Lecture 6: Common Surgical Procedures

Question 1

What determines selection of suture material and size?

Answer 1

• Tissue type
• Healing characteristics
• Location
• Expected Tension
• Size of suture
• Biocompatibility or allergy
• Cost and availability

Question 2

What sutures are people potentially allergic to?

Answer 2

• Silk
• Catgut
• Chromic gut
• Nickel (any stainless steel)
• Metals
• Adhesives

Question 3

What does closure style selection depend on?

Answer 3

• Wound size
• Location
• Amt of stress/tension during healing

Question 4

When do we use simple interrupted?

Answer 4

Low tension lacs/wounds

Use nonabsorbable

Question 5

What is the rule of halves?

Answer 5

Used in linear wounds

Question 6

When is simple running used?

Answer 6

Clean wound with easy approximation, such as a scalp lac

Technique of choice when stopping skin bleeds

Question 7

When are mattress sutures used?

Answer 7

• Skin edges are difficult to evert.
• Vertical and Horizontal types

Question 8

When is vertical mattress indicated?

Answer 8

• Lacs around joints or areas with significant tension
• Wounds on a surface that is concave or posterior neck surfaces

Far, far;near, near

Question 9

When is vertical mattress contraindicated?

Answer 9

• Face
• Palms
• Soles
• Areas where you cant see your needle

Question 10

When is horizontal mattress indicated?

Answer 10

• Wounds under tension or fragile
• Spreads tension out over length of wound edge

Question 11

Image of vertical vs horizontal

Answer 11

Question 12

Overview of a buried suture

Answer 12

Question 13

When is interrupted buried suture used and what kind of suture?

Answer 13

• Used in small laparoscopic incisions
• Absorbable sutures used
• No removal and good cosmetic results.

Question 14

When is running buried MC?

Answer 14

Plastic surgery

Question 15

Overview of running subcuticular/buried suture

Answer 15

Question 16

What is the minimum # of throws to make an instrument tie? When in doubt, how many?

Answer 16

• 3 is the minimum
• 5 is enough to hold most sutures together

Question 17

How do you do a free-hand tie?

Answer 17

With your non-dominant hand

Common in deep abdomen

Question 18

Pros and cons of staples

Answer 18

• Pro: fast af
• Cons: ugly

Question 19

When is dermabond used?

Answer 19

Closure of low tension, easily approximated wounds

Question 20

When is dermabond not used?

Answer 20

• Active infection
• Mucosal surfaces
• High moisture areas

Question 21

When are steristrips used?

Answer 21

• Placed after suture removal
• Small wounds that are easily approximated

Question 22

How do we stop skin edge bleeding?

Answer 22

1. Direct Pressure
2. Bovie electrocautery

Question 23

Overview of a bovie

Answer 23

Question 24

Management of a vessel bleed

Answer 24

1. Direct pressure for 5-7 mins
2. Bovie if 1-2mm
3. Tying off a vessel (if big or no bovie)

Question 25

Overview of a regular tie

Answer 25

Question 26

Overview of a stick tie

Answer 26

Best for arteries, more secure.