SUTURES/SURGICAL WOUND Flashcards
Types of Wounds
Intentional Chronic Traumatic SSI Non healing
Intentional Wound
- Created under sterile conditions
- Incision
- Excision–> removing something from skin surface
- Puncture–> camera in body (scopes)
Chronic Wound
- decubitus ulcer
- pressure sores /bed sores
Traumatic Wound
laceration-cut that goes beneath subcutaneous tissue
abrasion- a scrape
puncture- gun shot, stepping onto a nail
burn
Contusion/bruise
Hematoma
avulsion- tissue that as been torn off (a dog bite, finger cut off etc)
Types of Wound Healing
1st intention -primary union 2nd intention -granulation 3rd intention -delayed primary closure
1st Intention
- Wound edges are approximated
- CLEAN WOUND
- GOOD HEALING
- NO INFECTION
- MINIMAL SCARRING (cicatrix)
2nd Intention
- Mostly trauma wounds
- healing via granulation
- BACTERIAL CONTAMINATION
- EXCESSIVE TISSUE LOSS
- LONGER HEALING
- PROUD FLESH
3rd Intention
-delayed primary closure
-INFECTED TRAUMATIC WOUNDS
-wound is cleaned and left open
DEBRIDEMENT
GRANULATION
-Patient is then brought back for primary closure
Phases of wound healing
LAG/INFLAMMATION PHASE
PROLIFERATION PHASE
MATURATION PHASE
Lag phase
-healing starts within mins of incision
-1-5 days post op
-body’s natural reaction to heal itself
HEMOSTASIS–> CLOT, SCAB
PHAGOCYTOSIS–>PUS (wound still not healed)
1st intention wound healing
Proliferation phase
- lasts up to 2 weeks
- when everything is in place so healing can fully begin
- fibroblasts form from collagen
- capillary network
- granulation tissue
Maturation phase
- after 2 weeks up to a few months
- remodeling, differentiation
- SCAR FORMATION(cicatrix)
- wound regains it strength
- contraction
wound complications/disruptions
Hemorrhage –> bleeding caused my inadequate hemostasis
dehiscence
wound reopening after closure
eviseration
internal organ structure coming out of wound
EMERGENCY**
herniation
organ protruding inside your body
-usually due to weakness of muscle wall
sinus tract formations
1 opening
fistula formation: 2 openings
-collection of fluid finds and outlet or passage
fissure
tear or rip in tissue (anal fissure)
hematoma
localized collection of blood outside the blood vessels
- can cause wound to separate and get infected
- can create swelling, pain, drainage
adhesions
abnormal scar tissue
-happens in abdominal region
granulomas
mass of granulation tissue
- small area of inflammation
- produced in response to infection etc.
excessive scar formation:
- cicatrix
- keloid
- proud flesh
CICATRIX- scar of healed wound (not so noticeable)
KELOID- healing complication, excessive collagen growth on wound
PROUD FLESH- over growth of granulation ( new connective tissue /blood vessels)
Wound Classificaiton
CLASS I, CLASS II, CLASS III, CLASS IV
Class I -clean
-elective procedure
surgical incision
-ideal conditions
- NO BREAK IN ASEPTIC TECHNIQUE
Class II -clean contaminated
- when entering mucus membrane like GI , GU tract, or respiratory tract
- MINOR OR NO BREAK IN ASEPTIC TECH.
- NO INFECTION PRESENT
- may treat w/ antibiotics after procedure (surgeon will classify after surgery)
Class III- contaminated
- gross spillage from GI tract
- MAJOR BREAK IN ASEPTIC TECH.
- INFLAMMATION PRESENT
- Open traumatic wound less than 4 HRS old
- def will treat patient w/ antibiotics post surgery
Class IV- dirty or infected
- perforated viscera (organ) –ex. rupture in appendix
- dirty traumatic wound over 4-6 hrs OR foreign body present in wound
- BACTERIA PRESENT IN WOUND BEFORE SURGERY
- INFECTION W/ DRAINAGE
debridement
removing dead tissue, scraping it away
fistula
a tract between 2 epithelium- lined surfaces that is opened at both ends
SUTURES:
monofliment
single continuous fiber
- good healing properties
- relatively inert
- minimal tissue damage
- NOT as easy to work with
multifilament suture
multiple thread like structures(twisted or braided) into single strand
- absorbs moisture and hold body fluid b/c of capillary action(WICKING)
- HARBOR BACTERIA
- NOT USED IN PRESENCE OF INFECTION
- EASY to work with
- absorbable suture
2. non- absorbable suture
absorbable- able to be absorbed by tissue via hydrolysis (fluid breaks down suture)
-designed to hold tissue edges together until they heal
non-absorbable- resists absorption by tissue
-get encapsulated by tissue
natural absorbable sutures
- SURGICAL GUT
- from submucosa of sheep intestine
- MONOFILAMENT
- PACKED IN ALC
*PLAIN GUT
- CHROMIC GUT–> processed with salts to extend lifespan–> used primarily for urinary tracts
- absorbs fastest
CAT GUT–> collagen from animal intestine (multi)
Synthetic absorbable sutures
DEXON
PDS
MONOCRYL
VICRYL
- can be mono or multifilament
- wound support for 3 weeks to 6 months
- inert
- absorbed by HYDROLYSIS
natural non-absorbable sutures
SILK –> multi , high wicking action
STAINLESS STEEL–> strongest suture, most inert, special handling
Synthetic NON- absorbable sutures
NYLON- mono
- skin suture
- minimal tissue reaction
NUROLON- multifilament nylon
- used to close dura (on brain) or meninges
POLYPROPYLENE-PROLENE- mono
-inert
SUTURIING TECHNIQUES:
- primary suture line
- continuous. suture/ running suture
- interrupted suture
Mattress suture
subcuticular suture
used for cosmetic closure
-cant see on the dermal layer
purse string suture
pulled through like a drawstring
-used for intestines or appendix removal, appendectomy
Secondary suture line:
retention suture/stay suture
large gauged, non absorbable
- bolsters, bridges or bumpers (plastic or rubber tubing)
- -threaded over retention suture ends prior to tying*
anastamosis
reconnection of 2 structures
traction sutures
structures put in place to keep wound open instead of using retractor
–used for HEART & BRAIN
synthetic adhesives– DERMABOND
a glue in the wound that seals skin closed
pressure dressing
a bunch of DRESSING sponges on top of wound to prevent bleeding & dead space( fluid accumulation)
ligatures
used to tie off bleeding vessels
suture ligature stick tie
continuous ligature reel
free tie –> pre cut, single strands in package
tie on pass –>loaded onto a curved clamp to tie to help placement of tie around vessel in deep surgical wound
types of needles
keith – straight needle
curved – most commonly used
eyed – french eye, mayo
parts of needle
POINT, BODY, EYE
needle points
Cutting- used for SKIN, Cartilage, Tendons (cuts through tissue also)
Taper- just the point is sharp, doesn’t cut tissue around area, used for delicate, fine tissue like INTESTINE
Blunt- not very sharp, rounded blunt point,, used for organ structures that bleed a lot, like KINDEY, SPLEEN, LIVER
Swaged needles
single armed or double armed
- 1 needle on end or 1 needle on each end (2 total)
swaged contd. control release
when you can pull needle off of suture
swaged contd. permanently swagged
you need scissors to cut needle off of suture
tapered needle
round body, tapers to sharp point
-primary use is for soft tissue
spatula needle
side cutting needles, slat on top &bottom
-used for ophthalmic surgery, eyes, extremely thin layers of tissue like cornea etc
what type of wound that is expected to heal by 1st intention?
a clean wound
which class of surgical wound is considered dirty or infected?
class IV
when the wound is left open and allowed to heal from inner layer to outside surface is considered what type pf healing?
granulation… 2nd intention
which phase of wound healing begins within minutes of injury ?
lag phase
what is the suture diameter referred to as ?
gauge
what suture is most likely used for orthapedic wounds and abdominal fascia?
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