Sutures, Needles, Instruments & Count

Question 1

Suture Uses (3)

Answer 1

1. Hemostasis
2. Wound closure
3. Wound exposure

Question 2

Sutures must meet FDA standards such as

Answer 2

1. Sterility
2. Tensile strength
3. dye
4. labeling
5. size
6. absorption
7. packaging
8. needle attachment

Question 3

Suture Security (4)

Answer 3

1. Tensile strength
2. hold knot
3. nutrition and health of pt
4. Person’s ability to ligate vessels, tie knots and suture

Question 4

Selecting the proper suture material depends on?

Answer 4

1. tissue being sutured
2. MD preference
3. Cosmetic result
4. length of incision
5. location of incision
6. previous experience
7. procedure

Question 5

When selecting suture material

3 main chacterisitics to consider

Answer 5

1. Physical characteristics
2. Handling
3. Tissue reaction

Question 6

Suture Physical Characteristics

Answer 6

1. mono or multfilament
2. absorptive properties
3. tensile strength
4. diameter
5. knot strength
6. elasticity
7. memory

Question 7

Suture Handling Characteristics

Answer 7

1. Pliability
2. tissue drag
3. knot tying
4. knot slippage

Question 8

Suture Tissure Reaction characteristics

Answer 8

1. Inflammation
2. Absorption
3. potential for infection
4. potential for allergic reaction

Question 9

suture is attached to needle two ways

Answer 9

1. swaged
2. threaded

Question 10

Wound healing primary intention

Answer 10

The condition for enabling primary healing is that the wound edges are sharp and completely clean and free of microbes as is the case with a wound produced via surgical incision (in a sterile environment). It is also possible to close some cuts caused by trauma via primary intention but they need to be sutured within 4 to 6 hours after the incident in order for the wound edges not to have become too inflamed, colonised or necrotic. The advantage of primary healing is that the time to closure is short which reduces the risk of infection and, furthermore, the scarring is limited. If the wound edges cannot be approximated, the wound will need to heal by second intention.

Question 11

Wound healing secondary intention

Answer 11

Secondary intention healing implicates that the wound edges cannot be approximated. This can be the case if there is not enough skin in order to pull the edges together without causing stasis in the area, as is often the case in venous leg ulcers, or if the tissue loss is extensive with a need for considerable new tissue generation as e.g. in fourth degree burns. It is also the case if the wound area is dirty or colonised or the wound edges are not sharp and clean as both would be the case in blast trauma wounds. Secondary intention healing is almost always necessary in dehisced (sprung open) surgical wounds as the tensile strength of the peri-wound tissue (the wound edges and the tissue just next to them) has proven too weak to sustain the tension of e.g. sutures or staples. Secondary healing will typically be characterised by visible granulation tissue and the scar will be bigger than in wounds healed by first intention. The simple fact alone that wounds healing by second intention will be open for longer will render them at high risk of infection. Furthermore, as they will typically be colonised and often dirty and infected they will be prone to complications.

Question 12

Wound healing tertiary intention

Answer 12

In tertiary intention healing, there is a need for the wound to be open for a period of time before it can be sutured. Examples can be a wound left open to allow drainage and later is closed or a wound that is left to heal by secondary intention but encounters complications, where after a very thorough debridement is performed followed by an approximation of the wound edges.

Question 13

Wound dehiscence

1. preventable via ___?

Answer 13

Wound dehiscence is one of the most common complications of surgical wounds, involving the breaking open of the surgical incision along the suture. Typically, the sutures or closures around wound edges should stay intact while new tissue, known as “granulation tissue,” starts forming to help heal the wound. However, when wound dehiscence occurs, the edges starts to separate and the wound reopens instead of healing closed as planned.

1. Preventable via secondary /retention suture

Question 14

Evisceration

Answer 14

Evisceration is a rare but severe surgical complication where the surgical incision opens (dehiscence) and the abdominal organs then protrude or come out of the incision (evisceration). Evisceration is an emergency and should be treated as such

Question 16

Mastisol & Benzoin

Answer 16

Mastisol waterproof medical adhesive goes on clear, is non-staining and has a lower risk of adverse reactions

tincture of benzoin and mastisol are often used to augment the surgical strips used to create a negligible fine postoperative scar.