Primary Wound Closure Flashcards
What are Halsted’s Principles? (7)
Gentle tissue handing
Meticulous haemostasis
Preservation of blood supply
Strict asepsis
Accurate dissection and apposition of tissues
Minimal tension
Obliteration of dead space
What is the configuration of a suture material?
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.
Does natural or synthetic material cause a greater tissue inflammation? Why?
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.
When do absorbable suture materials loose their tensile strength by?
60 days
Define tensile strength
The tensile strength is the maximal stress the suture will withstand before breaking.
Do braided or monofilament tend to have greater tensile strength?
Braided
What does plasticity of a suture material allow?
The suture material to stretch and retain its new shape and length to accommodate tissue swelling.
What does the elasticity of a suture material allow?
The suture to return to its normal shape and length once the swelling has resolved, thus maintaining tissue apposition.
Do more sutures have elastic or plastic properties?
Elastic
What is suture material handling related to?
Pliability
What measures the slippiness of a suture material?
Coefficient of friction
Define memory
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.
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
High memory
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.
C) They lose their tensile strength within 60 days of implantation.
Which of the following properties affect suture handling
A) Tensile strength
B) Memory
C) Plasticity
D) Elasticity
B) Memory
Catgut:
A) Material?
B) Configuration?
C) Tensile strength?
D) Absorption?
A) Surgical Gut
B) Natural + absorbable
C) 7-10d (10-21 chromic)
D) Proteolysis; 70-90d
Vicryl:
A) Material?
B) Configuration?
C) Tensile strength? 14 d and 28 d
D) Absorption?
A) Polyglactin 910
B) Synthetic, absorbable, braided but coated,
C) 10% 14d, 8% 28d
D) Hydrolysis 60-90days (35d rapide)
Polysorb:
A) Material?
B) Configuration?
C) Tensile strength? 14d and 21d
D) Absorption?
A) Lactomer
B) Synthetic, absorbable, braided not coated
C) 14 - 80%, 21 0 30 %
D) Hydorlysis 56-70d
PDS:
A) Material?
B) Configuration?
C) Tensile strength? 14d and 28d + 42d
D) Absorption?
A) Polydioxanone
B) Synthetic, absorbable, monofilament
C) 14- 74%, 28 - 58%, 42 - 41%
D) Hydrolysis by 180-210 days
Monocryl:
A) Material?
B) Configuration?
C) Tensile strength? 14d
D) Absorption?
A) Poliglecaprone 25
B) Synthetic, absorb, monofilament
C) 20-30%
D) Hydrolysis by 90-120days
Ethilon/Monosof
A) Material?
B) Configuration?
C) Tensile strength?
D) Absorption?
A) Monofilament nylon
B) Synthetic, non absorb, monofilament
C) High
D) 67% after 11 years
Taper point needles:
A) Structure?
B) When are they used?
A) Fine point penetrating
B) Soft tissue
Taper cut needle:
A) Structure?
B) Use?
A) Oval body and reverse cutting point to allow greater ease of tissue penetration.
B) vascular surgery.
Conventional cutting needle:
A) Structure?
B) Use?
A) Triangular tip and are used for placing sutures in tougher tissue
B) Skin
what is the structure of reverse cutting needle?
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.
Which has greater knot security:
A) Multifilament vs monofilament?
B) Small or large diameter of suture?
C) Continuous or interrupted?
A) Multi
B) Smaller
C) interrupted
How many throws on a knot is enough?
4
What size material for skin?
3-0 4-0
How can “dog ears” be removed? (5)
Apex cutaneous suture;
Removal of one or two triangles;
Extension of fusiform incision;
Removal of arrowhead-shaped piece of skin;
Half-Z correction.
X are placed by undermining the wound edges and placing simple interrupted sutures between the dermis and underlying fascia.
The walking sutures
What is mesh expansion?
Consists in multiple punctate relaxing incisions.
Z plasty:
Where is the central limb in relation to the wound?
Perpendicular to
How far from the wound must the central limb of a z plasty be?
3cm
