Lecture 6: Common Surgical Procedures Flashcards
What determines selection of suture material and size?
- Tissue type
- Healing characteristics
- Location
- Expected Tension
- Size of suture
- Biocompatibility or allergy
- Cost and availability
What kind of suture material would you use for superficial wounds and delicate tissue (facial laceration, mucosal surfaces)?
absorbable sutures:
* polyglactin (vincryl)
* polyglycolic acid (dexon)
For deeper tissues and those requiring prolonged support, what suture material would you use?
non absorbable sutures
* nylon (ethilon)
* polypropylene (prolene)
What suture material would you opt for when the wound is expected to heal rapidly and not require long term support?
what if it requires prolonged support (CV/ortho sx)
Healing characteristics
rapidly: absorbable!!
long: non absorbable
ok…this is making sense
What kind of sutures are preferred in contaminated areas? why?
location of wound
monofilament sutures like nylon or polypropylene b/c they’re less likely to harbor bacteria
what kind of suture would you use when more flexible sutures are needed? ie your scalp!!
location of wound
multifilament
what kind of suture would you need for higher tension areas? ie joints or wounds under constant stress
What about lower tension areas?
braided polyester!! (ethibond)
this name just sounds strong!!!
what kind of suture would you need for lower tension areas?
expected tension
lower tension areas can use polglactin (Vicryl)
this word looks like velcro in my head and that seems like low tension like little baby shoes with velco
What sutures are people potentially allergic to?
- Silk
- Catgut
- Chromic gut
- Nickel (any stainless steel)
- Metals
- Adhesives
What does closure style selection depend on?
- Wound size
- Location
- Amt of stress/tension during healing
When do we use simple interrupted?
Low tension lacs/wounds
Use nonabsorbable (nylon or prolene)
What is the rule of halves?
Used in linear wounds
When is simple running used?
Clean wound with easy approximation, such as a scalp lac
Technique of choice when stopping skin bleeds
When are mattress sutures used?
- Skin edges are difficult to evert since it provides relief of wound tension while allowing skin edge approximation
- Vertical and Horizontal types
When is vertical mattress indicated?
- Lacs around joints or areas with significant tension
- Wounds on a surface that is concave or posterior neck surfaces
Far, far;near, near
Where is vertical mattress contraindicated?
- Face
- Palms
- Soles
- Areas where you cant see your needle
When is horizontal mattress indicated?
- Wounds under tension or fragile
- Spreads tension out over length of wound edge
Image of vertical vs horizontal
Overview of a buried suture
When is interrupted buried suture used and what kind of suture?
- Used in small laparoscopic incisions
- Absorbable sutures used (MC Vicryl or monocryl)
- No removal and good cosmetic results.
When is running buried MC?
Plastic surgery
best cosmetic result, no suture removal required
Overview of running subcuticular/buried suture
What is the MC used method of securing sutures in cutaneous surgery?
Instrument Tie
Square knot, or surgeons knot preferred
What is the minimum # of throws to make an instrument tie? When in doubt, how many?
- 3 is the minimum
- 5 is enough to hold most sutures together
the first throw in knotting sequence is often looped or twisted twice, producing the surgeons knot
How do you do a free-hand tie? +when is it helpful to use?
With your non-dominant hand
Common in deep abdomen (ligating a vessel)
Pros and cons of staples
- Pro: fast af
- Cons: more scaring
can be placed quickly so helps when trying to minimize blood loss by closing a bleeding wound
When is dermabond used?
Closure of low tension, easily approximated wounds
T/F Dermabond can be used as a primary closure
True!! can be used alone or in conjunction with buried suture
used for closure of low tension, easily approximated wounds
When is dermabond not used?
- Active infection
- Mucosal surfaces
- High moisture areas
When are steristrips used?
Adhesive tapes
- Placed after suture removal
- Small wounds that are easily approximated
How do we stop skin edge bleeding?
- Direct Pressure w gauze pad
- Bovie electrocautery
Overview of a bovie
- Patient must be grounded
- ensure your gloves are intact
- aplies an electrical current that coagulates the tissue and stops bleeding
Management of a vessel bleed
- Direct pressure for 5-7 mins
- Bovie if 1-2mm
- Tying off a vessel (if big or no bovie)
Overview of a regular tie
Overview of a stick tie
Best for arteries, more secure.
Tips for assisting during bleeding
- help retract
- suction blood
- use tapes/sponges to blot blood away from site
- **use care not to wipe or remove the eschar from site that has been cauterized
