Primary Wound Closure

Question 1

What are Halsted’s Principles? (7)

Answer 1

Gentle tissue handing
Meticulous haemostasis
Preservation of blood supply
Strict asepsis
Accurate dissection and apposition of tissues
Minimal tension
Obliteration of dead space

Question 2

What is the configuration of a suture material?

Answer 2

The configuration of a suture is the number of strands used to make it. Monofilament sutures are made from single strands, whereas multifilament sutures are made from multiple strands that are twisted or braided. Braided sutures have high capillarity, which means they absorb and retain fluid and bacteria. This can result in greater tissue reactions and may promote infection.

Question 3

Does natural or synthetic material cause a greater tissue inflammation? Why?

Answer 3

Natural
Natural suture materials are absorbed by proteolysis, which causes a significant tissue response. Synthetic suture materials are absorbed by hydrolysis, which causes minimal reaction and which is more predictable.

Question 4

When do absorbable suture materials loose their tensile strength by?

Answer 4

60 days

Question 5

Define tensile strength

Answer 5

The tensile strength is the maximal stress the suture will withstand before breaking.

Question 6

Do braided or monofilament tend to have greater tensile strength?

Answer 6

Braided

Question 7

What does plasticity of a suture material allow?

Answer 7

The suture material to stretch and retain its new shape and length to accommodate tissue swelling.

Question 8

What does the elasticity of a suture material allow?

Answer 8

The suture to return to its normal shape and length once the swelling has resolved, thus maintaining tissue apposition.

Question 9

Do more sutures have elastic or plastic properties?

Answer 9

Elastic

Question 10

What is suture material handling related to?

Answer 10

Pliability

Question 11

What measures the slippiness of a suture material?

Answer 11

Coefficient of friction

Question 12

Define memory

Answer 12

Memory is the ability of a suture to return to its original shape after deformation by tying. Sutures with high memory, such as monofilament sutures, can be stiff, difficult to handle and have poor knot security.

Question 13

Which of the following properties are characteristic of monofilament sutures?
A) High capillarity
B) Greater tensile strength compared to equivalent sized multifilament
C) Tissue drag
D) High memory

Answer 13

High memory

Question 14

Which of the following properties are characteristic of all absorbable sutures?
A) The are absorbed within 60 days of implantation.
B) They are absorbed by hydrolysis.
C) They lose their tensile strength within 60 days of implantation.
D) The rate of absorption is equal to the rate of loss of tensile strength.

Answer 14

C) They lose their tensile strength within 60 days of implantation.

Question 15

Which of the following properties affect suture handling
A) Tensile strength
B) Memory
C) Plasticity
D) Elasticity

Answer 15

B) Memory

Question 16

Catgut:
A) Material?
B) Configuration?
C) Tensile strength?
D) Absorption?

Answer 16

A) Surgical Gut
B) Natural + absorbable
C) 7-10d (10-21 chromic)
D) Proteolysis; 70-90d

Question 17

Vicryl:
A) Material?
B) Configuration?
C) Tensile strength? 14 d and 28 d
D) Absorption?

Answer 17

A) Polyglactin 910
B) Synthetic, absorbable, braided but coated,
C) 10% 14d, 8% 28d
D) Hydrolysis 60-90days (35d rapide)

Question 18

Polysorb:
A) Material?
B) Configuration?
C) Tensile strength? 14d and 21d
D) Absorption?

Answer 18

A) Lactomer
B) Synthetic, absorbable, braided not coated
C) 14 - 80%, 21 0 30 %
D) Hydorlysis 56-70d

Question 19

PDS:
A) Material?
B) Configuration?
C) Tensile strength? 14d and 28d + 42d
D) Absorption?

Answer 19

A) Polydioxanone
B) Synthetic, absorbable, monofilament
C) 14- 74%, 28 - 58%, 42 - 41%
D) Hydrolysis by 180-210 days

Question 20

Monocryl:
A) Material?
B) Configuration?
C) Tensile strength? 14d
D) Absorption?

Answer 20

A) Poliglecaprone 25
B) Synthetic, absorb, monofilament
C) 20-30%
D) Hydrolysis by 90-120days

Question 21

Ethilon/Monosof
A) Material?
B) Configuration?
C) Tensile strength?
D) Absorption?

Answer 21

A) Monofilament nylon
B) Synthetic, non absorb, monofilament
C) High
D) 67% after 11 years

Question 22

Taper point needles:
A) Structure?
B) When are they used?

Answer 22

A) Fine point penetrating
B) Soft tissue

Question 23

Taper cut needle:
A) Structure?
B) Use?

Answer 23

A) Oval body and reverse cutting point to allow greater ease of tissue penetration.
B) vascular surgery.

Question 24

Conventional cutting needle:
A) Structure?
B) Use?

Answer 24

A) Triangular tip and are used for placing sutures in tougher tissue
B) Skin

Question 25

what is the structure of reverse cutting needle?

Answer 25

Reverse cutting needles have the cutting surface on the convex surface of the needle. The cutting edge is away from the wound, which may decrease the risk of suture pull-through.

Question 26

Which has greater knot security:
A) Multifilament vs monofilament?
B) Small or large diameter of suture?
C) Continuous or interrupted?

Answer 26

A) Multi
B) Smaller
C) interrupted

Question 27

How many throws on a knot is enough?

Answer 27

4

Question 28

What size material for skin?

Answer 28

3-0 4-0

Question 29

How can “dog ears” be removed? (5)

Answer 29

Apex cutaneous suture;
Removal of one or two triangles;
Extension of fusiform incision;
Removal of arrowhead-shaped piece of skin;
Half-Z correction.

Question 30

X are placed by undermining the wound edges and placing simple interrupted sutures between the dermis and underlying fascia.

Answer 30

The walking sutures

Question 31

What is mesh expansion?

Answer 31

Consists in multiple punctate relaxing incisions.

Question 32

Z plasty:
Where is the central limb in relation to the wound?

Answer 32

Perpendicular to

Question 33

How far from the wound must the central limb of a z plasty be?

Answer 33

3cm