suture patterns

Question 1

surgeon’s knot

Answer 1

first throw passed through loop twice

creates friction, less slippage

bulkier, asymmetrical, less knot security

Question 2

ligation

Answer 2

use of suture and knots to occlude blood vessels

suture-chromic gut, silk, synthetic absorbable

more secure than hemostatic clips

more time consuming

Question 3

simple vessel ligature

Answer 3

square knot in crush from a hemostat

place several mm from cut end of vessel

3-4 throws

Question 4

double ligature

transfixation ligature

Answer 4

one simple ligature

one transfixing ligature-halsted or modified

transfixing prevents slippage

Question 5

tissue ligatures

Answer 5

used when vessels cannot be isolated

loosens when entrapped tissue dies

Question 6

vascular pedicle ligatures

Answer 6

three hemostatic forceps technique-ligature placed in crush

not good on very large pedicles

Question 7

modified miller’s knot

Answer 7

Question 8

interrupted sutures

Answer 8

precisely adjust tension

time consuming

suture separate

more foreign material

poor suture economy

fibrin forms seal

Question 9

continuous suture

Answer 9

cannot adjust tension

less time

break disrupts entire closure

less foreign material

better suture economy, better immediate seal

Question 10

interrupted cruciate

Answer 10

stronger than simple interrupted

resists tension

prevents eversion

Question 11

ford interlocking

Answer 11

great seal

LA-thoracotomy-fast

Question 12

continuous intradermal

Answer 12

used in place of skin sutures

modified horizontal mattress in dermis

saves time and suture

weaker than interrupted

Question 13

gambee

Answer 13

inverting

prevents eversion of mucosa

used for intestinal resection and anastomosis

Question 14

lembert

Answer 14

inverting

vertical mattress-like

interrupted or continuous

penetrates submucosa

does not enter lumen

Question 15

Cushing

Answer 15

horizontal mattress-like

penetrates submucosa-does not enter lumen

less inverting than lembert

Question 16

connell

Answer 16

horizontal mattress like

penetrates all layers

enters lumen-may wick bowel contents–>bacteria in abdomen

Question 17

double layer closure

Answer 17

closing large hollow viscera

layer 1-cushing

layer 2-continuous lembert

Question 18

vertical mattress

Answer 18

tension relieving

apposes or everts

resists tension well

Question 19

near and far

Answer 19

tension relieving

like vertical mattress

edge approximation-no tension on edge

excess tension–>inversion

far-far-near-near

far-near-near-far

Question 20

horizontal mattress

Answer 20

apposes or everts

resists tension less than vertical

can be stented

Question 21

locking loop

Answer 21

tendon suture

Question 22

triple loop pulley

Answer 22

tendon suture

difficult

one on left

Question 23

abdominal wall closure

Answer 23

linea alba/external rectus sheath-simple interrupted

SQ tissue-simple continuous

skin-simple interrupted or cruciate

Question 24

ovarian pedicle

Answer 24

modified miller’s knot

encircling ligature

transfixation ligature

Question 25

uterine body

Answer 25

transfixation vs stick ligature

encircling ligature

Question 26

testicular pedicle

Answer 26

modified miller’s knot

encircling ligature

transfixation ligature

SQ tissue-simple continuous or cruciates

skin-intradermal with buried knots

Question 27

buried suture

Answer 27

goal-suture ends deep to bury knot

first bite-deep to superfiicial

second bite-superficial to deep