Sutures and Stitches Chapter7 P53-60 Flashcards
GENERAL INFORMATION
1. What is a suture?
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Any strand of material used to ligate blood vessels or to approximate tissues
- How are sutures sized?
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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)
- Which is thicker, 1-O suture or 3-O suture?
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1-O suture (pronounced “one oh”)
CLASSIFICATION
1. What are the two most basic suture types?
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Absorbable and nonabsorbable
- What is an absorbable suture?
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Suture that is completely broken down by the body (dissolving suture)
- What is a nonabsorbable suture?
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Suture is not broken down (permanent suture)
SUTURES
1. Catgut
a) What are “catgut” sutures made of?
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Purified collagen fibers from the intestines of healthy cows or sheep (sorry, no cats)
b) What are the two types of gut sutures?
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Plain and chromic
c) What is the difference between plain and chromic gut?
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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
- Vicryl® Suture
a) What is it?
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Absorbable, braided, multifilamentous copolymer of lactide and glycoside
b) How long does it retain its strength?
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60% at 2 weeks, 8% at 4 weeks
c) Should you ever use PURPLE-colored Vicryl® for skin closure?
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NO—it may cause purple tattooing
- PDS®
a) What is it?
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Absorbable, monofilament polymer of polydioxanone (absorbable fishing line)
b) How long does it maintain its tensile strength?
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70% to 74% at 2 weeks, 50% to 58% at 4 weeks, 25% to 41% at 6 weeks
c) How long does it take to complete absorption?
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180 days (6 months)
d) What is silk?
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Braided protein filaments spun by the silkworm larva; known as a nonabsorbable suture
e) What is Prolene?
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Nonabsorbable suture (used for vascular anastomoses, hernias, abdominal fascial closure)
f) What is nylon?
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Nonabsorbable “fishing line”
g) What is monocryl?
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Absorbable monofilament
h) What kind of suture should be used for the biliary tract
or the urinary tract?
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ABSORBABLE—otherwise the suture will end up as a nidus for stone formation!
WOUND CLOSURE
GENERAL INFORMATION
1. What is the purpose of a suture closure?
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To approximate divided tissues to enhance wound healing
- What are the three types of wound healing?
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- Primary closure (intention)
- Secondary intention
- Tertiary intention (Delayed Primary Closure DPC)
- What is primary intention?
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When the edges of a clean wound are closed in some manner immediately (e.g., suture, Steri-Strips®, staples)
- What is secondary intention?
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When a wound is allowed to remain open and heal by granulation, epithelization, and contraction—used for dirty wounds, otherwise an abscess can form
- What is tertiary intention?
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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)
- What is another term for tertiary intention?
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DPC = Delayed Primary Closure
- Classic time to wait before closing an open abdominal
wound by DPC?
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5 days
- What rule is constantly told to medical students about
wound closure?
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“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
SUTURE TECHNIQUES
1. What is a taper-point needle?
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Round body, leaves a round hole in tissue
spreads without cutting tissue
- What is it used for?
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Suturing of soft tissues other than skin
e.g., GI tract, muscle, nerve, peritoneum, fascia
- What is a conventional cutting needle?
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Triangular body with the sharp edge toward the inner circumference; leaves a triangular hole in tissue
- What are its uses?
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Suturing of skin
- What is a simple interrupted stitch?
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see picture
- What is a vertical mattress stitch?
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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
- What is the vertical mattress stitch also known as?
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Far-far, near-near stitch—oriented perpendicular to wound
- What is it used for?
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Difficult-to-approximate skin edges; everts tissue well
- What is a horizontal mattress stitch?
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Simple stitch is made, the needle is reversed, and the same size bite is taken again—oriented parallel to wound
- What is a simple running (continuous) stitch?
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Stitches made in succession without knotting each stitch
- What is a subcuticular stitch?
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Stitch (usually running) placed just underneath the epidermis, can be either absorbable or nonabsorbable (pull-out stitch if nonabsorbable)
- What is a pursestring suture?
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Stitch that encircles a tube perforating a hollow viscus (e.g., gastrostomy tube), allowing the hole to be drawn tight and
thus preventing leakage
- What are metallic skin staples?
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see picture
- What is a staple removal device?
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see picture
- What is a gastrointestinal anastomosis (GIA) device?
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Stapling device that lays two rows of small staples in a hemostatic row and automatically cuts in between them
- What is a suture ligature (a.k.a. stick tie)?
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Suture is anchored by passing it through the vessel on a needle before wrapping it around and occluding the vessel; prevents slippage of knot-use on larger vessels
- What is a retention suture?
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Large suture (#2) that is full thickness through the entire abdominal wall except the peritoneum; used to buttress an abdominal wound at risk for dehiscence
- What is a pop-off suture?
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Suture that is not permanently swaged to the needle, allowing the surgeon to “pop off” the needle from the suture without cutting the suture
