Suture Patterns Flashcards
what is an interrupted pattern
series of individual sutures
which is more secure interrupted or continuous
interrupted
which allows for adjustment of tension interrupted or continuous
interrupted
which uses more suture interrupted or continuous
interrupted – more expensive, increased foreign material in wound
which takes longer interrupted or continuous
interrupted
what is a continuous pattern
start with a knot than continue with pattern to end of incision prior to tying final knot
how many knots in a continuous pattern
2
how do you adjust tension in continuous
tension adjusted after each bite taken
difficult to adjust tension at the end
which provides better air and watertight closure interrupted or contiuous
continuous
where do you start a suture pattern
at or just beyond the corner of the incision (1-3mm)
distance of bites from incision edge
3-5 mm
distance between bites
5-8 mm
which patterns are appositional
simple interrupted
simple continuous
cruciate
ford interlocking
intradermal
what type of suturing allows for best anatomical approximation and brings edges of incision together
appositional patterns
what results in fastest healing and gives best cosmetic results
appositional patterns
classification of simple interrupted
interrupted and appositional
is simple interrupted recommended if there is tension
no
simple interrupted impact on blood supply to incision edges
minimal, unless overtightened
uses of simple interrupted
close skin, subcutaneous layer, body wall
ligate blood vessels or nerves
classification of simple continuous
continuous and appositional
simple continuous effect on blood supply compared to simple interrupted
larger effect
uses of simple continuous
close subcutaneous layer, body wall, hollow organ incisions
less common in skin
classification of cruciate pattern
interrupted and appositional
strength of closure compared to simple interrupted
stronger – covers greater distance along incision
cruciate effect on blood supply compared to simple interrupted
larger effect
should cruciate be used when there is a concern for tension
no
uses of cruciate
close skin, body wall
does cruciate help prevent inversion of skin
yes
classification of ford interlocking pattern
continuous and appositional
ford interlocking and knot failure
some security in case of knot failure
ford interlocking effect on blood supply
same as simple continuous
what can ford interlocking cause when placed under tension
pressure necrosis
may become buried
what species is ford interlocking commonly used in
bovine
but can be used in small animals
classification of intradermal pattern
continuous and appositional
what does intradermal do
apposes skin and diminishes tension on skin closure
how does intradermal run
horizontally through dermis
intradermal impact on local blood supply
minimal
what do you do to the knot in intradermal
bury it
why is important to bury knot in intradermal
if knot sticks out patient may lick or chew it
prevents access of dirt and bacteria to deepest layers
in intradermal should bites backtrack
yes, about halfway
what can tissue forceps cause in intradermal and why
post operative bruising due to excess pressure needed to stabilize skin
what do inverting patterns do
turn incision edges inward
where are inverting patterns used
larger lumen hollow organs
what happens to lumen with inverting patterns
decreases lumen size
what helps provide watertight seal in inverting patterns
serosa-serosa apposition
where do you avoid using inverting and why
avoid when closing skin – delays healing
which patterns are inverting
lembert
cushing
purse string
what is the holding layer when suturing hollow organs
tunica submucosa
complications when suturing hollow organs
dehiscence
calculi or stone formation
adhesions
what patterns are used with single layer closure
simple interrupted or simple continuous commonly used
what type of pattern is used in double layer closure on the stomach
first layer – appositional pattern
second layer – inverting pattern
what type of pattern is used in double layer closure on the urinary bladder
first layer – inverting pattern
second layer – similar to stomach (inverting??)
what type of pattern is used in closure on the intestines
1 layer closure – appositional pattern
classification of lambert pattern
continuous and inverting
is lambert partial or full thickness
partial thickness – non penetrating pattern
uses of lambert
GI surgery
large lumen hollow organs
colon, bladder, stomach, rumen
is lambert continuous or interrupted
can be either
what is penetrated in lambert
serosa
muscularis
submucosa
what is not penetrated in lambert
mucosa of the hollow organ
how to make tissue more inverted in lambert
place bites farther from incision edge
classification of cushing pattern
continuous and inverting
is cushing partial or full thickness
partial thickness – non penetrating pattern
what is and is not penetrated in cushing
penetrates submucosa
does not penetrate organs lumen
what is cushing commonly used with
2 layer closure
uses of cushing
hollow viscera
urinary bladder
stomach
uterus
classification of connell pattern
continuous and inverting
is connell partial or full thickness
full thickness – penetrating
can this be used in 2 layer closure
yes, but only as first (inner) layer
uses of connell
hollow viscera
urinary bladder
stomach
uterus
purse string classification
continuous and inverting
is purse string pattern partial or full thickness
partial thickness – non penetrating
what is purse string pattern commonly used on
hollow organ viscera
what is purse string pattern used for
temporarily close anus during perianal surgery
maintain rectal prolapse reduction
close defect in hollow organ wall
what is finger trap pattern used for
secure tubes to patient
what is used in finger trap pattern
hand throws
what do everting patterns do
turn incision edges outwards
what is everting pattern used for
what can it lead to
suturing edges under tension
decrease tension on the suture line
can lead to delayed healing
what is tension
tendency of the incision to open up
which patterns are everting
mattress – horizontal and vertical
walking sutures
near-far patterns (surgeons stich) – near-far-far-near and far-near-near-far
classification of vertical mattress pattern
interrupted and tension relieving (everting)
effect of vertical mattress on blood supply
less than horizontal mattress
more than simple interrupted
degree of eversion of vertical mattress compared to horizontal mattress
horizontal mattress has more eversion than vertical
uses on vertical mattress
closure of high tension areas
commonly used for skin closure
how to differentiate horizontal and vertical mattress
vertical – sutures are perpendicular to incision
horizontal – sutures are parallel to incision
classification of horizontal mattress pattern
interrupted and tension relieving (everting)
uses of horizontal mattress
closure of high tension areas
commonly used for skin closure
which patterns require backing the needle in
horizontal and vertical mattresses
classification of near-far-far-near and far-near-near-far patterns
variation of vertical mattress
interrupted and everting (tension relieving)
what is the most appropriate pattern to use for considerable tension
near-far-far-near
far-near-near-far
uses of near-far-far-near and far-near-near-far patterns
closure of high tension areas
commonly used for skin closure
