Suture Patterns Flashcards
Interrupted sutures
Each stitch is interrupted with a knot
Simple interrupted
Cruciate
Horizontal mattress
Vertical mattress
Continuous suture patterns
Simple continuous
Intra dermal
Ford interlocking
Cushing, Connell & Lembert
Purse string
Knots
Basic unit = one throw
1 revolution of 1 end of suture around other
** this is the weakest point of the suture
Most secure knot
Square knot
2 mirror image simple knots
Half hitch knots
Happens due to uneven tension /tags during throws
Surgeons knot
1st throw = 2 revolutions of 1 end of suture around other
Used rarely to overcome tissue tension
Disadvantage = bulky = ^ foreign material in wounds, difficulty to tighten, doesn’t allow proper tension for ligating vessels
Knot security
Force required to cause knot to slip
Suture size - inversely related
Coefficient of friction - multifilament > monofilament
Knot configuration - square knot = reliable
Minimizing knot volume
Proper # of throws - generally 4 throws
Cut tags to appropriate length
- synthetic = 3mm (sharp)
- natural = 6mm (blunt)
Suture pattern classification
Two basic patterns
Interrupted - each stitch is cut or tied
Continuous - knots at beginning & end at running
Placement classification
Placement method = primary
Effect on wound margin = secondary
Appositional = bringing two margins together
Inverting = tissue ends are folding in towards
Everting = tissue ends are bunched upward
Benefits of interrupted
Precise wound apposition
Increased closure security
Cons
Time consuming
Poor suture economy - takes a lot
Increased foreign material
Common use for simple interrupted pattern
Skin, body wall, fascia
2-3mm from wound edge
5mM apart
Knots offset from the wound
(R handed surgeon = start right and move left)
Benefits of mattress sutures
Increases strength across wound
Used to over come mild tension
Cruciate pattern
Two interrupted sutures joined together
Good for tissue under tension
Great for apposition
Less suture used/wasted
Create an X when tied
Horizontal mattress
Everting skin - bites are horizontal /parallel to incision
Relieves heavier tension but can block capillaries leading to Local ischemia = Delayed healing
Used for facia & exotics
Vertical mattress
Appositional
Far far, near near
Stronger in tissues under tension than HM and disrupts blood flow less - LA common use
Benefits of continuous suture patterns
Rapid, even tension distribution, max tissue apposition, decreased suture material
Risk of suture line compromised*
Ford interlocking pattern
Used for skin closure in LA or abdominal incisions in SA
Each pass partially locked, half hitch
Good stability, great apposition
Use for simple continuous
Luminal organs, bladder, stomach, small intestine
Cushing, Connell, lembert
Inverting pattern - largely replaced by Appositional pat.
Hollow viscera w larger lumina
- stomach
- uterus
- urinary bladder
Cushing & Connell bites
Bites are parallel to the wound
Lembert bites
Bites are perpendicular to the wound
Use for Cushing, Connell, lembert
Cushing & lembert - partial thickness
Connell - full thickness
Purse string
Close hole or opening in body wall
- common for perineal surgeries or (finger trap) drainage tubes - w lots of manipulation
Intra dermal pattern
Variation of horizontal mattress
Not exposured sutures - sensitive areas, difficult patients
Less secure than percutanous sutures - skin edges must be apposed w tension
Buried knots
Crucial for intradermal sutures
Knots are buried deep to superficial
Where tags come out is where knots will be**
Intradermal pattern uniformity
Depth relative to wound edge
2-3 mm between bites
Friction knots
Increased holding power of first throw
Ligating Pedicles
Surgeons throw is inferior in regards to vascular hemostasis
Friction knot ex
Modified millers knot - large vessels, ovarian pedicles, bleeding
Miller’s knot -
Strangle knot -
