Sutures Flashcards
define” wound” and “healing”
Wound – Injury causing an interruption of the skin or mucous membranes
Healing – The process of returning integrity to the injured tissue
three traits of well-closed wound
The margins are well approximated without tension
The tissue layers are accurately aligned
The dead space is eliminated
more vascular supply = faster or slower healing?
faster
uses for absorbable vs nonabs. sutures
Absorbable - used in superficial vessel ligation, closure of the mucosa, areas of difficult removal, intradermal sutures, fascia closure.
Non-absorbable- SKIN CLOSURE, deep closure that requires extended period of time to heal.
monofilaments vs multifilaments vs silk
monofilament- feels like fishing line - slick, bacteria doesnt stick to, doesnt tie as tight
multifilament- feels like thread - ties more tightly BUT more likely bacteria can stick to the thread
Silk - braided suture- for tying in drains - so they dont fall out (like chest tubes)
natural abs. vs synthetic abs suture.
what are the most common of ear type?
Natural absorbable – the suture is dissolved by tissue enzyme digestion (mostly chromic gut - monofilament )
Synthetic absorbable – the suture is dissolved by hydrolysis in tissue fluids (mostly Vicryl - multifilament )
3 most common types of non-abs suture
Silk - braided
Nylon
Polypropylene
how are suture-diameter size indicated?
The more zeros the smaller the diameter of the suture. For example; 00000 read as 5-0 is smaller than 000 3-0.
cutting: conventional vs reverse vs tapered needle
Conventional cutting - cutting edge on the inner concave surface. Used for skin
Reverse cutting needle - cutting edge on the outer concave curve. Used for tough tissue to minimize trauma
Tapered needle - rounded body used on delicate tissue.
what would you use: superficial face? deep face?
superficial: monofilament (nylon)
deep: monofilament (nylon) + twisted/multifilament Abs (surgical gut chromic; non-dyed)
what would you use: knee?
braided abs (vicryl) + monofilmaent nylon
what would you use: infected wound?
leave open or monofilament abs (vicryl)
what would you use: deep upper arm ?
monofilament (nylon) + abs (vicryl)
what would you use: scalp?
monofilament (nylon)- color to easily find
+ abs (vicryl) [ if deep]
what would you use: bleeding vessel in hand laceration ?
braided abs (vicryl) + monofilament (nylon)
4 types of wound classification (clean –> infected)
Clean – aseptic technique in surgery unless contaminated by GI, GU, Resp sources; less than 2% likelihood of infection; primary closure
Clean-contaminated – GI, GU, Resp involvement
Contaminated – Gross spillage (bile, feces); trauma
Infected - Abscess
wound closure: primary intention, secondary intention, delayed primary intention
Primary intention - going to close right away
Secondary intention - don’t close at all (heals from the inside-out , so there is no dead space)
Delayed primary intention - packing/wound care, watch it THEN you close it (rarely used)
Tetanus prone wounds (8)
> 6 hours old > than 1 cm deep Stellate wounds (star-shaped) Devitalized tissue (already lacking blood-flow) Contaminated with soil, feces, or saliva Missile wounds (i.e. bullets, projectiles, arrows) Puncture or crush wounds Associated with burn or frostbite
who gets a tetanus shot?
Non-tetanus prone wound in UTD adult > ten years since last booster gets Tetanus and diphtheria (Td)
Tetanus prone wound UTD adult > 5 years since booster gets tetanus and diphtheria (Td)
