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 kind of suture material would you use for superficial wounds and delicate tissue (facial laceration, mucosal surfaces)?

Answer 2

absorbable sutures:
* polyglactin (vincryl)
* polyglycolic acid (dexon)

Question 3

For deeper tissues and those requiring prolonged support, what suture material would you use?

Answer 3

non absorbable sutures
* nylon (ethilon)
* polypropylene (prolene)

Question 4

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

Answer 4

rapidly: absorbable!!
long: non absorbable

ok…this is making sense

Question 5

What kind of sutures are preferred in contaminated areas? why?

location of wound

Answer 5

monofilament sutures like nylon or polypropylene b/c they’re less likely to harbor bacteria

Question 6

what kind of suture would you use when more flexible sutures are needed? ie your scalp!!

location of wound

Answer 6

multifilament

Question 7

what kind of suture would you need for higher tension areas? ie joints or wounds under constant stress

What about lower tension areas?

Answer 7

braided polyester!! (ethibond)

this name just sounds strong!!!

Question 8

what kind of suture would you need for lower tension areas?

expected tension

Answer 8

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

Question 9

What sutures are people potentially allergic to?

Answer 9

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

Question 10

What does closure style selection depend on?

Answer 10

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

Question 11

When do we use simple interrupted?

Answer 11

Low tension lacs/wounds

Use nonabsorbable (nylon or prolene)

Question 12

What is the rule of halves?

Answer 12

Used in linear wounds

Question 13

When is simple running used?

Answer 13

Clean wound with easy approximation, such as a scalp lac

Technique of choice when stopping skin bleeds

Question 14

When are mattress sutures used?

Answer 14

• Skin edges are difficult to evert since it provides relief of wound tension while allowing skin edge approximation
• Vertical and Horizontal types

Question 15

When is vertical mattress indicated?

Answer 15

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

Far, far;near, near

Question 16

Where is vertical mattress contraindicated?

Answer 16

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

Question 17

When is horizontal mattress indicated?

Answer 17

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

Question 18

Image of vertical vs horizontal

Answer 18

Question 19

Overview of a buried suture

Answer 19

Question 20

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

Answer 20

• Used in small laparoscopic incisions
• Absorbable sutures used (MC Vicryl or monocryl)
• No removal and good cosmetic results.

Question 21

When is running buried MC?

Answer 21

Plastic surgery

best cosmetic result, no suture removal required

Question 22

Overview of running subcuticular/buried suture

Answer 22

Question 23

What is the MC used method of securing sutures in cutaneous surgery?

Answer 23

Instrument Tie

Square knot, or surgeons knot preferred

Question 24

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

Answer 24

• 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

Question 25

How do you do a free-hand tie? +when is it helpful to use?

Answer 25

With your non-dominant hand

Common in deep abdomen (ligating a vessel)

Question 26

Pros and cons of staples

Answer 26

• Pro: fast af
• Cons: more scaring

can be placed quickly so helps when trying to minimize blood loss by closing a bleeding wound

Question 27

When is dermabond used?

Answer 27

Closure of low tension, easily approximated wounds

Question 28

T/F Dermabond can be used as a primary closure

Answer 28

True!! can be used alone or in conjunction with buried suture

used for closure of low tension, easily approximated wounds

Question 29

When is dermabond not used?

Answer 29

• Active infection
• Mucosal surfaces
• High moisture areas

Question 30

When are steristrips used?

Adhesive tapes

Answer 30

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

Question 31

How do we stop skin edge bleeding?

Answer 31

1. Direct Pressure w gauze pad
2. Bovie electrocautery

Question 32

Overview of a bovie

Answer 32

• Patient must be grounded
• ensure your gloves are intact
• aplies an electrical current that coagulates the tissue and stops bleeding

Question 33

Management of a vessel bleed

Answer 33

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

Question 34

Overview of a regular tie

Answer 34

Question 35

Overview of a stick tie

Answer 35

Best for arteries, more secure.

Question 36

Tips for assisting during bleeding

Answer 36

• 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