues.

A

skin incision

122
Q

In monopolar electrocautery, caution should be used inside ____, in patients with _____, and with _____ surgery.

A

chest, arrhythmias, minimally invasive

123
Q

Where does the current pass in bipolar electrocautery?

A

From one tip of the forceps to the other

124
Q

In bipolar electrocautery, what tissues are included in the circuit?

A

Only those between the electrodes

125
Q

What is an advantage of bipolar electrocautery over monopolar?

A

More precise, prevents adjacent tissue damage

126
Q

In bipolar electrocautery, the field can be relatively _____.

A

wet

127
Q

What are some disadvantages to using bipolar electrocautery?

A
  1. Lower power setting, needs more time
  2. Limited to dissection and coagulation, NO cutting
  3. Can cause charring and adherence to instrument
128
Q

What are the two electrodes called in bipolar electrocautery?

A

Active electrode and dispersive electrode

129
Q

What is battery powered cautery used for?

A

Quick, brief application

130
Q

In battery-powered cautery, current doesn’t _____.

A

transfer through the patient

131
Q

In battery-powered cautery, where is the heat transfer?

A

Direct from the tip of the instrument

132
Q

In battery-powered cautery, what is the instrument called?

A

bovie pen

133
Q

What 3 things do vessel sealing devices do?

A
  1. Apply pressure and bipolar energy to the tissues
  2. Denature collagen and elastin from vessel wall and c.t.
  3. Limit blood loss
134
Q

What is an advantage to using a vessel sealing device?

A

No foreign material used

135
Q

What is the seal cycle of LigaSure and what size vessels can it be used on?

A

2-4 seconds; vessels up to 7 mm

136
Q

What does EnSeal do?

A

Limits thermal spread to 2 mm

137
Q

What do ultrasonic energy systems do?

A

Deliver electrical energy in the form of mechanical energy

138
Q

In an ultrasonic energy system, the current delivers ultrasonic waves at _____ to cut and coagulate tissue _____.

A

55,000 vibrations/sec, simultaneously

139
Q

In ultrasonic energy systems, _____ produce vibration-induced heat and coagulation.

A

oscillations

140
Q

What type of coagulationdo ultrasonic energy systems use?

A

coaptive

141
Q

What is an advantage of using ultrasonic energy systems?

A

Less collateral tissue damage

142
Q

What is a disadvantage to using ultrasonic energy systems?

A

Not reliable >3mm

143
Q

What are some precautions that should be taken when using electrocautery?

A
  1. Do not use with explosive gas or liquid (fire hazard)
  2. Avoid grounding pad burns (use largest possible with good contact, avoid ECG leads nearby)
  3. Arrhythmias
  4. Smoke plume - use suction

Intro to Surgery (36 decks)

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