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ICMS > Surgical Knots & Suture Patterns > Flashcards

Surgical Knots & Suture Patterns Flashcards

1
Q

A knot consists of at least…

A

2 throws laid on top of each other and ignited

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2
Q

the knot is the _____ point of the suture

A

weak

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3
Q

incorrectly tied knots may lead to…

A

dehiscence/opening

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4
Q

Knot security is influenced by:

A
  • configuration of the knot
  • coefficient of friction of the material
  • Length of the cut ends
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5
Q

What are the 4 types of basic knots that are important to recognize?

A
  • Granny knot
  • Square knot
  • half-hitch/slip/tumble
  • surgeon’s
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6
Q

When is a good time to use a hand tie with suture material?

A

confined areas

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7
Q

Which knot do you want to avoid doing?

A

Granny knot

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8
Q

What type of knot is this?

A

Square knot

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9
Q

Failure to reverse the throws of a square knot results in a …

A

granny knot

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10
Q

What type of knot is this?

A

Granny knot

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11
Q

How is a half-hitch knot created?

A

by pulling one suture end vertically when tightening a knot

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12
Q

What type of knot is this?

A

Surgeon’s knot

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13
Q

What type of tissue is the surgeon’s knot used for?

A

elastic tissue or an area under tension
to ligate vascular pedicles where tissue tension precludes adequate tightening of a square knot

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14
Q

A Secure knot requires…

A
  • a correctly thrown knot
  • correctly tightened throws
  • correct type of first throw (single or double)
  • correct number of throws
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15
Q

How do you prevent the loosening of knots?

A
  • use square knots
  • ensure enough throws are placed for the material being used
  • leave sufficiently long ears (3mm)
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16
Q

What are the principles of suture placement?

A
  • use square or surgeon’s knot
  • ensure enough throws are placed
  • leave ears sufficiently long
  • choose suitable suture material & pattern
  • Choose appropriate size/strength
  • place a sufficient number of sutures
  • place sutures approx. 5 mm from wound edge
    Do not over-tighten sutures
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17
Q

What are the general rules & things of note for the number of throws?

A
  • 4 throws for interrupted patterns
  • 5 throws at the start of a continuous pattern - single strand to single strand
  • 6 throws at end of a continuous pattern (single strand to loop)
  • extra throws do not increase security
  • extra throws increase the amt of foreign material wound
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18
Q

What type of ligature is this?
When do you use it?

A

Single ligature
Use on small vessels

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19
Q

What type of ligature is this?
When do you use it?

A

Double ligature
Use on large vessels/arteries

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20
Q

What type of ligature is this?

A

Transfixing ligature

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21
Q

When is the 3 forceps technique commonly used?

A

for ovarian & uterine pedicles during spay (OVE/OVH)

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22
Q

What is the 3 forceps technique used for?

A

it allows for the placement of a ligature to a crushed line of tissue on a vascular pedicle

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23
Q

What are some important things to remember about knots?

A
  • knot security is inversely proportional to suture diameter
  • inadequate tightening of each throw results in bulkier, less secure knots
  • suture ears must be adequately long
  • Don’t include a frayed portion of material in a suture or ligature
  • Extra knots result in extra bulk
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24
Q

How do you classify suture patterns?

A

Based on:
-anatomical location
- tendency to cause tissue apposition, inversion, eversion
- continuous or interrupted pattern

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25
Q

What classification of suture patterns is this?

A

interrupted

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26
Q

What classification of suture patterns is this?

A

continuous

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27
Q

What are some advantages to a interrupted suture pattern?

A
  • each suture is a separate entity
  • can more precisely adjust tension along a wound
  • easy to place
  • failure of one knot often inconsequential
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28
Q

What are some disadvantages to interrupted suture patterns?

A
  • take longer to place
  • more foreign material is introduced into the wound/body
  • can run out of suture faster
29
Q

What suture pattern is this?

A

Simple suture - needle passes through the tissue once on each side of the wound before being tied

30
Q

What types of suture pattern are these?

A

Mattress - needle passes thorugh the tissue twice on each side before being tied

31
Q

A simple interrupted suture is a ______ suture.

A

appositional

32
Q

Inversion can occur with a simple interrupted suture pattern if…

A

the suture is overtightened

33
Q

When is it most common to use a simple interrupted suture?

A

skin, SQ tissue, GIT

34
Q

Why would you place a series of simple interrupted sutures?

A
  • to facilitate proper alignment
  • to prevent tissue strangulation
  • to use just enough tension to prevent gaping
35
Q

A cruciate mattress suture is an ______ suture & resists ______.

A

appositional; tension

36
Q

A cruciate mattress suture helps to avoid…

A

ischemia and eversion

37
Q

Where do you commonly use a cruciate mattress suture?

A

skin

38
Q

Horizontal mattress suture is an ______ suture pattern.

A

appositional

39
Q

horizontal mattress suture resists _____ but can cause _______ _______ if tied too tightly

A

tension; marked eversion

40
Q

A vertical mattress suture resists _______ more than the horizontal mattress suture.

A

tension

41
Q

a vertical mattress suture causes _______ eversion than a horizontal mattress.

A

less

42
Q

vertical mattress suture is used in

A

high tension areas

43
Q

What are some advantages to continuous suture patterns?

A
  • fewer knots
  • less foreign material
  • quicker
  • potentially better for an air-tight/water-tight seal
  • better suture economy
44
Q

What are some disadvantages of continuous sutures?

A
  • less control of wound tension & approximation
  • disastrous effect if suture breakage
  • suture material needs to be handled more carefully
45
Q

A simple continuous suture is an ______ pattern used in areas of _____ tension.

A

appositional; low

46
Q

A simple continuous suture pattern is most commonly used on….

A

SQ tissue, linea alba

47
Q

Excess tension on a simple continuous suture pattern can cause…

A

tissue strangulation

48
Q

A ford interlocking suture is also known as a

A

blanket stitch

49
Q

A ford interlocking suture is commonly used in

A

large animal surgery, long wounds (ventral midline/thoracotomy), skin suture

50
Q

A ford interlocking suture is an ______ pattern

A

appositional

51
Q

What suture pattern is this?

A

Ford interlocking suture pattern (aka Blanket stitch)

52
Q

intradermal sutures are great because…

A

there is no need to remove sutures

53
Q

intradermal sutures are ______ sutures.

A

appositional

54
Q

a disadvantage for intradermal suture is…

A

it has less strength so cannot be used for high tension wounds

55
Q

What does the image represent?

A

the process for burying knots

56
Q

Lembert suture is when you invert a

A

continuous vertical mattress suture

57
Q

A Lembert suture is used to close…

A

hollow viscera

58
Q

Connell & Cushing sutures are inverting, __________________

A

continuous horizontal mattress sutures.

59
Q

Connel & Cushing sutures cause…

A

greater inversion & stenosis of the viscus than appositional patterns

60
Q

What is the difference between Connell and Cushing sutures?

A

Cushing takes bites parallel to incision and the bite goes into the submucosa but not the mucosa.
Connell bites are parallel to the incision but the bite penetrates the lumen and is often the first layer of a 2-layer closure

61
Q

When is a purse-string suture used?

A
  • Closure of hollow viscera or stumps
  • securing tubes/catheters
  • around anus during perineal Sx
62
Q

Tendon sutures resist tension/distraction forces caused by…

A

weight bearing

63
Q

What are the three main types of tendon sutures used?

A
  • three-loop pulley
  • Bunnell
  • Far-Near-Near-Far
64
Q

Skin staples are an alternative to…

A

sutures

65
Q

skin staples are fast and have reasonable…

A

cosmetic results

66
Q

To place skin staples, you need

A
  • to evert wound edges
67
Q

What are some disadvantages to skin staples?

A
  • more expensive than suture
  • need special extractor for removal
68
Q

What are some tissue adhesives that can be used?

A
  • Cyanoacrylates
  • non-absorbable synthetic adhesives

ICMS (22 decks)

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