Suture Technique- Exam 1 Flashcards
What are the 4 goals of suturing?
stop bleeding
close any dead space
approximate the wound edges
minimize scar formation
What size suture is the thickest?
0 is the thickest
for superficial wounds and delicate tissues what are the sutures of choice? What sutures are good for deeper tissues?
absorbable sutures such a vicryl or polyglycolic acid
non-absorbable sutures like nylon or polypropylene
What type of suture would you use in a contaminated area and why?
monofilament sutures like nylon or polypropylene are preferred because they are LESS likely to harbor bacteria
When are multifilament sutures used commonly?
on the scalp because you need a more flexible suture on the scalp
When would you want to use a braided polyester suture?
in high tension areas such as a joint or wounds constantly under stress
How are chromic gut sutures differ than catgut sutures?
catgut are derived from the submucosal layer of the small intestine of sheep or cattle
chromic are gut sutures that are treated with chromium salts to delay absorption and prolong tensile strength
Closing the abdominal fascia in an open bowel resection.
4-0
2-0
0
5-0
What would you choose?
0
Closing the skin of an incision following carpal tunnel repair.
0- vicryl
2-0 monocryl
6-0 catgut
4-0 nylon
4-0 nylon because it is non-absorbable
Closure of an incision on the scalp.
0- vicryl
2-0 silk
4-0 monocryl
4-0 prolene
4-0 prolene
bright blue suture
A 15-year-old male presents to the ED with a 2cm laceration just above his right eyebrow.
6-0 nylon
2-0 nylon
0 vicryl
2-0 vicryl
6-0 nylon
What 3 things would you base the STYLE of closure on?
Wound size
Location
Amount of stress/tension the wound will undergo while healing
_____ is the MC type of suture and easiest to perform. When should they be used? What is the MC type of material use?
simple interrupted
Must ONLY be used in Low Tension lacerations/wounds
Nonabsorbable - Nylon or Prolene
When starting to suture using simple interrupted sutures, where should you stand?
stand in the middle with the linear wound facing horizontal in front of you
After placing the first suture using the simple interrupted technique, where should you do your next one? What is it called?
Each subsequent stitch is then placed halfway between the previous stitch and the wound edge on that side.
the rule of halves
Where should you stand in the simple running stitch?
stand at the top and the wound should be verticle
_____ is the technique of choice to help stop bleeding from the skin edge
simple running/continuous stitch
______are a good choice when the skin edges are difficult to evert. What does it provide? What are the 2 types?
Mattress sutures
Provide relief of wound tension while still allowing skin edge approximation
vertical and horizontal mattress
What are the indications for a vertical mattress suture? What are the CIs?
Lacerations around joints or areas with significant tension
Think wounds that occur on a surface that is concave or posterior neck surfaces.
CI: Face, Palms, Soles, Areas where blind, deep suture should not be performed
What is the technique for a vertical mattress suture?
“Far, Far; Near, Near”
What type of suture?
vertical mattress
What are the indications for a horizontal mattress?
Excellent for wounds under tension and very fragile wounds
Spreads the tension out over the length of wound edge
What is the technique for a horizontal mattress?
What type of suturing technique?
horizontal mattress
When would you want to use a subcuticular (Buried) suture? Where are they commonly used?
Wounds under little tension
Pts who are prone to keloid formation
Used very commonly to close small laparoscopic incisions with absorbable suture (Vicryl or monocryl)
What are the pros for using a subcuticular suture technique?
No Suture removal required and better cosmetic result
What is the technique for an interrupted subcuticular suture?
“Deep to superficial; superficial to deep”
What is the MC suture technique used in plastic surgery? What is the technique?
running subcuticular
Suture is ran along the incision in the subq tissue parallel to the incision line.
Suture then tied with knot buried.
Needle then pulled through skin and suture is cut at skin surface.
Skin is then covered with glue or steri-strips
What is the MC used method of securing sutures? Why is it different?
The square knot, or surgeon’s knot, is traditionally preferred.
The first throw in the knotting sequence is often looped or twisted twice, producing the surgeon’s knot.
An absolute minimum of _____ are needed for knot security, but some sutures require more throws to remain tied. When in doubt, ______ will hold almost all sutures securely.
three throws
five throws
When is a free hand tie helpful? What hand?
when tying a knot deep in the abdomen
aka when ligating a vessel
Most often performed with the non-dominant hand
What is the main advantage of staples over sutures? What is the con?
staples can be placed quickly
aka close a bleeding scalp wound quickly to decrease blood loss
mores scarring
What is the technique for placing staples? How far apart should staples be placed?
about 1 cm apart
Name 2 situations that skin glue can be used?
primary closure in low tension, easy to approximate wounds
in conjunction with low tension wounds
When is skin glue CI?
Contraindicated in wound with active infection or on mucosal surfaces, and areas of high moisture
When are steri-strips (adhesive tape) used?
Often are placed after sutures are removed to help keep the skin closure from separating.
Can be used as a means of closure for relatively small wounds whose edges easily come together.
What is the technique for applying steri-strips?
Cut the tape so that at least 2–3 cm are on each side of the skin edge once the tape is in place.
Place tape strips one at a time, several millimeters apart.
The tapes should be placed across (perpendicular to) the long axis of the wound.
Tapes stay in place for several days and should be allowed to fall off on their own.
The patient can wash the area but should do so gently.
Besides applying pressure, name an additional way to stop the skin edges from bleeding? Need to make sure the pt is ______
Use Electrocautery device - AKA Bovie
pt is grounded first before using Bovie
What are the 2 different options for using Bovie?
coag and cut
can be used to cut through tissue and to stop bleeding
What type of tissue is bovie NOT a good option for?
Can remove lesions but does vaporize tissue so NOT to be used when removing suspicious lesions that could be cancerous or pre-cancerous.
How long should you apply pressure to a vessel first before moving on to alt options?
Try this technique for at least 5–7 minutes.
What is 2nd line in bleeding from a vessel if the vessel is small (1-2mm)?
Electrocautery unit
When would you want to tie off a vessel? What are your 2 options?
If you do not have access to an electrocautery unit or
if the vessel is a larger vein or larger (3–4 mm) artery
regular or stick tie
When should a regular tie be used when trying to stop a vessel from bleeding? What is the step by step procedure?
Adequate for most veins and small arteries (2-3mm)
What am I?
regular tie a bleeding vessel
____ is the more secure technique to control bleeding from a blood vessel. What type of vessel especially?
Stick Tie
It is especially useful for arteries, because the thicker wall and increased interior pressure of an artery can cause a regular tie to come off of the vessel.
What am I?
stick tie used to control bleeding in a vessel
**What should you NOT due to when assisting a bleed during sx?
Use care not to wipe or remove the eschar from site that has been cauterized
