Suture Flashcards
1
Q
Memory
A
Capacity of a suture to return to its former shape after being re-formed
2
Q
Free-tie
A
Suture strand without a needle
Reel
3
Q
Tie on a pass
A
Suture strand loaded at the tip of the strand on an instrument (tonsil, hemostat)
4
Q
Suture ligature
A
Suture that is threaded or swaged on a needle
5
Q
Double arm
A
Needle on both ends of the suture strand
6
Q
Elasticity
A
Ability to be stretched
7
Q
Pop-offs
A
Suture can be easily pulled off the needle
8
Q
Tensile strength
A
Amount of tension or pull, expressed in pounds, that a strand of suture can be withstand before it breaks
9
Q
Tissue drag
A
Ease at which the suture slips through the tissue
10
Q
Cr=
A
Control release
Pop-offs
11
Q
Micro/ophthalmic surgery
A
11-0, 10-0, and 9-0
12
Q
Vascular surgery
A
8-0, 7-0, 6-0
13
Q
Skin (subcuticular)
A
5-0, 4-0, 3-0
14
Q
Fascia
A
2-0,0, 1
15
Q
Retention
A
2
16
Q
Steels
A
4,5,6,7
17
Q
7-0 size resembles
A
Hair
18
Q
Monofilament
A
Single thread
19
Q
Multifilament
A
Braided suture
20
Q
Multifilament advantages
A
Strength
Soft and pliable
Good handling
Good knotting
21
Q
Multifilament disadvantages
A
Bacterial harbours (wicking action)
Capillary action
Tissue trauma
22
Q
Monofilament advantages
A
Smooth surface
Less tissue trauma
No bacterial harbors
No capillarity
23
Q
Monofilament disadvantages
A
Handling and knotting
Ends/knot burial
Stretch
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
25
Multifilament (braided) features
Fibers are braided or twisted together
More tissue resistance
Easier to handle
Fewer knots needed
26
Critical wound healing period (skin)
5-7 days
27
Critical wound healing period (mucosa)
5-7 days
28
Critical wound healing period (subcutaneous)
7-14 days
29
Critical wound healing period (peritoneum)
7-14 days
30
Critical wound healing period (fascia)
14-28 days
31
Non- absorbable suture
Not biodegradable and permanent
32
Non-absorbable suture examples
Nylon
Prolene
Stainless steel
Silk (natural, can break down over several years)
33
Absorbable suture
Degraded via inflammatory response
34
Absorbable suture examples
Vicryl
Monocryl
PDS
Chromic
Cat gut (natural)
35
Polypropylene suture (prolene) color
Blue suture
Blue packet
36
Polypropylene suture (prolene) absorbable or non-absorbable
Non-absorbable
37
Polypropylene suture (prolene) is used for
General soft tissue approximation and/or ligation
Cardiovascular
Ophthalmic
Neurological
38
Polypropylene suture (prolene) features
Monofilament
Extremely high tensile strength
Very flexible
Extremely smooth textile, resulting in minimal tissue trauma
39
Polyester suture (Ethibond) color
Green or white suture
Orange packet
40
Polyester suture (Ethibond) absorbable or non-absorbable
Non-absorbable
41
Polyester suture (Ethibond) is used for
Orthopedic surgery
Cardiovascular surgery
42
Polyester suture (Ethibond) features
Multifilament (braided)
Extremely high tensile strength
Very pliable which provides minimal breakage
Coated remitting in minimal tissue trauma
43
Silk suture color
Black suture
Blue packet
44
Silk suture absorbable or non-absorbable
Non-absorbable (usually absorbed in 2 years time)
45
Silk suture is used for
General soft tissue approximation
Ligation (stick ties)
Ophthalmic procedures
Neurological procedures
46
Silk suture features
Multifilament (braided)
Extremely high tensile strength
Coated with wax to limit absorption, increase ductility, and minimize tissue reactivity
47
Nylon
Mono filament ethilon
Braided nurolon
48
Nylon color
Black or clear suture
Green packet
49
Nylon nonabsorbable or absorbable
Non absorbable
50
Nylon is used for
General soft tissue approximation (ethilon)
Cardiovascular (nurolon)
Ophthalmic procedures
Neurological procedures
Used often for skin closure and drain stitches
51
Polydioxanone (PDS) color
Purple or clear suture
Silver packet
52
Polydioxanone (PDS) absorbable or nonabsorbable
Absorbable
Fully absorbed within 6-8 months
Slowly absorbed so less tissue reaction usually occurs
53
Polydioxanone (PDS) monofilament or multifilament
Monofilament
54
Polydioxanone (PDS) is used for
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
Polyglactin 910 (Vicryl) color
Purple or white suture
Purple packet
56
Polyglactin 910 (Vicryl) absorbable or non-absorbable
Absorbable
Fully absorbed within 8-10 weeks
57
Polyglactin 910 (Vicryl) braided or single
Multifilament (braided
58
Polyglactin 910 (Vicryl) is used for
General soft tissue approximation and ligation
Decreased tendency to irritate tissue
Strong tensile strength
59
Poliglecaprone 25 (monocryl) color
Violet or clear suture
Pink packet
60
Poliglecaprone 25 (monocryl) absorbable or nonabsorbable
Absorbable
Fully absorbed within 13-17 weeks
61
Poliglecaprone 25 (monocryl) braided or single
Monofilament
62
Poliglecaprone 25 (monocryl) is used for
General soft tissue approximation (used for subqutaneous skin closure often)
NOT for use in cardiovascular or neurological tissues, microsurgery, or ophthalmic surgery
63
Chromic catgut color
Brown suture
Brown packet
64
Chromic catgut absorbable or nonabsorbable
Absorbable
Catgut is treated with chromium salt solution to resist body enzymes, thereby prolonging the absorption time of 90 days
65
Chromic catgut multifilament or monofilament
Monofilament
66
Chromic catgut is used for
General closure
Ophthalmic
Orthopedics
Obstetrics/ gynecology
Gastro-intestinal tract surgery
67
Plain catgut color
Yellow suture
Yellow packet
68
Plain catgut is derived from
Sheep or bovine intestines
69
Plain catgut absorbable or non-absorbable
Absorbable
Starts losing tensile strength within 12 days, absorbed within 2 months
70
Plain catgut is ideal for
Tissues which heal rapidly and require minimal support
71
Plain catgut is used for
General closure
Ophthalmic
72
Stainless steel suture color
Silver suture
Tan package
73
Stainless steel absorbable or nonabsorbable
Non-absorbable
74
Stainless steel single or braided
Monofilament (single)
75
Stainless steel tensile strength
Indefinite
76
Stainless steel tissue reaction
Minimal reaction
77
Stainless steel coating
None
78
Stainless steel is used in
Bone
Sternum
Wound closure
Stapling lungs, bowl, etc. in stapling devices
79
Mersilene (polyethylene tereohthalate) color
Green or white suture
Polyester fiber suture
Turquoise packet
80
Mersilene (polyethylene tereohthalate) absorbable or nonabsorbable
Non-absorbable
81
Mersilene (polyethylene tereohthalate) multifilament or monofilament
Multifilament
82
Mersilene (polyethylene tereohthalate) features
Knot handling and tensile strength is very high
83
Mersilene (polyethylene tereohthalate) is used for
Soft tissue approximation
Respiratory tract
Some CV procedures
84
Surgical needles
Wide variety with different company's naming systems
2 basic configurations for curved needles
Cutting
Tapered
85
Surgical needles (cutting)
Cutting edge can cut through tough tissues, such as skin
Indicated by triangle on package
86
Surgical needles (tapered)
No cutting edge
For sitter tissue inside the body
Indicated by circle on package
87
Surgical needles (reverse cutting)
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
Surgical needles (convential cutting)
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
Surgical needles (taper point)
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
Surgical needles (bluntl
Round shaft that ends in a blunt tip
Primary for the kidney or liver due to the tissue being so friable or weak
91
Needle eye
Portion of the needle where the suture strand is attached
92
French-eyed needle
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
Swaged needle
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
Closure types (primary closure/ primary intention)
Wound edges are brought together so that they are adjacent to each other (re-approximated)
95
Closure types (primary closure/primary intention) examples
Well-repaired lacerations
Well reduced bone fractures
Healing after flap surgery
96
Closure types (secondary closure/secondary intention)
Wound is left open and closes naturally (granulation)
97
Closure types (secondary closure/ secondary intention) examples
Gingivectomy
Gingivoplasty
Tooth extraction sockets
Poorly reduced fractures
98
Closure types (tertiary closure (delayed primary closure)
Wound is left open for a number of days and then closed if it is found to be clean
99
Closure types (tertiary closure/ delayed primary closure) examples
Healing of wounds by use of tissue grafts
100
Types of closures
Simple interrupted closure
Most commonly used, good for shallow wounds without edge tension
101
Types of closure
Continuous closure (running sutures)
Good for hemostasis (scalp wounds) and long wounds with minimal tension
102
Types of closure
Locking continuous
Useful in wounds under moderate tension or in those requiring additional hemostasis because of oozing from the skin edges
103
Types of closures
Subcuticular
Good for cosmetic results
104
Types of closure
Vertical mattress
Useful in maximizing wound eversion, reducing dead space, and minimizing tension across the wound
105
Types of closure
Horizontal mattress
Good for fragile skin and high tension wounds
106
Types of closure
Percutaneous ( (deep) closure
Good to close dead space and decrease wound tension
107
Simple interrupted suturing
Apply the needle to the needle driver
Clasp needle 1/2 to 2/3 back from tip
108
Simple interrupted suturing (rule of halves)
Matches wound edges better; avoids dog ears
Vary from rule when too much tension across wound
109
Vertical mattress
Good for everything wound edges
Neck, forehead creases, concave surfaces
110
Horizontal mattress
Good for closing wound edges under high tension, and for hemostasis
111
Pursestring suture
Drawstring placed in circular fashion so that when pulled on both ends will close the opening
112
Retention suture
Reinforces the wound in case there is a chance for dehiscence
113
Adhesive tapes (steri-strips)
Reinforces the subcuticular closure
114
Layer closure for abdominal wounds midline incision order
1. Peritoneum
2. Fascia
3. Muscle
4. Subcutaneous
5. Subcuticular
6. skin
115
Topical adhesives
Indications
Selection of approximated, superficial, clean wounds especially face, torso, limbs
May be used in conjunction with deep sutures
116
Topical adhesives
Benefits
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
Topical adhesives
Contraindicated with infection, gangrene, mucosal, damp or hairy areas, allergy to formaldehyde or cyanoacrylate, or high-tension areas
118
Dermabond
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
Dermabond features
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
Model of wound healing step 1
hemostasis
Within minutes post-injury, platelets aggregate at the injury site to form a fibrin clot
121
Model of wound healing step 2
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
Model of wound healing step 3
Proliferative
Angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction
123
Model of wound healing step 4
Remodeling
Collagen is remodeled and realigned along tension lines and cells that are no longer needed are removed by apoptosis
124
CDC surgical wound classification
Clean
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
CDC Surgical wound classification
Clean-contaminated
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
CDC surgical wound classification
Contaminated
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
CDC surgical wound classification
Dirty or infected
Greater than 27% risk of infection
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera
