Suture Patterns

Question 1

Interrupted sutures

Answer 1

Each stitch is interrupted with a knot
Simple interrupted
Cruciate
Horizontal mattress
Vertical mattress

Question 2

Continuous suture patterns

Answer 2

Simple continuous
Intra dermal
Ford interlocking
Cushing, Connell & Lembert
Purse string

Question 3

Knots

Answer 3

Basic unit = one throw
1 revolution of 1 end of suture around other
** this is the weakest point of the suture

Question 4

Most secure knot

Answer 4

Square knot
2 mirror image simple knots

Question 5

Half hitch knots

Answer 5

Happens due to uneven tension /tags during throws

Question 6

Surgeons knot

Answer 6

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

Question 7

Knot security

Answer 7

Force required to cause knot to slip
Suture size - inversely related
Coefficient of friction - multifilament > monofilament
Knot configuration - square knot = reliable

Question 8

Minimizing knot volume

Answer 8

Proper # of throws - generally 4 throws
Cut tags to appropriate length
- synthetic = 3mm (sharp)
- natural = 6mm (blunt)

Question 9

Suture pattern classification

Answer 9

Two basic patterns
Interrupted - each stitch is cut or tied
Continuous - knots at beginning & end at running

Question 10

Placement classification

Answer 10

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

Question 11

Benefits of interrupted

Answer 11

Precise wound apposition
Increased closure security
Cons
Time consuming
Poor suture economy - takes a lot
Increased foreign material

Question 12

Common use for simple interrupted pattern

Answer 12

Skin, body wall, fascia
2-3mm from wound edge
5mM apart
Knots offset from the wound
(R handed surgeon = start right and move left)

Question 13

Benefits of mattress sutures

Answer 13

Increases strength across wound
Used to over come mild tension

Question 14

Cruciate pattern

Answer 14

Two interrupted sutures joined together
Good for tissue under tension
Great for apposition
Less suture used/wasted
Create an X when tied

Question 15

Horizontal mattress

Answer 15

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

Question 16

Vertical mattress

Answer 16

Appositional
Far far, near near
Stronger in tissues under tension than HM and disrupts blood flow less - LA common use

Question 17

Benefits of continuous suture patterns

Answer 17

Rapid, even tension distribution, max tissue apposition, decreased suture material
Risk of suture line compromised*

Question 18

Ford interlocking pattern

Answer 18

Used for skin closure in LA or abdominal incisions in SA
Each pass partially locked, half hitch
Good stability, great apposition

Question 19

Use for simple continuous

Answer 19

Luminal organs, bladder, stomach, small intestine

Question 20

Cushing, Connell, lembert

Answer 20

Inverting pattern - largely replaced by Appositional pat.
Hollow viscera w larger lumina
- stomach
- uterus
- urinary bladder

Question 21

Cushing & Connell bites

Answer 21

Bites are parallel to the wound

Question 22

Lembert bites

Answer 22

Bites are perpendicular to the wound

Question 23

Use for Cushing, Connell, lembert

Answer 23

Cushing & lembert - partial thickness
Connell - full thickness

Question 24

Purse string

Answer 24

Close hole or opening in body wall
- common for perineal surgeries or (finger trap) drainage tubes - w lots of manipulation

Question 25

Intra dermal pattern

Answer 25

Variation of horizontal mattress
Not exposured sutures - sensitive areas, difficult patients
Less secure than percutanous sutures - skin edges must be apposed w tension

Question 26

Buried knots

Answer 26

Crucial for intradermal sutures
Knots are buried deep to superficial
Where tags come out is where knots will be**

Question 27

Intradermal pattern uniformity

Answer 27

Depth relative to wound edge
2-3 mm between bites

Question 28

Friction knots

Answer 28

Increased holding power of first throw
Ligating Pedicles
Surgeons throw is inferior in regards to vascular hemostasis

Question 29

Friction knot ex

Answer 29

Modified millers knot - large vessels, ovarian pedicles, bleeding
Miller’s knot -
Strangle knot -