Misc

Question 1

Wound healing phases

Answer 1

• Hemostasis and Inflammation
• Fibroplasia
• Wound Maturation

Question 2

Wound maturation and strength timeline

Answer 2

• At 2 weeks the wound has achieved about 20% of its pre-wound strength.
• By 5 weeks it is at about 50%.
• By 10 weeks it is at about 80% of pre-wound strength.
• Remodeling and maturation of the scar will continue for a year or more.

Question 3

Main types of suture

Answer 3

Absorbable vs non-absorbable

Monofilament vs braided

Question 4

Monofilament suture basics

Answer 4

nylon, pds, biosyn

- More issues with knot slippage 4-5 knots
- Less infection risk

Question 5

Braided suture basics

Answer 5

Vicryl

• less slippage but more infection risk
• 3 knots

Question 6

Suture absorption times and utility. 
Fast, 
vicryl, 
PDS, 
Proline, 
Silks, 
chromics.

Answer 6

Fast (loses tensile strength in 5-7 days)
Vicryl (loses 50% strength in 2-3 weeks)
PDS lasts much longer (good for cartilage [used in rhinoplasty])
Good absorbable monofilament
Proline (least thrombogenic stitch, good for vascular)
Silk considered non-absorbable but it will over 1-2 years
Chromics: gut suture bathed in chromic salts to make them last longer. Good for intraoral closures

Question 7

Basics of suture choice

Answer 7

depends on wound
    match the tension needed on the wound
    Suture retains tension of the wound
After 1 week
    Tensile strength of a wound is 10% what it was before (roughly 10%/every week)
Sigmoid curve
    Most strength recovered weeks 2-6
After 1 year
    80% of what it was before

Question 8

Types of needles and why?

Answer 8

Taper: gradually taper to the point, and a cross-section anywhere along the shaft would reveal a round shaft, as shown in the inset. Taper needles are used for tissue that is easy to penetrate, such as bowel or blood vessels.
- V20 or SH needles
Cutting: triangular in shape, and the apex forms a cutting surface, which facilitates penetration of tough tissue, such as skin
-PS2 or PS3 needles

Reverse cutting: similar but cutting edge faces down instead of up. This may decrease the likelihood of sutures pulling through tissue in some cases.

Question 9

Timing of suture removal

Answer 9

• Face: 3-4 days
• Scalp: 5 days
• Trunk: 7 days
• Arm or leg: 7-10 days
• Foot 10-14 days