Sutures and Stitches Flashcards

1
Q

What is a suture?

A

Any strand of material used to ligate

blood vessels or to approximate tissues

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2
Q

How are sutures sized?

A

By diameter; stated as a number of O’s:
the higher the number of O’s, the smaller
the diameter (e.g., 2-O suture has a
larger diameter than 5-O suture)

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3
Q

Which is thicker, 1-O suture

or 3-O suture?

A

1-O suture (pronounced “one oh”)

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4
Q

What are the two most basic

suture types?

A

Absorbable and nonabsorbable

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5
Q

What is an absorbable

suture?

A

Suture that is completely broken down

by the body (dissolving suture)

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6
Q

What is a nonabsorbable

suture

A

Suture is not broken down (permanent

suture)

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7
Q

What are “catgut” sutures

made of?

A

Purified collagen fibers from the intestines

of healthy cows or sheep (sorry, no cats)

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8
Q

What are the two types of

gut sutures?

A

Plain and chromic

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9
Q

What is the difference
between plain and chromic
gut?

A

Chromic gut is treated with chromium salts
(chromium trioxide), which results in more
collagen crosslinks, making the suture more
resistant to breakdown by the body

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10
Q

What is it? Vicryl

A

Absorbable, braided, multifilamentous

copolymer of lactide and glycoside

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11
Q

How long does it retain its

strength? vicryl

A

60% at 2 weeks, 8% at 4 weeks

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12
Q

Should you ever use
PURPLE-colored Vicryl®
for skin closure?

A

NO—it may cause purple tattooing

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13
Q

pds What is it?

A

Absorbable, monofilament polymer of

polydioxanone (absorbable fishing line)

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14
Q

How long does it maintain

its tensile strength?

A

70% to 74% at 2 weeks, 50% to 58% at

4 weeks, 25% to 41% at 6 weeks

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15
Q

How long does it take to

complete absorption?

A

180 days (6 months)

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16
Q

What is silk?

A

Braided protein filaments spun by the
silkworm larva; known as a nonabsorbable
suture

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17
Q

What is Prolene?

A
Nonabsorbable suture (used for vascular
anastomoses, hernias, abdominal fascial
closure)
18
Q

What is nylon?

A

Nonabsorbable “fishing line”

19
Q

What is monocryl?

A

Absorbable monofilament

20
Q

What kind of suture should
be used for the biliary tract
or the urinary tract?

A

ABSORBABLE—otherwise the suture

will end up as a nidus for stone formation!

21
Q

What is the purpose of a

suture closure?

A

To approximate divided tissues to

enhance wound healing

22
Q

What are the three types of

wound healing?

A
  1. Primary closure (intention)
  2. Secondary intention
  3. Tertiary intention (Delayed Primary
    Closure DPC)
23
Q

What is primary intention?

A

When the edges of a clean wound are
closed in some manner immediately
(e.g., suture, Steri-Strips®, staples)

24
Q

What is secondary intention?

A

When a wound is allowed to remain open
and heal by granulation, epithelization,
and contraction—used for dirty wounds,
otherwise an abscess can form

25
Q

What is tertiary intention?

A
When a wound is allowed to remain open
for a time and then closed, allowing for
débridement and other wound care to
reduce bacterial counts prior to closure
(i.e., delayed primary closure)
26
Q

What is another term for

tertiary intention?

A

DPC Delayed Primary Closure

27
Q

Classic time to wait before
closing an open abdominal
wound by DPC?

A

5 days

28
Q

What rule is constantly told
to medical students about
wound closure?

A
“Approximate, don’t strangulate!”
Translation: If sutures are pulled too
tight, then the tissue becomes ischemic
because the blood supply is decreased,
possibly resulting in necrosis, infection,
and/or scar
29
Q

What is a taper-point

needle

A

Round body, leaves a round hole in tissue

spreads without cutting tissue

30
Q

taper What is it used for?

A

Suturing of soft tissues other than skin
(e.g., GI tract, muscle, nerve, peritoneum,
fascia)

31
Q

What is a conventional

cutting needle?

A

Triangular body with the sharp edge
toward the inner circumference; leaves a
triangular hole in tissue

32
Q

What is a vertical mattress

stitch?

A

Simple stitch is made, the needle is
reversed, and a small bite is taken from
each wound edge; the knot ends up on
one side of the wound

33
Q

What is the vertical mattress

stitch also known as?

A

Far-far, near-near stitch—oriented

perpendicular to wound

34
Q

vert mattress What is it used for?

A

Difficult-to-approximate skin edges;

everts tissue well

35
Q

What is a horizontal

mattress stitch?

A

Simple stitch is made, the needle is
reversed, and the same size bite is taken
again—oriented parallel to wound

36
Q

What is a subcuticular

stitch?

A

Stitch (usually running) placed just
underneath the epidermis, can be either
absorbable or nonabsorbable (pull-out
stitch if nonabsorbable)

37
Q

What are the guidelines for
the number of minimal
throws needed?

A
Depends on the suture material
Silk—3
Gut—4
Vicryl®, Dexon®, other braided
synthetics—4
Nylon, polyester, polypropylene,
PDS, Maxon—6
38
Q

How long should the ears of

the knot be cut?

A
Some guidelines are:
Silk vessel ties—1 to 2 mm
Abdominal fascia closure—5 mm
Skin sutures, drain sutures—5 to
10 mm (makes them easier to find
and remove
39
Q

When should skin sutures be

removed?

A
As soon as the wound has healed enough
to withstand expected mechanical
trauma
Any stitch left in more than 10 days will
leave a scar
Guidelines are:
Face—3 to 5 days
Extremities—10 days
Joints—10–14 days
Back—14 days
Abdomen—7 days
40
Q

In general, in which group
of patients should skin
sutures be left in longer
than normal?

A

Patients on steroids

41
Q

How should the sutures

be cut?

A
Use the tips of the scissors to avoid
cutting other tissues
Try to remove the cut ends (less foreign
material decreases risk of infection)
Rest the scissor-hand on the non–scissorhand
to steady