Sutures & Needles Flashcards by Angela Bryan

Which types of tissue tend to heal slowly?

Dense fascia

Tendons

Ligaments

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40%

2 months time

Fascia regains approximately ___ percent of its orginal strength in ___ months.

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True or false:

Visceral wounds heal rather slowly.

False

Visceral wounds heal rapidly, attaining maximal strength within 14-21 days

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True or false:

No tissue ever regains 100% of its original strength.

False

The urinary bladder will regain 100% of its original strength within 14 days

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How long will the stomach take to regain maximum strength?

14-21 days

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True or false:

Skin heals relatively quickly.

False

Skin heals relatively slowly

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When sutures are removed from the skin at the 10-14 day mark, a wound has regained only what percentage of its original strenth back?

10%

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Collagen synthesis occurs ___ days postoperatively.

5-42 days postoperatively

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List in order the following tissues from the slowest to heal to the fastest to heal:

Colon

Stomach

Bladder

Fascia

Skin

Fascia

Skin

Colon

Stomach

Bladder

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Which type of sutures are broken down by the non-inflammatory process of hydrolysis?

Synthetic absorbables:

Monofilament

Multifilament

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Which type of sutures undergo digestion by acid proteases produced by inflammatory cells?

Natural absorbables:

Catgut

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What are the advantages of using a SYNTHETIC absorbable?

Predictable rate of breakdown

Non-reactive

Do NOT stimulate inflammatory cells

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What are 2 examples of a SYNTHETIC absorbable suture?

Monocril

Vicryl

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Which type of suture is “encapsulated and walled off by the body’s fibroblasts”?

Nonabsorbable

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What are the NATURAL nonabsorbable sutures?

Silk

Cotton

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What are the METAL nonabsorbalbe sutures?

Stainless steel

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What are the SYNTHETIC nonabsorbable sutures?

Nylon

Polyester

Polypropylene

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Which type of nonabsorbable suture is often preferred for skin suturing?

Synthetic NYLON

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True or false:

Synthetic absorbable sutures disappear more quickly than they lose tensile strength.

False

Synthetic absorbable sutures lose strength more quickly than they disappear.

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Which type of suture is the following referring to? :

More throws for knots

More tension for tissue apposition

Less drag

No capillarity

Monofilament

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Which type of suture is the following referring to? :

Better knot security

Less tension required for tissue apposition

Coated to reduce drag

Multifilament

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True or false:

The construction of multifilament sutures allows bacteria, tissue fluids, and inflammatory cells to penetrate the interstices of the stand.

False

Multifiament sutures DO NOT allow inflammatory cells to penetrate them.

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What is the downside to suture capillarity?

Bacteria are sequestered away from PMNs and macrophages

(Bacteria and tissue fluids are able to penetrate the interstices of the multifimant suture stand, BUT inflammatory cells CANNOT!)

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Place the following in order of increasing stiffness:

Braided polyesters

Silk

Stainless steel

Nylon and gut

Silk - least stiff

Brainded polyesters - less stiff

Nylon and gut - stiff

Stainless steel - very stiff

True or false: Multifilament nonabsorbable sutures should NEVER be used in a contaminated wound with the potential for infection.

TRUE

True or false: Synthetic absorbables elicit minimal inflammatory responses, similar to nylon.

TRUE

True or False: All absorbable sutures induce a cellular reaction.

FALSE All NON-absorbable sutures induce a cellular reaction.

Put the following in order of increasing potential of causing a cellular reaction: Polyester Nylon Silk and cotton Polypropylene and steel

Polypropylene and steel Nylon Polyester Silk and cotton

Tissues that heal slowly such as skin, fascia, and tendons/ligaments should usually be closed with what type of sutures?

Nonabsorbable sutures

Tissues that heal rapidly such as viscera, bladder, and GI tract may be closed with which type of sutures?

Absorbable sutures

Which type of sutures should be used in URINARY and BILIARY tracts?

Rapidly absorbable sutures

Place the following in order of increasing infection-potentiating effect: Synthetic monofilament Synthetic multifilament Natureal materials (gut, silk, etc.)

Synthetic monofilament Synthetic multifilament Natureal materials (gut, silk, etc.)

Which type of suture should you use where infection is more likely, monofilament or multifilament?

Monofilament

Dead space = potential infection Sutures = potential infection WHAT DO YOU DO??

Close dead space in the least amount of suture material possible.

True or false: Extra throws can add additional strength.

False Extra throws do NOT add strength, just bulk!

Square knot

Granny knot

Half-hitch (or tumbled) knot

Surgeon's knot

Where are sutures the WEAKEST?

At the knot

For interrupted sutures, how many throws and knots are adequate?

4 throws 2 knots

For continuous patterns, how many throws and square knots are adequate?

6-8 throws 3-4 knots

How long should cut ends be in length?

3-5 milimeters

Which suture pattern is stronger, interrupted or continuous?

Continuous

What are the components of a needle?

Swage - green Body - yellow Point - purple

Which type of needle should be used for soft tissues that do NOT resist needle penetration, such as (1) abdominal viscera, (2) cardiovascular, and (3) neurological procedures?

Tap & taper cut

Taper & taper cut

What type of needle should be used for (1) skin, (2) fascia, and (3) dense tissue?

Reverse cutting

Spatula

What are spatula needles used for?

Cornea, sclera, eyelid muscle repairs

What type of needle should be used in hernia repairs?

Blunt taper

What else can the blunt taper needle be used for?

Used to suture friable tissues such as LIVER and KIDNEY

Blunt taper needle

Compaired to sutures, what are the advantages of staples?

Greater resistance to infection Decreased inflammatory response Decreased closure time Promotion of skin edge eversion Good cosmetic results

What type of wounds can skin glue be used on?

Small skin wounds with NO TENSION

When will the skin glue slough from the skin?

Typically sloughs with the keratinized epithelium in 5-10 days after application

True or false: Skin glue is intended for use as a bridge over the top of a wound, between cut edges, and to glue skin together.

FALSE Do NOT put glue between cut edges Do NOT super glue skin together ONLY use as a bridge over the top