Surgical Skills Flashcards
Name some cutaneous appositional patterns
Simple interrupted
Cruciate
Name some cutaneous tension alleviating appositional patterns
Far-Far-Near-Near
Far-Near-Near-Far
Name some cutaneous tension alleviating everting patterns
Horizontal mattress
Vertical mattress
What are the uses for simple interupted patterns?
Apposition of skin,
subcutaneous tissue,
fascia,
vessels,
nerves,
GI
and urinary tract
What are the uses for the interrupted cruciate pattern?
Appositional pattern
resists tension and prevents eversion
skin
What are the uses for the simple continuous pattern?
appositional pattern
provides more airtight or fluid tight dea
can fail completely if knot is weak or inadequate
used on skin, subcutaneous, fascia, GI, urinary tract
What are the uses for the continuous intradermal suture pattern?
An appositional pattern
good skin apposition
weaker than skin sutures
no sutures to remove
can be used instead of subcuteanous, so skin sutures may not be necessary
What are the uses for the Ford Interlocking pattern?
An appositional pattern
More secure than simple continuous if knot fails
more difficult to remove
skin, diaphragm, fascia
What are the uses for the Cushing suture pattern?
It is an inverting pattern
it engages the submucosas, but not the mucosa
for closing hollow viscera like the baldder, stomach or uterus
NOT SKIN
What are the uses for the interrupted horizontal mattress pattern?
(parallel to incision line)
appositional to everting suture pattern (depends on tightness of throw)
can strangulate blood
closure in high tension area, or closure of flat tendons.muscle with minimal fascia vessels at wound edges
What are the uses for the interrupted vertical mattress suture pattern?
(perpendicular to incision line)
appositional to everting
stronger in tissue inder tension then horizontal mattress
less likely to occlude small vessels closure in area of high tension (skin)
What are the uses for the Far-Near-Near-Far and Far-Far-Near-Near suture patterns?
Provides necessary tension for wound without direct tentsion on wound edge
thus tension relieving
skin, subcutaneous and fascial closure under tension
When do you use a surgeon knott?
When tension causes the firts throw to slip, with suture of low coefficient of friction
add bulk to knott = dec security
place at lteast 3 more throws
How long should suture tags be cut in the body?
How long should they be cut in the skin?
Body - 3-4 mm long
Skin - 1.5-2 cm tags
leave tags larger with larger suture
What are 4 tension relieving patterns?
Vet Mattress,
Horizontal Mattress,
Far-far-near-near,
far-near-near-far
When would you want to ligate a vessel with a transfixion ligature?
When you would want to reduce the risk of the ligature slipping off, as in a large pulsing artery.
When closing the subcutaneous layer, how do you burry the knot?
- On the side near you, take the first bite deep to superficial
- On the side opposite you, take a bite superficial to deep and Tie two knots
- On the side near you, take a bite deep to superficial, then superficial to deep on the side across. Repeat or a continuous pattern.
- Bites should be taken 5-8mm apart
- To close, on the side near you, take a bite deep to superficial, leaving the suture loose so that the deep loop remains loose
- On the side opposite you, take a bite superficial to deep, pulling the needle up alongside the deep loop
- Tie the end to the deep loop to bury the final knot – when tying to a loop, 6 throws are suggested
