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Surgical Procedures 2 > Suture > Flashcards

Suture Flashcards

1
Q

Memory

A

Capacity of a suture to return to its former shape after being re-formed

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2
Q

Free-tie

A

Suture strand without a needle

Reel

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3
Q

Tie on a pass

A

Suture strand loaded at the tip of the strand on an instrument (tonsil, hemostat)

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4
Q

Suture ligature

A

Suture that is threaded or swaged on a needle

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5
Q

Double arm

A

Needle on both ends of the suture strand

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6
Q

Elasticity

A

Ability to be stretched

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7
Q

Pop-offs

A

Suture can be easily pulled off the needle

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8
Q

Tensile strength

A

Amount of tension or pull, expressed in pounds, that a strand of suture can be withstand before it breaks

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9
Q

Tissue drag

A

Ease at which the suture slips through the tissue

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10
Q

Cr=

A

Control release

Pop-offs

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11
Q

Micro/ophthalmic surgery

A

11-0, 10-0, and 9-0

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12
Q

Vascular surgery

A

8-0, 7-0, 6-0

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13
Q

Skin (subcuticular)

A

5-0, 4-0, 3-0

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14
Q

Fascia

A

2-0,0, 1

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15
Q

Retention

A

2

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16
Q

Steels

A

4,5,6,7

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17
Q

7-0 size resembles

A

Hair

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18
Q

Monofilament

A

Single thread

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19
Q

Multifilament

A

Braided suture

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20
Q

Multifilament advantages

A

Strength

Soft and pliable

Good handling

Good knotting

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21
Q

Multifilament disadvantages

A

Bacterial harbours (wicking action)

Capillary action

Tissue trauma

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22
Q

Monofilament advantages

A

Smooth surface

Less tissue trauma

No bacterial harbors

No capillarity

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23
Q

Monofilament disadvantages

A

Handling and knotting

Ends/knot burial

Stretch

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24
Q

Monofilament features

A

Single strand of suture material

Minimal tissue trauma

Smooth tying but more knots needed

Harder to handle due to memory

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25
Q

Multifilament (braided) features

A

Fibers are braided or twisted together

More tissue resistance

Easier to handle

Fewer knots needed

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26
Q

Critical wound healing period (skin)

A

5-7 days

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27
Q

Critical wound healing period (mucosa)

A

5-7 days

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28
Q

Critical wound healing period (subcutaneous)

A

7-14 days

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29
Q

Critical wound healing period (peritoneum)

A

7-14 days

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30
Q

Critical wound healing period (fascia)

A

14-28 days

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31
Q

Non- absorbable suture

A

Not biodegradable and permanent

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32
Q

Non-absorbable suture examples

A

Nylon

Prolene

Stainless steel

Silk (natural, can break down over several years)

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33
Q

Absorbable suture

A

Degraded via inflammatory response

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34
Q

Absorbable suture examples

A

Vicryl

Monocryl

PDS

Chromic

Cat gut (natural)

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35
Q

Polypropylene suture (prolene) color

A

Blue suture

Blue packet

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36
Q

Polypropylene suture (prolene) absorbable or non-absorbable

A

Non-absorbable

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37
Q

Polypropylene suture (prolene) is used for

A

General soft tissue approximation and/or ligation

Cardiovascular

Ophthalmic

Neurological

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38
Q

Polypropylene suture (prolene) features

A

Monofilament

Extremely high tensile strength

Very flexible

Extremely smooth textile, resulting in minimal tissue trauma

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39
Q

Polyester suture (Ethibond) color

A

Green or white suture

Orange packet

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40
Q

Polyester suture (Ethibond) absorbable or non-absorbable

A

Non-absorbable

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41
Q

Polyester suture (Ethibond) is used for

A

Orthopedic surgery

Cardiovascular surgery

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42
Q

Polyester suture (Ethibond) features

A

Multifilament (braided)

Extremely high tensile strength

Very pliable which provides minimal breakage

Coated remitting in minimal tissue trauma

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43
Q

Silk suture color

A

Black suture

Blue packet

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44
Q

Silk suture absorbable or non-absorbable

A

Non-absorbable (usually absorbed in 2 years time)

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45
Q

Silk suture is used for

A

General soft tissue approximation

Ligation (stick ties)

Ophthalmic procedures

Neurological procedures

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46
Q

Silk suture features

A

Multifilament (braided)

Extremely high tensile strength

Coated with wax to limit absorption, increase ductility, and minimize tissue reactivity

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47
Q

Nylon

A

Mono filament ethilon

Braided nurolon

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48
Q

Nylon color

A

Black or clear suture

Green packet

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49
Q

Nylon nonabsorbable or absorbable

A

Non absorbable

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50
Q

Nylon is used for

A

General soft tissue approximation (ethilon)

Cardiovascular (nurolon)

Ophthalmic procedures

Neurological procedures

Used often for skin closure and drain stitches

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51
Q

Polydioxanone (PDS) color

A

Purple or clear suture

Silver packet

52
Q

Polydioxanone (PDS) absorbable or nonabsorbable

A

Absorbable

Fully absorbed within 6-8 months

Slowly absorbed so less tissue reaction usually occurs

53
Q

Polydioxanone (PDS) monofilament or multifilament

A

Monofilament

54
Q

Polydioxanone (PDS) is used for

A

General soft tissue approximation

Pediatric cardiovascular tissue where growth is expected to occur

Ophthalmic procedures

Ideal for internal tissues where a long lasting, absorbable suture is preferable (abdominal closure)

55
Q

Polyglactin 910 (Vicryl) color

A

Purple or white suture

Purple packet

56
Q

Polyglactin 910 (Vicryl) absorbable or non-absorbable

A

Absorbable

Fully absorbed within 8-10 weeks

57
Q

Polyglactin 910 (Vicryl) braided or single

A

Multifilament (braided

58
Q

Polyglactin 910 (Vicryl) is used for

A

General soft tissue approximation and ligation

Decreased tendency to irritate tissue

Strong tensile strength

59
Q

Poliglecaprone 25 (monocryl) color

A

Violet or clear suture

Pink packet

60
Q

Poliglecaprone 25 (monocryl) absorbable or nonabsorbable

A

Absorbable

Fully absorbed within 13-17 weeks

61
Q

Poliglecaprone 25 (monocryl) braided or single

A

Monofilament

62
Q

Poliglecaprone 25 (monocryl) is used for

A

General soft tissue approximation (used for subqutaneous skin closure often)

NOT for use in cardiovascular or neurological tissues, microsurgery, or ophthalmic surgery

63
Q

Chromic catgut color

A

Brown suture

Brown packet

64
Q

Chromic catgut absorbable or nonabsorbable

A

Absorbable

Catgut is treated with chromium salt solution to resist body enzymes, thereby prolonging the absorption time of 90 days

65
Q

Chromic catgut multifilament or monofilament

A

Monofilament

66
Q

Chromic catgut is used for

A

General closure

Ophthalmic

Orthopedics

Obstetrics/ gynecology

Gastro-intestinal tract surgery

67
Q

Plain catgut color

A

Yellow suture

Yellow packet

68
Q

Plain catgut is derived from

A

Sheep or bovine intestines

69
Q

Plain catgut absorbable or non-absorbable

A

Absorbable

Starts losing tensile strength within 12 days, absorbed within 2 months

70
Q

Plain catgut is ideal for

A

Tissues which heal rapidly and require minimal support

71
Q

Plain catgut is used for

A

General closure

Ophthalmic

72
Q

Stainless steel suture color

A

Silver suture

Tan package

73
Q

Stainless steel absorbable or nonabsorbable

A

Non-absorbable

74
Q

Stainless steel single or braided

A

Monofilament (single)

75
Q

Stainless steel tensile strength

A

Indefinite

76
Q

Stainless steel tissue reaction

A

Minimal reaction

77
Q

Stainless steel coating

A

None

78
Q

Stainless steel is used in

A

Bone

Sternum

Wound closure

Stapling lungs, bowl, etc. in stapling devices

79
Q

Mersilene (polyethylene tereohthalate) color

A

Green or white suture

Polyester fiber suture

Turquoise packet

80
Q

Mersilene (polyethylene tereohthalate) absorbable or nonabsorbable

A

Non-absorbable

81
Q

Mersilene (polyethylene tereohthalate) multifilament or monofilament

A

Multifilament

82
Q

Mersilene (polyethylene tereohthalate) features

A

Knot handling and tensile strength is very high

83
Q

Mersilene (polyethylene tereohthalate) is used for

A

Soft tissue approximation

Respiratory tract

Some CV procedures

84
Q

Surgical needles

A

Wide variety with different company’s naming systems

2 basic configurations for curved needles
Cutting
Tapered

85
Q

Surgical needles (cutting)

A

Cutting edge can cut through tough tissues, such as skin

Indicated by triangle on package

86
Q

Surgical needles (tapered)

A

No cutting edge

For sitter tissue inside the body

Indicated by circle on package

87
Q

Surgical needles (reverse cutting)

A

Opposing cutting edges in a triangular configuration that extend into the full length of the shaft

Used for skin because they have a flat edge in the direction of the pull

88
Q

Surgical needles (convential cutting)

A

Three cutting edges that are directed along the inner curve of the needle

Place a small cut in the direction of the pull of the suture

89
Q

Surgical needles (taper point)

A

Combine a sharp taper point with a cutting tip

Designed to penetrate tougher tissue while still making smaller hous in the tissue

Primary choice for use in vascular tissue

90
Q

Surgical needles (bluntl

A

Round shaft that ends in a blunt tip

Primary for the kidney or liver due to the tissue being so friable or weak

91
Q

Needle eye

A

Portion of the needle where the suture strand is attached

92
Q

French-eyed needle

A

Loaded by pulling the taut strand into a V-shaped area just above the eye

Loaded more quickly than a closed-eye needle

Results in more tissue damage than the eyeless needle

93
Q

Swaged needle

A

Needles that are manufactured with suture strands inserted into one end

Continuous with the suture strand

Hole created in the tissue by the needle should be completely filled by the suture strand when suturing

94
Q

Closure types (primary closure/ primary intention)

A

Wound edges are brought together so that they are adjacent to each other (re-approximated)

95
Q

Closure types (primary closure/primary intention) examples

A

Well-repaired lacerations

Well reduced bone fractures

Healing after flap surgery

96
Q

Closure types (secondary closure/secondary intention)

A

Wound is left open and closes naturally (granulation)

97
Q

Closure types (secondary closure/ secondary intention) examples

A

Gingivectomy

Gingivoplasty

Tooth extraction sockets

Poorly reduced fractures

98
Q

Closure types (tertiary closure (delayed primary closure)

A

Wound is left open for a number of days and then closed if it is found to be clean

99
Q

Closure types (tertiary closure/ delayed primary closure) examples

A

Healing of wounds by use of tissue grafts

100
Q

Types of closures

Simple interrupted closure

A

Most commonly used, good for shallow wounds without edge tension

101
Q

Types of closure

Continuous closure (running sutures)

A

Good for hemostasis (scalp wounds) and long wounds with minimal tension

102
Q

Types of closure

Locking continuous

A

Useful in wounds under moderate tension or in those requiring additional hemostasis because of oozing from the skin edges

103
Q

Types of closures

Subcuticular

A

Good for cosmetic results

104
Q

Types of closure

Vertical mattress

A

Useful in maximizing wound eversion, reducing dead space, and minimizing tension across the wound

105
Q

Types of closure

Horizontal mattress

A

Good for fragile skin and high tension wounds

106
Q

Types of closure

Percutaneous ( (deep) closure

A

Good to close dead space and decrease wound tension

107
Q

Simple interrupted suturing

A

Apply the needle to the needle driver

Clasp needle 1/2 to 2/3 back from tip

108
Q

Simple interrupted suturing (rule of halves)

A

Matches wound edges better; avoids dog ears

Vary from rule when too much tension across wound

109
Q

Vertical mattress

A

Good for everything wound edges

Neck, forehead creases, concave surfaces

110
Q

Horizontal mattress

A

Good for closing wound edges under high tension, and for hemostasis

111
Q

Pursestring suture

A

Drawstring placed in circular fashion so that when pulled on both ends will close the opening

112
Q

Retention suture

A

Reinforces the wound in case there is a chance for dehiscence

113
Q

Adhesive tapes (steri-strips)

A

Reinforces the subcuticular closure

114
Q

Layer closure for abdominal wounds midline incision order

A
  1. Peritoneum
  2. Fascia
  3. Muscle
  4. Subcutaneous
  5. Subcuticular
  6. skin
115
Q

Topical adhesives

Indications

A

Selection of approximated, superficial, clean wounds especially face, torso, limbs

May be used in conjunction with deep sutures

116
Q

Topical adhesives

Benefits

A

Cosmetic, seals out bacteria, apply in 3 minutes, holds 7 days 5-10 to slough), seal moisture, faster, clear, convenient, less supplies, no removal, less expensive

117
Q

Topical adhesives

A

Contraindicated with infection, gangrene, mucosal, damp or hairy areas, allergy to formaldehyde or cyanoacrylate, or high-tension areas

118
Q

Dermabond

A

A sterile, liquid topical skin adhesive

Reacts with moisture on skin surface to form a strong, flexible bond

Only for easily approximated skin edges of wounds (punctures from minimally invasive surgery; simple, throughly cleansed, lacerations

119
Q

Dermabond features

A

Standard surgical wound prep and dry

Crack ampule or applicator tip up; invert

Hold skin edges approximated horizontally

Gently and evenly apply at least two thin layers on the surface of the edges with a brushing motion with at least 30 seconds between each layer, hold for 60 seconds after last layer until not tacky

Apply dressing per Doctor preference

120
Q

Model of wound healing step 1

A

hemostasis

Within minutes post-injury, platelets aggregate at the injury site to form a fibrin clot

121
Q

Model of wound healing step 2

A

Inflammatory

Bacteria and debris are phagocytosed and removed, and factors are released that cause the migration and division of cells involved in the proliferative phase

122
Q

Model of wound healing step 3

A

Proliferative

Angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction

123
Q

Model of wound healing step 4

A

Remodeling

Collagen is remodeled and realigned along tension lines and cells that are no longer needed are removed by apoptosis

124
Q

CDC surgical wound classification

Clean

A

1-5% risk of infection

Uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered

Primary closed, but if necessary, drained with closed drainage

Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria

125
Q

CDC Surgical wound classification

Clean-contaminated

A

3-11% risk of infection

Operative wounds in which the respiratory, alimentary, genital, or urinary tract is entered under controlled conditions and without unusual contamination

No evidence of infection or major break in technique is encountered

126
Q

CDC surgical wound classification

Contaminated

A

10-17% risk of infection

Open, fresh, accidental wounds, operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, nonpurulent inflammation is encountered

127
Q

CDC surgical wound classification

Dirty or infected

A

Greater than 27% risk of infection

Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera

Surgical Procedures 2 (2 decks)

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