Sutures Flashcards
what type of wound has a more successful closure?
a fresh wound
who are the first responders that immediately begin the healing process?
pro inflammatory cytokines released by platelet aggregation
wounds greater than a width of a dime _____ heal well on their own if at all?
WILL NOT
3 basic principles of wound repair
1.minimize trauma to tissue
2. minimize tension on wound edges (approximate!)
3. accurately approximate wound edges & landmarks, especially vermillian borders of lips
inflammatory phase of wound healing
begins immediately and lasts 5 days
proliferative phase of wound healing
within 24 hours has sealed the wound from surface water not emersion
continues for approx 6 months
**at 24 hrs the surgically closed wound is sealed to shower water
remodeling phase of wound healing
approx 2 more years
orderly phases of wound healing
inflammation
granulation tissue
wound contraction
collagen accumulation/remodeling
close the wound
-fresh wound hours old
-large clean wound
-over cartilage or bone
-to reduce scarring
-to reduce bleeding
-surgically debrided & irrigated wounds
Don’t close the wound!
-days old or contaminated wound (unless in cosmetic area)
-abscess that are drained
-wounds that have opened after previous repair or dehiscence
-foreign bodies in wound
from what direction does the wound heal best?
from the bottom going up
what doesn’t work well in abscesses?
local anesthetics d/t generally acidic (H+) environment of the abscess fluid
*lidocaine is mildly acidic & blocks the sodium channels of depolarization
what has a greater chance of infection?
the more suture in the wound
where do sutures always pull out?
sutures in muscle & fat
for best cosmetic results:
close wound parallel to langer’s lines (provides least tension)
undermining
releases the epidermis & dermis from subQ tissue so it can be moved over the defect & approximated without undue tension on the wound edges
simple interrupted sutures
individual sutures placed in a line
continuous running sutures
continuous line of suture
running lock sutures
*
vertical mattress sutures
used in areas of thicker skin & where skin edges that may be under greater tension
- a horizontal line on each side of the lac
horizontal mattress sutures
good closure for fragile tissue like skin grafts & flaps that may have compromised vascular perfusion
-vertical lines on either side of the lac
running subQ closure (intradermal)
-sutures totally buried in the dermis or subdermis
-use absorbable suture
-to avoid puckering always enter the skin on the opposite side slightly behind where the needle exited
what kind of wounds make dog ears?
oblong wounds
needles sizes
the higher the number the smaller the needle
-the finer & sharper the needle point the less traumatic it will be to the tissue
non absorbable suture
nylon, ethilon, surgilon, dermalon, prolene, merseline
absorbable suture
cat gut plain & chromic
poly-glycolic acid type suture
silk & cotton absorb over years
braided suture
a square knot & lock will work
monofilament suture
you’ll need 4-6 square knots with good tails to stay tied
cat gut sutures
chromic gut = 90 days to dissolve
plain gut = 12-20 days to dissolve
benzoin
will protect skin & make strips adhere better
steri strips
apply at right angles to edges of the wound, applied a few mm apart
dermabond
skin glue
staples
placed 4-5 mm apart
approximate edges w/ 2 toothed forceps
how long do sutures usually stay in?
face = 3-5 days
scalp = 7 days
chest & extremities = 8-10 days
high tension areas (joints, hands) = 10-14 days
back = 10-14 days
