Suture Patterns Flashcards
Interrupted vs. continuous patterns:
How do interrupted patterns compare to continuous patterns with regard to security? Efficiency?
more secure —> failure of 1 or 2 single interrupted sutures does not usually affect the integrity of closure and it allows for adjustments of tension throughout the suture line
less efficient —> more time needed to tie individual knots
How do interrupted patterns compare to continuous patterns with respect to price of suture? Presence of foreign material in wound?
more expensive —> uses more suture material
more foreign material (suture) in the wound
How are continuous patterns done?
begin with an initial knot and continue with the pattern to the end of the incision prior to tying the final knot
- only 2 knots, but knots MUST be tied properly
What are 2 cons to using a continuous pattern over an interrupted one? 3 pros?
CONS: failure of 1 knot leads to disruption of entire suture line, less precise control of suture tension and wound approximation
PROS: time efficient/faster, less foreign material in the wound, better air and water-tight closure
How are interrupted and continous patterns started?
- begin at the end of the incision nearest to your dominant hand
- take the first bite from the top at or just beyond the corner of the incision (~1-3 mm)
How should bites be spaced from the incision edge and between sutures?
- distance from incision edge = ~3-5 mm
- distance between sutures = ~5-8 mm
What is an appositional pattern? When are they used?
bring the tissue in direct approximation of the two cutting surfaces
used when there is no excessive tension on the incision edges
What pattern enables the best anatomical approximation (and the best cosmetic results)? What does this allow?
appositional pattern
brings the edges of the incision together, resulting in the fastest healing
What are 5 examples of appositional patterns?
- simple interrupted
- simple continuous
- cruciate
- Ford interlocking
- intradermal
What type of pattern is the simple interrupted pattern? When is it used?
interrupted, appositional
when there is normal tension on the incision’s edges —> NOT recommended when there is tension
What impact does the simple interrupted pattern have on local blood supply to the incision edges? What can excessive tension lead to?
minimal impact, unless overtightened
inversion of the skin margins
What are 2 common uses of the simple interrupted pattern?
- close skin, subcutaneous layer, and body wall
- ligation of blood vessels or nerves
Simple interrupted steps:
What can happen when knots are tied too tightly?
post-operative swelling, redness, and discomfort, which can impair wound healing
What type of pattern is the simple continuous pattern? How does it affect local blood supply and apposition?
continuous, appositional
larger effect on blood supply compared to simple interrupted
provides better apposition with an air- and water-tight seal
What does excessive tension in the simple continuous pattern lead to?
puckering and tissue strangulation
What are 4 things that the simple continuous pattern is used to close?
- subcutaneous layer
- body wall
- hollow organs
- skin (less common)
What are the 5 steps to performing the simple continuous pattern?
- place a simple interrupted suture ~5 mm beyond the edge of the incision; secure the suture and cut the short end
- return to the original side of the incision and move ~5 mm down the incision
- repeat steps 1 and 2 until ~5 mm before the edge of the incision
- when taking the final bite, do not tighten the suture all the way, creating a small loop
- tie the long end of the suture to the loop and tighten
What type of pattern is the cruciate pattern? How does it compare with closure and blood supply?
interrupted, appositional
stronger closure than simple interrupted, since it covers greater distance along the incision
larger effect on blood supply compared to the simple interrupted
What does the cruciate pattern specifically help resist? When should it NOT be used?
resists tension while preventing inversion of the skin edges
concern for tension
What 3 things is the cruciate pattern best for closing?
- skin (esp mass removals)
- body wall
- gingiva
What are the 3 steps to performing the cruciate pattern?
- begin as if performing a simple interrupted, but after exiting through the opposite side of the skin DO NOT TIE THE KNOT
- take a second bite on the same side of the incision
- tie to the short end of the suture from step 1
What are 3 special considerations with the cruciate pattern?
- place each bite a distance from the surgical incision edge that is equal to the thickness of the tissue (~3-5 mm)
- space sutures approximately twice the distance apart (~6-8 mm)
- leave the loop loose enough to accommodate post-operative swelling