Sutures

Question 1

define” wound” and “healing”

Answer 1

Wound – Injury causing an interruption of the skin or mucous membranes
Healing – The process of returning integrity to the injured tissue

Question 2

three traits of well-closed wound

Answer 2

The margins are well approximated without tension
The tissue layers are accurately aligned
The dead space is eliminated

Question 3

more vascular supply = faster or slower healing?

Answer 3

faster

Question 4

uses for absorbable vs nonabs. sutures

Answer 4

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.

Question 5

monofilaments vs multifilaments vs silk

Answer 5

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)

Question 6

natural abs. vs synthetic abs suture.

what are the most common of ear type?

Answer 6

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 )

Question 7

3 most common types of non-abs suture

Answer 7

Silk - braided
Nylon
Polypropylene

Question 8

how are suture-diameter size indicated?

Answer 8

The more zeros the smaller the diameter of the suture. For example; 00000 read as 5-0 is smaller than 000 3-0.

Question 9

cutting: conventional vs reverse vs tapered needle

Answer 9

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.

Question 10

what would you use: superficial face? deep face?

Answer 10

superficial: monofilament (nylon)
deep: monofilament (nylon) + twisted/multifilament Abs (surgical gut chromic; non-dyed)

Question 11

what would you use: knee?

Answer 11

braided abs (vicryl) + monofilmaent nylon

Question 12

what would you use: infected wound?

Answer 12

leave open or monofilament abs (vicryl)

Question 13

what would you use: deep upper arm ?

Answer 13

monofilament (nylon) + abs (vicryl)

Question 14

what would you use: scalp?

Answer 14

monofilament (nylon)- color to easily find

+ abs (vicryl) [ if deep]

Question 15

what would you use: bleeding vessel in hand laceration ?

Answer 15

braided abs (vicryl) + monofilament (nylon)

Question 16

4 types of wound classification (clean –> infected)

Answer 16

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

Question 17

wound closure: primary intention, secondary intention, delayed primary intention

Answer 17

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)

Question 18

Tetanus prone wounds (8)

Answer 18

> 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

Question 19

who gets a tetanus shot?

Answer 19

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)