Needles, Suture Patterns and Knots

Question 1

Why might you use a straight vs. a curved needle or a combination needle?

Answer 1

• straight - superificially - manipulated directly by surgeons fingers (e.g. purse-string in anus)
• curved - in deep or small surgical fields where working area is limited; always manipulated by needle holders
• combo - J-, ski-, or f-needles; straight body and curved point; for intracorporeal endoscopic suturing or placement of large gauge orthopedic suture
  
  • S-needle: very thick skin (LA)

Question 2

What procedures are different length curved needles preferred for?

Answer 2

• 1/4 circle - ophthalmic procedures
• 3/8 circle - require less pronation and supination of surgeon’s wrist than 1/2 but more difficult to use in deep/inaccessible sx fields (1/2 or 5/8 better for these)

Question 3

What are the different needle point configurations and what are they used for?

Answer 3

• blunt - friable tissue
• taper point - find point that pierces and spreads tissues apart during passage; delicate tissues (GI organs, fat, bladder, mm)
• tapercut - reverse cutting point and oval body - less chance for inadvertent tissue damage during passage
• cutting - very tough/fibrous tissue (skin, periosteum, fascia)
• spatula or side-cutting - ocular sx
• diamond point - plastic surgery

Question 4

What are eyed suture needles (non-swaged) typically used for?

Answer 4

passing large suture in orthopedic surgery

Question 5

What are advantages to using an interrupted suture pattern? Disadvantage?

Answer 5

they allow more precise wound margin apposition, selective adjustments to the wound edge closure; however, they do take longer to place

Question 6

Simple interrupted is what type of pattern? What are the advantages/disadvantages of using it?

Answer 6

appositional (unless excessive tension applied - then inversion)

• A: quick/easy to place, disruption of a single suture doesn’t cause entire suture line to fail
• DA: takes longer to place than a continuous pattern, results in more foreign material in wound

Question 7

Horizontal mattress is what type of pattern? What are the advantages/disadvantages of using it?

Answer 7

everting

• A: used primarily in areas of tension
• DA: local ischemia of skin may result when placed under tension

Question 8

Cruciate is what type of pattern? What are the advantages/disadvantages of using it?

Answer 8

appositional

• A: can be used in areas of tension
• DA: can cause eversion and local ischemia, but less than that cause by a horizontal mattress

Question 9

Vertical mattress is what type of pattern? What are the advantages/disadvantages of using it?

Answer 9

everting (though less than horizontal mattress)

• A: stronger than horizontal mattress sutures when placed in areas of tension
• DA: time consuming to place

Question 10

Lembert is what type of pattern? What is the disadvantage of using it?

Answer 10

inverting (“far-near, near-far” pattern); can be used in continuous fashion to close hollow viscera

• DA: significant inversion

Question 11

Gambee is what type of pattern? What are the advantages/disadvantages of using it?

Answer 11

appositional; utilized in intestinal sx to minimize mucosal eversion

• A: may enhance healing
• DA: requires more tissue manipulation than simple interrupted pattern

Question 12

What are the advantages of using continuous suture patterns?

Answer 12

• quicker to insert, distribute tension evenly along wound
• typically used for viscera, body wall, SQ, and intradermal sites
• avoided for skin closure b/c risk of damage to entire suture line by the patient licking/chewing/scratching

Question 13

Simple continuous is what type of pattern? What are the advantages/disadvantages of using it?

Answer 13

appositional (everting under tension)

• A: relatively air tight and fluid tight
• DA: should not be used in areas where tightening the suture might result in a purse-string-like effect

Question 14

Ford Interlocking (Continuous Lock) is what type of pattern? What are the advantages/disadvantages of using it?

Answer 14

appositional

• A: greater degree of tissue stability than with simple continuous, quick to place
• DA: uses a lot of suture and may be more difficult to remove

Question 15

Continuous Lembert is what type of pattern? What is disadvantage of using it?

Answer 15

inverting

• DA: causes more inversion than the other inverting patterns b/c bites are taken perpendicular to the incision

Question 16

Connell and Cushing are what type of pattern? How do they differ, and what is the advantage of using them?

Answer 16

inverting; often used close hollow viscus

Connell: enters the lumen (takes full-thickness bites)

Cushing: does not penetrate lumen (partial-thickness bite)

• A: create water tight seal

Question 17

Intradermal is what type of pattern? What is the advantage of using it?

Answer 17

appositional

• A: useful in areas or patients (i.e. fractious) that you do not want to remove sutures from

Question 18

Factors that influence knot security are….

Answer 18

material used, the length of the cut ends, and the structural configuration of the knot

Question 19

Why do the ending knots of continuous patterns require 2-3 additional throws?

Answer 19

because such knots are composed of three suture strands

Question 20

What is one scenario in which a half hitch or slip knot may be purposely tied? What must you do following this scenario?

Answer 20

to overcome tension or apply a ligature deep into a wound or body cavity; a square knot must be tied over the slip knot for knot security

Question 21

Describe simple/circumferential ligatures and give examples

Answer 21

• may be used on vessels or pedicles
• when used on pedicles, often used in combo w/ a transfixation ligature (circumferential should be placed proximally- closer to great vessels)
• ex: modified miller’s knot, square knot, surgeon’s knot

Question 22

Describe transfixation ligatures and give examples

Answer 22

• may be placed on single vessels (usually arteries) or pedicles
• suture penetrates vessel and encloses it
• security of placement is the advantage compared to circumferential ligature, but this does NOT mean transfixations are more secure
• ex: Halstead transfixation ligature, modified transfixation ligature, figure of eight transfixation ligature