Suture Patterns Flashcards
what are the different suture pattern classifications?
Opposing
- sutures bring the tissues together end-on-end
- this provides optimal healing and minimal scarring
Everting
- sutures turn the tissue edges outwards
- provides more stability to wound and reduces movement
- improves healing however scarring is likely
Inverting
- sutures turn tissue edges inwards
- don’t normally want to do
- used on intestine wall as stops adhesions in the abdominal cavity and creates water-tight seal
What are the ideal suture placement guidelines?
1cm suture length
0.5cm spacing between sutures
0.5cm depth into tissue
keep knots inferiorly and on same side
- where gravity will pull them
- if in centre of wound it will be treated as a FB to push out which delays healing
all dependent on patient and wound type/area
- 1cm length stitches may be extreme on smaller breeds
- 0.5cm depth may not be possible on thin tissues
What are the main components of a surgical knot?
basic knot = initial double throw to reduce risk of loosening before the second throw is placed
the loop = part of suture material within the tissue
the knot = a number of throws (normally 6)
(throw = linking of two strands of material around each other)
the ears = the cut ends of suture material which prevents knot from coming untied
what are the key points of simple interrupted sutures?
an interrupted suture pattern
- so time-consuming to place or remove
- however, if a suture fails the integrity of the surgical line is maintained
mainly used on the skin
- very good at holding wound edges in position
- don’t really need to use internally
what are the key points of simple continuous sutures?
a continuous suture pattern with one knot at each end
- so quick and simple to place or remove
- however, if a suture fails the integrity of the entire surgical line is compromised
commonly used on muscle layer as avoids interference but holds wound edges in opposition well
- if used on the skin important patient doesn’t traumatise
what are the key points of vertical mattress sutures?
an interrupted suture pattern
- so time-consuming to place or remove - especially as you pass through tissue twice for each suture
- however, if a suture fails the integrity of the surgical line is maintained
wound edges often evert
- so good to use on wounds under high-tension
- eg closing skin flap after sinus surgery
what are the key points of horizontal mattress sutures?
can be continuous or interrupted
sutures visible on outside run parallel to wound
causes large amount of eversion so not often used
what are the key points of ford interlocking sutures?
a continuous suture pattern with one knot at each end
- so quick and simple to place or remove - also not as fast as simple continuous
- however, if a suture fails the integrity of the entire surgical line is compromised
interlocking the sutures allows edges to hold in opposition well
provides more support than simple continuous sutures
most commonly used on skin of abdomen
what are the key points of cruciate sutures?
an interrupted suture pattern
- so time-consuming to place or remove - especially as you pass through tissue twice for each suture
- however, if a suture fails the integrity of the surgical line is maintained
holds wound edges in opposition well
- especially wounds under tension due to skin deficit or movement
- eg. large skin margin when removing a mast cell tumor
- eg knee closure as highly mobile skin
better at holding tension than simple interrupted as each suture has 4 points of contact with the wound edge, instead of 2, so pressure distributed further
what are the key points of purse string suture pattern?
a continuous suture pattern
- so quick to place and remove
used to tie off hollow organs or close orifices to facilitate surgery
- eg. close the anus to allow surgery in anal region
what are the key points of subcuticular sutures?
can be continuous or interrupted
no part of the suture is visible on skin surface
- often better tolerated by patients so less likely to interfere
- nothing to pull or lick off - ideal for exotics as hard to stop interference
- sometimes less itchy
what are the main rules of suturing?
handle tissues gently to aid healing
- lift dont squeeze
minimise handing of suture material
- minimises all chances of contamination
- so less risk with wicking effect
use correct needle size
- keep same diameter as suture material
- suitable gap that doesn’t cause more trauma
use needle holders correctly
- you should only need to click the rachet once to secure the needle
provide even tension to every suture
provide opposition without crushing
the wound should never be gapping or overlapping with another
sutures should always be placed at least 5mm from wound edge and placed squarely across the wound
