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
- Purpose of the procedure
- Strength of tissues
- Degree of tension
- Healing properties of the tissues
- Risk of complications
2
Q
What are some classifications of suture patterns?
A
- Effect on wound margin (appositional vs. inverting vs. everting)
- Tension-relieving
- Placement (interrupted vs. continuous)
- Misc. patterns/techniques
- By tissue type (subcuticular/intradermal, SQ, skin, tendon)
3
Q
_____ patterns are avoided in the skin.
A
Inverting
4
Q
Inverting patterns are used to close _____.
A
hollow viscera
5
Q
_____ patterns work nearly everywhere.
A
Appositional
6
Q
Everting patterns can be used in _____.
A
the skin
7
Q
In an interrupted pattern, every suture has a _____.
A
knot
8
Q
Why are interrupted patterns more secure than continuous?
A
A single knot can fail while others are still in place
9
Q
With interrupted patterns, it is easier to _____.
A
adjust tension
10
Q
What are some disadvantages of interrupted suture patterns?
A
There is more foreign material in the wound;
They are slower to perform
11
Q
Where are the knots located in continous suture patterns?
A
Single knot at beginning and end
12
Q
What are some advantages of continuous patterns?
A
- Less foreign material
- Better seal
- Distributes tension evenly
- Quicker
13
Q
What are some disadvantages of continuous patterns?
A
- Failure of knot or suture could lead to complete dehiscence
- Less able to adjust tension or apposition
- Bulkier knot at end (end + loop)
- Can create purse-string effect
14
Q
What are the 7 appositional suture patterns?
A
- Simple interrupted
- Simple continuous
- Buried intradermal
- Continuous horizonal/intradermal
- Cruciate
- Ford interlocking
- Modified Gambee
15
Q
What are the 7 inverting suture patterns?
A
- Lembert
- Cushing
- Connell
- Utrecht
- Halstead
- Parker-Kerr
- Purse-string
16
Q
What are the 3 types of everting patterns?
A
- Horizontal mattress
- Vertical mattress
- Skin staples
17
Q
What is the goal of appositional patterns?
A
To bring tissues into close approximation
18
Q
What are some locations where a simple interrupted pattern can be used?
A
skin, linea, SQ, viscera
19
Q
What are some advantages of a simple interrupted pattern?
A
- Secure
- Can adjust tension
- Disruption of one knot doesn’t compromise entirety
- Easy
20
Q
What are some disadvantages of a simple interrupted pattern?
A
- Slow
- More foreign material
21
Q
When would you use a modified Gambee pattern?
A
intestinal anastomosis
22
Q
In a modified Gambee, why do we use additional submucosal purchase?
A
To minimize mucosal eversion
23
Q
What is an advantage of a modified Gambee pattern?
A
Less wicking of GI contents
24
Q
What are some disadvantages of using a modified Gambee pattern?
A
More tissue manipulation, slower
25
Where would you use a simple continuous pattern?
Intradermally, SQ, linea, fascia, viscera, vasculature
26
Where might you want to avoid using a simple continuous pattern?
in the skin (maybe)
27
What are some advantages to using a simple continuous pattern?
1. Creates a seal
2. Fast
3. Easy
28
What are some disadvantages to using a simple continuous pattern?
1. Excess tension leads to eversion/puckering
2. Can cause strangulation
3. Not as strong
29
Where would you use an interrupted intradermal/subcuticular pattern?
SQ, fascia, holding layer
30
An interrupted intradermal/subcuticular pattern is basically a _____ with the knot _____ or \_\_\_\_\_.
simple interrupted, deep, buried
31
Where would you use a continuous intradermal pattern?
Skin
32
A continuous intradermal pattern is basically a modified \_\_\_\_\_.
running horizontal mattress
33
What are some advantages of using a continuous intradermal pattern?
1. Quick
2. Easy
3. Cosmetic
4. No suture removal required
34
What are some disadvantages to using a continous intradermal pattern?
1. Not as strong as skin sutures
2. Expertise/practice required for proper knot burial
35
Where should you use a Ford interlocking pattern?
Thick skin
36
A Ford interlocking pattern is basically a modified _____ with each pass partially \_\_\_\_\_.
simple continuous, locked
37
What are some advantages to using a Ford interlocking pattern?
1. Even tension distribution
2. Fast
38
What are some disadvantages to using a Ford interlocking pattern?
1. Microcirculatory compromise
2. Nor very exact apposition
3. Expertise/practice in ending the pattern is required
39
Where would you use a cruciate pattern?
Skin, muscle, fascia
40
How often is the wound crossed for each knot in a cruciate pattern?
2x
41
What are some advantages of using a cruciate pattern?
1. Resists tension
2. Stronger than simple interrupted
3. Fast
42
What are some disadvantages to using a cruciate pattern?
1. Less effective exact apposition
2. Difficult to place evenly
43
Where would you use a lembert pattern?
Hollow viscera, joint capsule imbrication
44
A lembert pattern can be _____ or \_\_\_\_\_.
continuous, interrupted
45
How are bites of a lembert pattern taken?
perpendicular
46
T/F: A Lembert pattern does not penetrate the lumen
True
47
What is an advantage to using a Lembert pattern?
good seal
48
What is the pattern used in a Lembert (how is the suture placed)?
Inverting; Placed far-near, near-far
49
Where would you use a Halstead pattern?
hollow viscera
50
A Halstead pattern is basically 2 _____ together.
interrupted Lemberts
51
A Halstead pattern is basically a modified _____ and _____ together.
Lembert, horizontal mattress
52
T/F: Halstead pattern does not penetrate the lumen
True
53
How are bites in a Halstead pattern placed?
perpendicular
54
What is an advantage of using a Halstead pattern?
good seal
55
What is a disadvantage of using a Halstead pattern?
Could cause microcirculatory compromise
56
Where would you use a Cushing pattern?
hollow viscera
57
How are bites taken in a Cushing pattern?
parallel
58
T/F: A Cushing pattern penetrates the lumen
False
59
What is an advantage of using a Cushing pattern?
Good seal
60
What is the most common inverting pattern in small animals?
Cushing
61
Where should you use a Connell pattern?
Hollow viscera
62
How are bites taken in a Connell pattern?
parallel
63
T/F: Connell pattern penetrates the lumen
True
64
What is an advantage of using a Connell pattern?
good seal
65
What is a disadvantage of using a Connell pattern?
May wick GI contents
66
Where would you use a Utrecht pattern?
Hollow viscera (uterus in large animal)
67
How are bites taken in a Utrecht pattern?
Diagonal ~45°
68
T/F: A Utrecht pattern does not penetrate the lumen
True
69
What is an advantage of using a Utrecht pattern?
Good seal
70
Where would you use a Parker-Kerr pattern?
viceral stumps
71
A Parker-Kerr pattern is a _____ pattern sewn over a _____ and _____ as the _____ is removed.
Cushing, clamp, tightened, clamp
72
What is done in a Parker-Kerr pattern after the clamp is removed?
oversewn with a second layer
73
What is a purse-string pattern used for?
To secure -ostomy tubes, temporarily close anus or treat prolapse
74
A purse-string pattern is basically a continuous \_\_\_\_\_.
Lembert
75
How is a purse-string pattern placed?
In a circular fashion
76
What happens to the tissue in a purse-string pattern when the suture is pulled tight?
it inverts
77
What is a disadvantage of using a purse-string pattern?
Can cause microcirculatory damage
78
Where would you use a horizontal mattress pattern?
Areas of tension or friable tissue, muscle, fascia, tendon
79
What does a horizontal mattress pattern form when complete?
square
80
Horizontal mattress sutures can be _____ or \_\_\_\_\_.
interrupted, continuous
81
What is a disadvantage of using a horizontal mattress pattern?
Can cause local tissue ischemia
82
What would you use skin staples instead of?
nylon skin sutures
83
What is an advantage of using skin staples?
Fast
84
What are some disadvantages to using skin staples?
1. More painful to remove
2. Can flip and imbed into tissues
3. Need special staple remover
85
Skin staples have a tendency to _____ in animals.
evert
86
Skin staples must _____ during placement.
appose tissues gently
87
How are skin staples placed?
Line up arrow on stapler with incision, use downward pressure while clamping handle
88
What are the 2 types of hand ties?
one-handed and two-handed
89
When should you use hand ties?
In hard to reach areas, deep in cavities
90
What are some advantages to using hand ties?
faster, more secure
91
What are some disadvantages to using hand ties?
Requires more suture, need PRACTICE!
92
Where are one-handed ties used and what is a disadvantage?
Used in confined areas;
Less tension control
93
What is an advantage of using a two-handed tie?
better control and accuracy
94
What are some advantages to using inatrument ties?
1. Wastes less suture
2. Fast
95
Generally speaking, what is electrosurgery/electrocautery?
Atraumatic use of electromagnetic energy to coagulate blood vessels, cut, dissect, and ablate tissues.
96
What is electrosurgery, specifically?
Passage of electrical current from instrument through tissues using alternating current.
97
What is electrocautery, specifically?
Uses heat generated bu direct electric current into a metal wire or probe
98
What are 3 characteristics of an electrical current?
1. Takes path of least resistance
2. Seeks ground
3. Requires a complete circuit
99
What is the circuit used in electrocautery?
Generator --\> active electrode --\> patient --\> inactive electrode (grounding pad)
100
What is an electrical current?
Waveforms transmitted by the generator
101
What type of electrical current does cutting use?
continuous
102
What type of electrical current does coagulation use?
intermittent
103
What does tissue effects by electrocautery depend on?
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
What are the high resistance tissues?
bone, scar tissue, adipose
105
What are the low resistance tissues?
muscle, vasculature
106
What is the tissue effect at 250°C?
Tissue carbonization from dehydration
107
What is the tissue effect at 100°C?
Cell wall rupture
108
What is the tissue effect at 90°C?
Tissue dessication
109
What is the tissue effect at 70°C?
Protein denaturing
110
What is the tissue effect at 50°C?
Enzymatic activity inactivated
111
What is the tissue effect at 40°C?
Inflammation and edema
112
What is fulguration coagulation?
Holding electrode away from tissue using coagulation mode with gap from electrode to tissue
113
What is dessication coagulation?
Direct contact electrode and tissue in coagulation mode
114
What is coaptive coagulation?
Lumen of vessel is occluded by metal instrument and wall is coagulated
115
In monopolar electrocautery, where does the current pass through?
Via hand-held electrode, through patient to grounding pad
116
In monopolar electrocautery, the field must be \_\_\_\_\_.
dry
117
In monopolar electrocautery, an _____ is created on tissue.
eschar/coagulum
118
In monopolar electrocautery, there is direct contact or indirect via \_\_\_\_\_.
instrument arc
119
In monopolar electrocautery, what size ground plate should be used?
Largest plate with good contact
120
In monopolar electrocautery, vessels _____ in size are coagulated.
\>2mm
121
In monopolar electrocautery, you can cut for _____ or other tissues.
skin incision
122
In monopolar electrocautery, caution should be used inside \_\_\_\_, in patients with \_\_\_\_\_, and with _____ surgery.
chest, arrhythmias, minimally invasive
123
Where does the current pass in bipolar electrocautery?
From one tip of the forceps to the other
124
In bipolar electrocautery, what tissues are included in the circuit?
Only those between the electrodes
125
What is an advantage of bipolar electrocautery over monopolar?
More precise, prevents adjacent tissue damage
126
In bipolar electrocautery, the field can be relatively \_\_\_\_\_.
wet
127
What are some disadvantages to using bipolar electrocautery?
1. Lower power setting, needs more time
2. Limited to dissection and coagulation, NO cutting
3. Can cause charring and adherence to instrument
128
What are the two electrodes called in bipolar electrocautery?
Active electrode and dispersive electrode
129
What is battery powered cautery used for?
Quick, brief application
130
In battery-powered cautery, current doesn't \_\_\_\_\_.
transfer through the patient
131
In battery-powered cautery, where is the heat transfer?
Direct from the tip of the instrument
132
In battery-powered cautery, what is the instrument called?
bovie pen
133
What 3 things do vessel sealing devices do?
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
What is an advantage to using a vessel sealing device?
No foreign material used
135
What is the seal cycle of LigaSure and what size vessels can it be used on?
2-4 seconds; vessels up to 7 mm
136
What does EnSeal do?
Limits thermal spread to 2 mm
137
What do ultrasonic energy systems do?
Deliver electrical energy in the form of mechanical energy
138
In an ultrasonic energy system, the current delivers ultrasonic waves at _____ to cut and coagulate tissue \_\_\_\_\_.
55,000 vibrations/sec, simultaneously
139
In ultrasonic energy systems, _____ produce vibration-induced heat and coagulation.
oscillations
140
What type of coagulationdo ultrasonic energy systems use?
coaptive
141
What is an advantage of using ultrasonic energy systems?
Less collateral tissue damage
142
What is a disadvantage to using ultrasonic energy systems?
Not reliable \>3mm
143
What are some precautions that should be taken when using electrocautery?
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
