Sutures, Needle & Stapler Flashcards
Absorbable Synthetic Monofilament
. PDS
. Monocryl
. Maxon
. Biosyn
. Caprosyn
Absorbable Synthetic Multifilament
. Vicryl (Polyglactin) & Coviden (Polysorb)
. Dexon (Polyglycolic Acid)
Nonabsorbable Synthetic Monofilament
. Nylon (Ethilon & Dermalon)
. Novafil (Polybutester & Coviden)
. Prolene & Surgelene (Polypropylene)
. PTFE/Monotex (Polytetrafluro-Ethylene)
. Stainless steel
Nonabsorbable Natural Multifilament
Silk
Nonabsorbable Synthetic Multifilament
. Surgical Cotton
. Nurolon & Surgilon (Braided Nylon)
. Mersilene & Ethicon [Polydek & Telflex] (Polyethylene Terephthalate)
. Ethibond [Dacron] (Polyethylene)
Monofilament
Prolene, Nylon, Catgut, PDS, Monocryl
Multifilament (braided or twisted):
Silk, Vicryl, Braided Polyester
Natural (Produced or exists in nature)
Silk worms cotton
Actual Cat Gut
Collagen
Beef or sheep intestine
Synthetic fibers (Produced artificially by chemicals)
Polyglactin
Polypropylene
Poliglecaprone
most commonly used Suture guage/diameter
1 through 4-0
orthopedic wounds and abd fascia used Suture guage/diameter
1 - #0
Suture guage/diameter used for aortic anastomosis (large vessel) & small vessel?
. 4-0 and 5-0 are used for aortic anastomosis (large vessel);
. 6-0 and 7-0 for (small vessel)anastomoses like coronary or carotid arteries
microvascular and eye procedures used Suture guage/diameter
8-0 through 11-0
subcuticular skin closures used Suture guage/diameter
3-0 and 4-0
4-0 is used to close dural incisions
Suture Purpose:
Wound Closure
*Tissue approximation
–Bringing individual surfaces together (e.g.. skin, fascia)
*Anastomosis
–Joining of tubular structure together (e.g. intestine, blood vessels) by suturing to promote unhindered flow of fluids
–Hemostasis
*Decrease blood loss
*Allow better visualization of the surgical field
Absorbable Natural Monofilament
Plain Gut & Chromic Gut
Standard length for ligatures/ties
Absorbable: 54 in
Non-absorbable: 60 in
Length for superficial & deep bleeders?
Superficial: no more than 18in
Deep: between 18-30
What length of tail is cut for monofilament & multifilament suture?
Monofilament: typically cut 1/4 in strand (a tail)
Multifilament: are cut closer to the knot (1/8 in.) [leaving no tail]
What instrument is used for tying?
Usually a long pean or right angle clamp
Free-Tie:
A strand of suture (no needle)
Suture Ligature (Stick-Tie):
- A strand of suture w/ a needle
- Sutures on the vessel and tied
- To prevent slippage
Ligature Reels:
. Wound w/ absorbable or Non-absorbable sutures
. Used in superficial bleeders
. Most commonly used ligature reels: chromic, plain, silk & polyglactin (Vicryl)
Needle eyes:
Point where suture strand is attached.
Ex.
. Closed eye
. French eye
. Swaged (Eyeless)
. Single (Swaged)
. Double (Swaged)
Closed Eye:
Causes more tissue damage
(Ex. Sewing Needle)
French Eyed:
. Fast Loading
. Causes more tissue damage (v-shaped area above the eye)
Swaged (Eyeless)
. Needless are continuous w/ the suture strand or the needle may be detached
. Less tissue damage
. Detachable needle is referred to as a controlled release
Single (Swaged) - Arm
. Single needle is attached to the suture
. Used for interrupted or continuous suturing
Double (Swaged) - Arm:
. Needles swaged to each end of the suture
. Used for anastomosis of vessels
Needle Points:
Are cutting needles used for though tissue like sclera, tendon or skin
Ex.
Conventional, Reverse & Side cutting needles
Conventional Cutting Needle:
. 3 cutting edges directed along the inner curve of the needle
. Place a small cut in the direction of the pull of the structure
Reverse Cutting Needle:
. Opposing cutting edges in a triangular configuration that extends into the shaft
. Used in the skin results in less tearing of the tissue
Side Cutting Needle:
. Does not penetrate into deeper tissues
. Used primarily in ophthalmic procedures
Tapered Point Needle:
. Round shaft without a cutting edge
. Penetrates tissues without cutting it (intestines)
Blunt Point Needle:
. Round shaft with a blunt tip
. Used for friable tissues (kidney & liver)
Taper Cut Needles aka Ground Point Needles:
. Point with sharp edges but a round body of a tapered needle
. Used for graft
. Makes smaller holes in the tissue
. Primary choice for vascular tissue
What is the range of needle length?
1/2 to 4 in
What is the guage size range of a needle?
12-30
Smaller needles have the larger what?
Gauge number
CP = ?
Cutting Point
CT=?
Circle Taper
CTX=?
Circle Taper Extra Large
CV=?
Cardiovascular
FS=?
For skin
FSL=?
For skin large
KS=?
Keith Straight
MO=?
Mayo
PS=?
Plastic Surgery
S=?
Spatula
OS=?
Orthopedic Surgery
RB=?
Renal (artery) Bypass
SH=?
Small Half Circle
TF=?
Tetralogy of Fallot
UR=?
Urology
Order of layer closure for abdominal wounds:
Order of layer closure for abdominal wounds:
Fast Healing Layer: Abdominal
Peritoneum
Primary Supportive soft tissue structure: Abdomen
Fascia
Slowest healing layer: Abdominal
Fascia
Muscles
. Not typically closed but may be loosely approximated with interrupted absorbable sutures
Peritoneum
. Thin membrane lining the abdominal cavity
. Fast healing
. May not require suturing if the fascia is closed properly
. Continuous 3-0 absorbable suture is frequently used
Fascia
. Tough connective tissue covering the muscle; primary supportive soft tissue structure of the abdomen
. Heals slowly
. Heavy interrupted non absorbable suture is used
. Absorbable- slow absorbing & high tensile strength
. If facial layer is weak a mesh can be applied
Subcutaneous Tissue:
. Placement of few interrupted sutures to prevent dead space
. Plain gut is often used
Subcuticular Tissue:
. Area of tough connective tissue beneath the skin above the subcutaneous
. Subcuticular closure is used to minimize scaring
. Absorbable sutures are often used
Skin Tissue:
. Closed with interrupted or continuous monofilament, Nonabsorbable sutures in a cutting needle
. Polypropylene or nylon preferred
Primary Suture Line
- Suture that approximate wound edges for first intention healing
- Interrupted, Continous
Continuous or Running Suture
- Single strand spure placed na series of sliches for closure
- Even distributed tension is the hallmark of mis cosure
- Drawback the suture losens fone segment breaks
Interrupted Sutures
- Used in fascia & heart closures
- Useful in infected wounds, “interrupts the pathway of bacteria”
Traction Sutures
- Used to retract a structure that may not be easily retracted with a conventional retractor
Purse String Suture
- Drawstring Suture is placed in a circular fashion around a structure in such a way that pulling on the suture tightens & closes an opening such as the appendix
Subcuticular Suture
- Buried Suture
- Used for skin closure ONLY
- Steristrips may be used to reintorce the suture
Secondary Suture Line
- Useful for support of the primary suture line
- Helps ease tension on the primary suture line
Retention Sutures
- Large gange, interrote, Non absorbable sutures placed lateral to the primary suture line for wound reinforcement