Suture Patterns Flashcards
what direction do you suture if you are right-handed?
right to left
what direction do you suture?
towards yourself! From point most distant to point closest to you
what are the interrupted suture patterns?
- simple
- cruciate
- mattress
- pulley
what are the continuous suture patterns?
- simple
- ford interlocking
- intradermal
- cushing/connell
- lembert
what are advantages of interrupted suture patterns?
- ease of placement
- adjustable tension
- loss of knot less disastrous
- strength, tissue mobility
what are disadvantages of interrupted suture patterns?
more time and material
what are the 2 types of pulley sutures?
- far far near near
- far near near far
what suture is a single passage thru each side of the incision, then tied?
simple interrupted
what suture is two opposite passages through each side of the incision, then tied?
mattress (interrupted suture)
what sutures are multiple passages through tissue in the same direction, varying distance from the wound edge?
pulley
cruciate suture (details)
- appositional, moderate “tension” suture
- applications: skin, body wall closure
what do you use cruciate sutures for?
skin, body wall closure
what suture:
Two passages on each side in same ‘horizontal’ plane
Forms a ‘square’ with both suture ends exiting same side
horizontal mattress
what is horizontal mattress used for?
tension-relieving: buttons, rubber tubing
may interfere with blood supply to edges
applications: skin, fascia
useful for stents
what suture?
Two passages on each side of incision in same ‘vertical’ plane; perpendicular to incision
1st > 1 cm, 2nd 0.5 cm from edge Not the same as far-far-near-near
vertical mattress
what are vertical mattress sutures used for?
- apposition to slight eversion
- tension-relieving: buttons, rubber tubing
- applications: skin, fascia
the tighter you pull, the more the skin will evert
near and far sutures
- pulley sutures
- tension relieving
- variation of vertical mattress
- all forehand bites
- far far near near
- far near near far
continuous sutures: pros vs cons
Advantages
Speed of placement
Less suture material
Ease of removal
Better initial seal
Disadvantages
Loss of knots or suture breakage, potentially more disastrous
simple continuous uses
Appositional
Too tight will necrose, invert or evert, or
wrinkle
Widely used and versatile
Any tissue where apposition is desired
Minimal to moderate tension
Use if good seal desired
what type of needle do you use with an intradermal suture?
cutting: because the dermis has such dense collagen
intradermal suture details
- placed within dermis: “subcuticular”
- begin with buried interrupted knot
- pass sutures in dermis parallel to incision
- continuous horizontal mattress
- absorbable suture
- cutting needle
what is deeper: intradermal or subcutaneous?
subcutaneous: below the dermis, internal
intradermal is through the dermis, internal
what needle do you use for intradermal sutures?
cutting
what needle do you use for subcutaneous sutures?
taper or cutting
describe cutting sutures
- across the incision
- external
- nonabsorbable suture - needs removed!
- CUTTING NEEDLE
what kind of needle do you use with a cutaneous suture?
cutting !
what are the benefits of inverting suture patterns?
- hollow organ closure
- minimize mucosal eversion
- minimize adhesion risk
what are the 3 types of inverting social patterns?
- cushing
- connell
- lembert
cushing/connell suture
- for closing hollow viscera
- continuous pattern
- suture passed parallel to incision
is cushing partial or full thickeness?
partial- “cushing… stop pushing”
is connell full or partial thickness?
full- Connell, with an “L”, into the Lumen
cushing and connell are both types of what sutures?
inverting suture patterns
lembert is what type of suture pattern?
inverting suture pattern
lembert details
- for closure of hollow viscous
- second layer
- suture passed perpendicular to incision! (difference between this and connell/cushing)
- suture enters and exits tissue on same side of incision
- partial thickness
ford interlocking
- similar to simple continuous
- needle passed thru previous suture loop before taking next bite
- pattern ended by tying to a loop
- backhand last bite?
- skin is most common application
- not commonly used in small animals- requires tight skin sutures
what species are ford interlocking sutures most commonly used in?
large animal- requires tight sutures so not often used in small animals
decision making for suture patterns
- tissue type/location
- tension: cruciate vs mattress vs pulley
- species: apposition, eversion, inversion
- interrupted vs continuous
