Suture and Suturing Flashcards
what is a caveat of surgical tape on instrument packs
only tells you it reached a certain temperature on the outside, not internally (and it doesn’t guarantee is was that hot for long enough to sterilize)
if right handed, where do you want your scalpel blade/ other commonly used instruments
to the right
the small metal bowl is for ___________ and the large metal bowl is for _______________
saline; garbage
after scrubbing in, what two “extras” do you need to get for your bowls
1) saline for small bowl
2) chlorhexidine for beaker
when do you use the following grip for a scalpel
1) finger/dinner knife
2) pencil
1) initial/longer incisions
2) stab/short incisions
if I needed to make a stab incision I would use _____ grip but if i needed to make my long, initial incision I would use _______ grip
pencil; finger/dinner knife
what technique do you want to use for making your incision through the linea
stab (pencil grip) while tenting tissues; reverse press cut (cutting edge is facing upwards)
what forcep do we use for general tissue handling
Adson tissue
what are examples of tissues we can use Adson tissue forceps on
SQ fat, linea alba during closure
how does Adson brown differ from Adson tissue
Adson brown allows a stronger grasp of tissues
to tent the linea during initial abdominal approach you would use _______ forceps and for closure of the linea you would use _______ forceps
Adson brown; Adson tissue
what would you use debakey forceps for
handling gentle tissues like vessels, GI, bladder
what grip do we use for all forceps
pencil grip
what grip do we use for needle drivers
tripod (thumb and ring finger)
what type of scissors are used on suture
sharp-blunt
you would use _______ scissors for the linea alba and _______ scissors for fat and soft tissue
mayo; metzembaum
when would you use tip clamping vs jaw clamping
tip clamping: single vessel
jaw clamping: vascular pedicle
what is a benefit of carmalt hemostats and why
prevents tissue slippage due to longitudinal striations down entire length and cross-striations at bottom
what is a perfect use for carmalt hemostats
ovariohysterectomy -> used to clamp large vascular pedicles
you can use ________ hemostats for large vascular pedicles, _________ for small vascular pedicles, and ________ for single vessels and very small vascular pedicles
carmalt; kelly/crile; mosquito
swaged needles are more _______ but less _________ compared to eyed needles
expensive; traumatic
what is the difference between absorbable and non-absorbable suture
absorbable: loses significant tensile strength within 60 days of implantation
non-absorbable: maintains 100% of tensile strength for at least 60 days
how are natural vs synthetic absorbable sutures absorbed
natural: enzymatic processes of cellular proteases and collagenases
synthetic: hydrolysis
rate of absorption should be proportional to….
rate of returning strength of healing tissue
what is the following healing time (approximate):
- stomach/bladder
- GI
- fascia
- tendons
stomach/bladder: 2 weeks
GI: 3 weeks
fascia: 6-7 weeks
tendons:»_space;
multifilament can be (2)
braided or twisted
when do we use knotless/barbed suture
laproscopy
coated sutures are created to improve __________, improve _________, reduce ________ and reduce __________
pliability; knot formation; drag; infection
what is elasticity
the degree to which suture will deform under stress or load and return to its original form when the load is removed
what is capillarity
the degree to which a suture will absorb fluid following immersion
T/F suture metric and standard sizes are inconsistent and can vary between materials and manufacturers
T
what is catgut made from
sheep intestinal submucosa or cattle intestinal serosa
what can we use catgut on
vessel ligations
why is catgut not commonly used
rapid and inconsistent absorption and lots of tissue reaction
Vicryl maintains _____ of its tensile strength within _____ weeks
50%; 2-3 weeks
what type of suture is Vicryl (Polyglactin 910)
synthetic braided, multifilament, absorbable suture
what is Vicryl (Polyglactin 910) a good option for
intradermal; used often in large animals
what type of suture is Monocryl (Polyglecaprone 25)
synthetic monofilament, absorbable suture
what are the absorption characteristics of Monocryl
loses 50% of its tensile strength within 1 week and 70-80% within 2 weeks; gone by 90-120 days with little tissue reaction
when might we use Monocryl
subq, intradermal, urinary tract (if no infection)
what type of suture is PDS II
monofilament, synthetic, absorbable
how is PDS II absorbed
approx 50% of tensile strength remains at 5-6 weeks
what tissues is PDS II great for
the linea alba (heals in 6-7 weeks)
put the following suture in order from fastest to slowest absorption:
- Vicryl
- Monocryl
- PDS II
Monocryl, Vicryl, PDS II
what type of suture is Prolene
non-absorbable, synthetic, monofilament, polyolefin
why is Prolene very resistant to degradation
lacks hydrolyzable bonds
what is Prolene good to use for
skin closure (must remove later)
T/F Prolene can be used intradermally
F; need to be able to go back and remove it
what type of suture is Nylon
non-absorbable, synthetic, monofilament, polyamide
T/F nylon is a great option for permanent implantation
F; susceptible to degradation
what type of knots do we want to see while suturing
square
how many throws to form a secure simple interrupted knot
5
when would you want to use a surgeons throw
1) fatty ovarian pedicle ligature
2) linea
would NOT want to use on a small vessel (larger loop so not as tight)
T/F surgeons throws are safer than simple throws
F
what are the rules for performing a continuous suture line? when do we forget the rules?
first knot should have 1 extra throw (6) and the last knot should have 2 extra throws (7); does not apply to a buried SQ or intradermal (not enough space)
how big should suture tags be
2-4mm
T/F you should stabilize the needle with the teeth of your forceps
F; behind the teeth
when suturing, you always want to keep your hands
parallel to the table
what is the most common way to lose a square not
not maintaining even tension and not keeping hands parallel
how big should your suture tags be for skin sutures
6-10 mm
what type of suture pattern is more likely to prevent slippage off of the pedicle cut end
Miller knot
