Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Skin Closure Techniques & Controlling Bleeding > Flashcards

Skin Closure Techniques & Controlling Bleeding Flashcards

Intraoperative Procedures

1
Q

4 Goals of Suturing

A
  1. Stop bleeding
  2. Close any dead space
  3. Approximate the wound edges
  4. Minimize Scar Formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Peritoneum would need what type of suture material to close it?

A

3-0 monocryl (some don’t close this layer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Fascia may need what type of suture material to close it?

A

large absorbable suture - 0- vicryl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Deep space (deep dermal) may need what type of suture material to close it?

A

smaller absorbable - 3-0 vicryl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Skin can be closed by what materials?

A

subcutaneous suture, staples, or glue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

For superficial wounds and delicate tissues (e.g., facial lacerations, mucosal surfaces), use what type of suture?

A

absorbable sutures - polyglactin (e.g., Vicryl) or polyglycolic acid (e.g., Dexon).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

For deeper tissues and those requiring prolonged support, what type of suture do you use?

A

non-absorbable sutures like nylon (e.g., Ethilon) or polypropylene (e.g., Prolene) are often used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If the wound is expected to heal rapidly and not require long-term support, what type of suture may be preferred?

A

absorbable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

_____ sutures are used when prolonged support is necessary, such as in cardiovascular or orthopedic surgeries.

A

Non-absorbable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

the Selection of Suture Material and Size depends on what 7 factors?

A

1) Type of Tissue
2) Healing Characteristics
3) Location of the Wound
4) expected tension
5) size of suture
6) biocompatibility and allergy considerations
7) cost and availability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • If the wound is expected to heal rapidly and not require long-term support, _____ sutures may be preferred.
  • _____ sutures are used when prolonged support is necessary, such as in cardiovascular or orthopedic surgeries.
A
  • absorbable
  • Non-absorbable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what sutures are preferred in contaminated areas because they are less likely to harbor bacteria?

A

monofilament sutures - nylon or polypropylene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what sutures may be used in areas where a more flexible suture is needed, such as the scalp?

A

multifilament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

difference between the sutures used for high-tension areas vs lower-tension areas?

A
  • High-tension - stronger; braided polyester (e.g., Ethibond)
  • Lower-tension - finer material; polyglactin like Vicryl.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the correlation to the number to the diameter size of the suture?

A

smaller = larger diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

types of suture allergies

A
  1. silk
  2. catgut
  3. chromic gut
  4. nickel
  5. other metal components - titanium, alloys
  6. adhesives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chromic gut sutures are treated with ____ _____ to delay absorption and prolong their tensile strength.

A

chromium salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Some sutures, particularly those made of ?, may contain traces of nickel.

A

stainless steel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Selecting the style of closure is based on:

A
  1. Wound size
  2. Location
  3. Amount of stress/tension the wound will undergo while healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most Common type and easiest to perform suturing technique

A

simple interrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

characteristics of simple interrupted suturing

A
  • individually placed and tied
  • Allows for eversion of edges
  • ONLY for in Low Tension
  • ensure every stitch is of equal - helps healing; less scarring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most commonly used material in simple interrupted?

A

Nonabsorbable - Nylon or Prolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

benefit of rule of halves for simple interrupted?

A

Ensures tension is evenly distributed along the wound edges

  • better wound healing
  • less risk of tissue ischemia or necrosis
  • Aesthetically pleasing outcome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
  • Place sutures again and again without tying each individual suture.
  • Easier of the wound is very clean
  • Best to help stop bleeding from skin edge - Ex) scalp laceration
A

Simple Running/Continuous Stitch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

indications for Mattress Suture

A
  • good choice when the skin edges are difficult to evert.
  • Provide relief of wound tension while still allowing skin edge approximation
26
Q

types of mattress suture

A
  1. vertical
  2. horizontal
27
Q

indications for vertical mattress

A
  1. for joints or areas with significant tension
  2. thick wounds that occur on a surface that is concave or posterior neck surfaces.
28
Q

contraindications for vertical mattress

A

Face, Palms, Soles, Areas where blind, deep suture should not be performed

29
Q

technique for vertical mattress

A

“Far, Far; Near, Near”

30
Q

indications for horizontal mattress

A
  • Excellent for wounds under tension and very fragile wounds
  • Spreads the tension out over the length of wound edge
31
Q

technique for horizontal mattress

A

box-like closure

32
Q
  • Can be Interrupted or Running
  • interrupted sutures but with buried knots
  • Requires a little more skill - must enter the skin on opposite side at a depth similar to where you exited
A

Subcuticular (Buried) Suture

33
Q

indications for Subcuticular (Buried) Suture

A
  1. Wounds under little tension
  2. prone to keloids
34
Q

interrupted subcuticular is MC used to close what type of incisions?

A

small laparoscopic

35
Q

MC sutures used for interrupted subcuticular

A

vicryl or monocryl

36
Q

Pro of interrupted subcuticular

A

No Suture removal required and better cosmetic result

37
Q
  • MC used in plastic surgery
  • Best cosmetic result
  • No suture removal required
A

Running Subcuticular

38
Q

technique for running subcuticular

A

Starts with buried simple subcuticular suture with a short tail cut and rest of suture left long.

  • Suture is ran along the incision in the subq tissue parallel to incision line.
  • tied with knot buried
  • Needle pulled through skin and suture is cut at skin surface.
  • Skin is covered with glue or steri-strips
39
Q

The most commonly used method of securing sutures in cutaneous surgery.

A

Instrument Tie

40
Q

An absolute minimum of ? throws are needed for knot security, but some sutures require more to remain tied. When in doubt, ? throws will hold almost all sutures securely.

A
  • three
  • five
41
Q

which type of tie is helpful when tying a knot deep in the abdomen

A

Free Hand Tie

42
Q

free hand tie is MC performed with which hand?

A

non-dominate
a right handed surgeon is holding the needle driver in right hand while tying with the left

43
Q

indications for staples

A
  • main pro: quick; if you need close a bleeding wound ASAP
  • Used often to close laparotomy incisions
44
Q

con of stapling

A

more scarring

45
Q

technique for stapling?
how far should staples be?

A
  1. evert edges
  2. place the center of stapler at point where skin edges come together
  3. gently touch stapler to skin, grasp handle to compress
  4. release handle, move stapler few mm back to separate staple from device

staples should be 1 cm apart

46
Q

how to remove staples

A
  1. staple remover device - Put the jaws under the staple, and close the device.
  2. No staple remover - use a clamp
    - open clamp to bend the staple; can be painful
47
Q
  • Can be applied as a primary closure or in conjunction with buried suture
  • Used for closure of low tension, easily approximated wounds
  • CI: active infection or on mucosal surfaces, and areas of high moisture
A

Skin Glue (DermaBond)

48
Q

Often are placed after sutures are removed to help keep the skin closure from separating.
Can be used as a means of closure for relatively small wounds whose edges easily come together.

A

steri strips

49
Q

technique for steri strips

A
  1. Cut strips so that 2–3 cm are on each side
  2. Place strips one at a time, several mm apart.
  3. placed across (perpendicular) the long axis of wound
  4. Stays for several days and should be allowed to fall off on their own.
  5. can wash the area but gently
50
Q

ways to control Bleeding from Skin Edges

A
  1. applying pressure
  2. electrocautery - bovie
  3. tie off vessel
51
Q

things to make sure with using a bovie

A
  1. Make sure pt is grounded
  2. Ensure your gloves are intact
52
Q

Surgeon can ask for setting of “____” to enhance the ability of cutting currents to coagulate small bleeders during dissection and coagulation currents to dissect tissue during hemostasis.

Bovie

A

Blend

53
Q

T/F: Bovies can remove/vaporize all types of lesions

A

F

NOT to be used when removing suspicious lesions that could be cancerous or pre-cancerous

54
Q

technique for applying pressure when controlling bleeding

A
  • Application of pressure is always a good first choice.
  • It prevents further blood loss and may allow the vessel to clot
  • Try this technique for at least 5–7 minutes.
55
Q

what size vessel can be used by electrocautery to stop its bleeding?

A

small - 1-2 mm

56
Q

when to tie off a bleeding vessel?

A
  • If you do not have access to an electrocautery unit or
  • large vein/artery (>3–4 mm)
57
Q

2 options of tying a bleeding vessel

A
  • regular
  • stick tie
58
Q

which tie is best for a small bleeding vessel?
technique?

A

regular tie

  1. Grasp end of vessel with a small clamp, hold it away from surrounding tissues.
  2. Pass a piece of 3-0 or 4-0 silk or Vicryl suture material (needle not needed) around vessel and under the clamp.
  3. Tie the suture securely, placing at least 3 or 4 knots.
59
Q

most secure tie to control bleeding vessel?

A

stick tie

60
Q

why is it best to use a stick tie on arteries?

A

thicker wall and increased interior pressure of an artery

61
Q

Tips for Assisting During Bleeding

A
  1. If you can’t see, it is likely that the surgeon can’t see
  2. Help retract
  3. Suction blood
  4. Use tapes/sponges to blot blood away from surgical site
  5. Suction surgical smoke/plume away from surgical site
  6. Use care not to wipe or remove the eschar from site that has been cauterized

Surgery (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions