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Small Animal Surgery > Suture Technique - Knot tying, suture patterns, and hemostasis > Flashcards

Suture Technique - Knot tying, suture patterns, and hemostasis Flashcards

1
Q

Knot security is determined by:

A
  1. Size and structure of the suture material
  2. Coefficient of friction - the higher the coefficient of friction, the stronger the knot (silk - strong knots)
  3. Length of cut ends
  4. Quality of the knot - surgeon dependent
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2
Q

Knot Tying Technique and what to avoid

A
  • Pull the suture ends in opposite directions at uniform rate and with equal tension
  • Avoid:
    • Creating friction between the strands while tightening the throw
    • Crimping suture with instruments
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3
Q

4 throws = how many knots?

A

2 knots

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4
Q

3 throws are as secure as 6 for most sutures tested, but tensile failure load is greater with __

A

6

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5
Q

Recommendations:

Interrupted pattern’

Continuous Pattern, beginning and end

A
  • Interrupted patter - 4 throws (2 square knots)
  • Continuous pattern - 6 throws (3 square knots)
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6
Q

Where do sutures almost always fail? Why?

A

at the knot, unless the suture has been damaged; knotting reduces strength by 10-40%

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7
Q
A
  • Simple knot
  • Aka - throw
  • One throw = simple knot
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8
Q
A

Square knot - it takes two throws to make a square knot

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9
Q
A

Surgeon’s knot - two wraps around first throw; second throw of a square knot goes ontop

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10
Q
A

Half-hitch knot - jerk up on one strand, usually done with a square knot ontop

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11
Q
A

Granny knot - BAD

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12
Q

Burying the knot - indications

A
  • Inverted knot reduces likelihood that suture ends will become exposed
  • Indications:
    • Subcutaneous sutures
    • Intradermal pattern
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13
Q

Principles of wound closure

A
  • Closure should be as anatomic as possible (like tissues are apposed)
  • Use the least amount of suture material that will accurately and reliably appose the tissues
  • Dead space should be minimized
  • Use absorbable material for buried sutures whenever possible - some excetions
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14
Q

“Routine” Wound Closure - what layers are usually included (ex - abdominal incision)

A
  • Fascia - want to use longer acting suture material becuase it takes a long time to heal (PDS)
  • Subcutaneous tissue
  • Skin
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15
Q

What is the most common pattern with suturing subcutaneous tissue? And what can be done to decrease “dead space”?

A
  • Simple continuous pattern
  • Periodic bites into the underlying fascia can be sued to decrease “dead space”
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16
Q

Subcutaneous pattern

A
  • Can be used for animals with a lot of subcutaneous fat
  • Bites taken perpendicular to skin edge, but no dermis engaged
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17
Q

Intradermal pattern (aka ____)

A
  • Subcuticular pattern
    • More accurate apposition of skin edges - engages dermis
    • bites taken perpendicular or parallel to skin edge
    • Skin sutures may not be needed
    • Continuous pattern
    • Slightly overlapping bites (<25%) results in tighter closure
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18
Q

Perpendicular bites vs Parallel bites

A
  • Thick skin - perpendicular to the incision
  • Thin skin - parallel to the incision
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19
Q
  • Skin suture guidelines
    • distance between sutures should be:
    • Distance between skin suture and wound edge should be:
A
  • 2 times the skin thickness
  • 5mm rule - you don’t want any skin suture less than 5mm from the wound endge becuase any less will compromise blood supply
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20
Q

Interrupted suture patterns: pros and cons

A
  • Advantages
    • Precise placement and control of tension
    • Failure of one suture or knot inconsequential
  • Disadvantages:
    • Increased surgical time
    • Increased volume of suture left in the wound
    • Poor suture economy
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21
Q

Continuous Suture Patterns

A
  • Advantages:
    • Speed of placement
    • Less suture left in wound
    • More air- or water-tight
      • Good for urinary bladder and stomach
    • Suture economy
  • Disadvantages
    • Less precise control of tension and approximation
    • Failure may result in loss of entire suture line
22
Q
A

Simple interrupted suture

23
Q
A

simple cutnaneous suture

24
Q
A

Ford Interlocking suture

25
Q
A

Cruciate or Cross Mattress Suture

26
Q
A

Figure-of-eight suture - like an upside down cruciate

27
Q

Name six appositional suture patterns

A
  • Simple interrupted
  • Simple continuous
  • Ford interlocking
  • Cruciate or cross mattress
  • Figure-of-eight
  • Intradermal suture pattern (w/ perpendicular or parallel bites)
28
Q

5 Tension relieving sutures

A
  1. Vertical Mattress
  2. Far-far-near-near
  3. Far-near-near-far
  4. Horizontal mattress
  5. Quilled and Stent
29
Q
A

Vertical Mattress

Placed far from the wound incision - if you tie it tight enough, skin will evert

30
Q
A

Far-far-near-near

31
Q
A

far-near-near-far

32
Q
A

Horizontal mattress

*blood supply is cut off with horizontal mattress - if suturing skin, vertical mattress is preferable

33
Q
A

Quilled suture - not as common when we have ability to do walking sutures

34
Q

When to use inverting suture patterns?

A
  • closure of hollow viscera
  • Imbrication (plication)
  • NOT for use in skin b/c skin has natural tendency to already invert - dorsal surface of epithelium won’t heal together
35
Q

Three inverting suture patterns:

A
  1. Lembert
    1. Halsted variation
  2. Cushing
  3. Connell
36
Q
A

Lembert suture

  • Different from vertical mattress - you go in and come out and go OVER the skin - needle stays in the same direction
37
Q
A

Halsted Suture Pattern

38
Q
A

Cushing

  • Needle goes into the skin through the dermis, but does not go all the way to the lumen of that hollow organ
  • DOES NOT GO INTO LUMEN!!!
39
Q
A

Connell

  • Same as cushing, but SUTURE GOES INTO THE LUMEN
40
Q

Friction sutures are made for:

A

anchoring tubes

41
Q

How to secure a tube with friction sutures

A
  • Just one square knot
  • Then surgeons throw (1/2 of surgeons knot) - tie off tube, and then you finish the surgeon knot.
  • Square knot - tube - half of surgeons throw - finish surgeons throw
42
Q

Securing a tube with friction sutures without using needle holders and forceps:

A
  1. Pass the suture through the needle
  2. Tie a square knot
  3. Insert the tube
  4. Place the tube onto the swuare knot and tie a surgeon’s knot
  5. Repeat the process for multiple friction sutures.
43
Q

Hemostasis - sterile gauze application

A

Holding pressure with gauze - helps capillary bleeding.

DO NOT DAB!

Press with slight/moderate pressure and hold for a few seconds. Reapply if necessary.

44
Q

Using Hemostatic Forceps

A
  • Pay attention to the grooves inside the forceps
  • Should be perpendicular to the suture
  • End-on application
    • Used for isolated blood vessels (grooves perpendicular to the vessel)
  • Perpendicular application
    • Used for blood vessels with pedicles (like ovarian pedicle during ovariohysterectomy - NOT for isolated vessels)
45
Q

vet product of gelfoam is:

A

Vetspon - less expensive, almost identical

46
Q

Electrosurgery:

  • Electrodessication
  • Electrocoagulation
  • Electroincision
A
  • Electrodessication - dessicating tumor surface
  • Electrocoagulation - stops vessels from bleeding
  • Electroincision - used during surgery, not used on skin because of dermal necrosis
47
Q

Electrosurgery: monopolar vs bipolar

A
  • Monopolar is MC
    • foot panel to activate coagulation
  • Bipolar
    • Looks like a pair of forceps - creates a circuit when you pinch the tissue - neuro surgeons like this one because they feel like they have more control
48
Q

Direct vs Coaptive Electrocoagulation

A
  • Coaptive - apply to forceps
  • Direct - apply directly to tissues - control excessive capillary hemorrhage
49
Q

Electrocautery

A
  • Electricity is used to ehat a metal element - no circuit like in electrocoagulation
  • Then, that element is applied to the tissue
  • No current passes through the tissue!!!!
50
Q

Radiosurgery

A
  • Ultra high-frequency radio waves pass from wire tip (active electrode) into the tissue to be cut or coagulated, depending on the waveform setting chosen, and on to a flat antenna (passive electrode)
  • No need for conductive gel
  • Patient not part of an electrical circuit
  • Wire electrode remains cold
51
Q

When does laser hemostasis not work?

A

Once you have blood in the field

52
Q

Tissue and Vessel Fusion Benefits

A
  • No dislodged clips
  • Reduced lateral thermal spread, sticking, and charring
  • No foreign material left behind
  • Leaves tissue in its normal anatomical position

Small Animal Surgery (17 decks)

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