Suturing

Question 1

Describe the two broad categories of suture material

Answer 1

Absorbable - suture material is evenly broken down and removed
Non-absorbable - where the suture material is not broken down and has to be removed

Question 2

Where are absorbable suture materials commonly used?

Answer 2

Body cavities or tissue layers deeper than the skin

Question 3

Where are non-absorbable suture materials commonly used?

Answer 3

To hold skin edges until they have healed together

Question 4

Describe the two main suture needle types

Answer 4

Both circular

• one cutting (skin)
• one round bodied (soft tissue)

Question 5

Describe the 3 degrees of tightness of placing suture patterns, and where each is used

Answer 5

Loose: commonly performed in the skin
Tight but not too tight: aims to hold the tissue edges in perfect apposition but not tight enough to restrict blood flow
Strangulating: required when ligating blood vessels in order to prevent them from bleeding

Question 6

What is the main advantage and disadvantage of interrupted suture patterns?

Answer 6

• Is one knot breaks or undoes, the remainder will still hold in place
• As each suture requires its own knot, more foreign material is left in the body

Question 7

What is the main advantage and disadvantage of continuous suture patterns?

Answer 7

• Only 2 knots are required so less foreign material is left inside the body
• If the suture breaks at any point it will all come undone

Question 8

Name and describe the 3 second categorisation suture patterns (what the pattern does to the tissue edges)

Answer 8

Appositional - hold the tissue edges in apposition to enable optimum healing
Tension-relieving - holds the tissue edges in apposition but in a way as to relieve them from tension
Inverting - causes the tissue edges to invert relative to one another

Question 9

What are the advantages of inverting sutures?

Answer 9

More water tight so used to suture the edges of hollow organs e.g. bladder, uterus

Question 10

How must you adapt sutures in the gut lumen and for what reason?

Answer 10

Inverting sutures reduce the lumen size so appositional are used. To keep it water tight the bites must be placed closer together

Question 11

How many throws should be placed on top of a knot?

Answer 11

5-6

Question 12

What is the advantage of the square knot?

Answer 12

When the second throw is placed on top of the first, it tightens the first more

Question 13

Why is a surgeons knot used over a square knot?

Answer 13

The first double throw of a surgeons knot causes extra friction ensuring it doesn’t loosen before the securing second throw

Question 14

Which knot should be used in situations where you need the sutures to be placed loosely, and why?

Answer 14

Surgeons

Unlike in the square knot, the surgeons knot will not continue to get tighter as more throws are added

Question 15

From the inside, out what are the 3 tissue layers that need to be stitched up in an abdomen?

Answer 15

Muscle layer
Subcutaneous layer
Skin layer

Question 16

Which tissue layer is the most important and why?

Answer 16

Muscle layer

Strength holding layer

Question 17

When suturing the muscle layer what must be incorporated into the suture pattern?

Answer 17

External fascia

Question 18

What are the two ways of avoiding tissue adhesions in the abdominal cavity?

Answer 18

• Tie the knot facing away from the abdomen

- When suturing don’t include the parietal peritoneum

Question 19

Which suture pattern is prefeed for the muscle layer?

Answer 19

Simple continuous pattern

Question 20

What is the purpose of closing the subcutaneous layer?

Answer 20

• Eliminate dead space

- Bring the skin closer to reduce tension

Question 21

What happens if dead space is not eliminated when suturing?

Answer 21

Filled with fluid - seroma

Will leak and delay healing

Question 22

Which suture pattern is recommended to close the subcutaneous layer?

Answer 22

Simple continuous

Question 23

In which way do knots need to face in the subcutaneous layer and why?

Answer 23

Need to face downwards and be buried as they will protrude through the skin and delay healing

Question 24

What is the purpose of closing the skin layer?

Answer 24

Prevent invasion by microorganisms into deeper tissue and minimise scarring

Question 25

Which suture patterns are often recommended for the skin?

Answer 25

Simple interrupted
Cruciate mattress
Intradermal

Question 26

In a simple continuous suture of the muscle layer, how far apart should each bite be?

Answer 26

5mm