Suturing Flashcards
What are the functions of suture material?
Wound closure - Ligation - Attachment of tubes - Stay sutures
What are the ideal properties of suture material in relation to tissue interaction?
Maintains strength until healing - Rapid resorption after use - Easily removed - Minimal tissue reaction - Doesn’t favour bacterial growth - Minimal drag - Suitable for all wounds
What are the ideal properties of suture material in relation to the surgeon?
Easy to handle - Pliable - Good knot security
What are the ideal properties of suture material?
Easy to sterilise - Non-capillary - Non-electrolytic - Non-corrosive - Non-allergenic - Non-carcinogenic
What suture materials are synthetic absorbable multifilament?
Vicryl - Dexon - Polysorb - Panacryl
For synthetic absorbable multifilament suture materials, how long does it take for it to be absorbed?
60 to 90 days
What are the main uses of synthetic absorbable suture material?
Vessel ligation - General soft tissue closure (skin & mouth)
What are the two suture materials that are synthetic absorbable monofilaments?
Monocryl - Caprosyn (short duration) PDS II - Maxon - Biosyn (long duration)
What are the uses of synthetic absorbable monofilament suture materials?
General soft tissue closure - Visceral closure (monocryl) (short duration) Soft tissues needing a lot of support - Muscle, fascia, linea alba, viscera (long duration)
What materials are non-absorbable monofilament?
Prolene (surgi pro) - Ethilon (monosof) - Flexon
What’s the use for non-absorbable monofilament suture material?
Inert (skin, stoma, vessels) - Prolonged support (hernia/tendon)
What materials are non-absorbable multifilament?
Mersilene - Ethibond - Novafil - Supramid
What are the uses of non-absorbable multifilament suture materials?
Ligament prosthesis - Skin closure
What are the natural suture materials? Are they multifilament or monofilament?
Catgut - Collagen (absorbable) Mersilk - PermaHand (non-absorbable) Mutifilament
What are natural suture materials used for? Which type does what?
Vessel ligation Absorbable for small - Non-absorbable for large
What general rules should be followed to avoid suture complications?
Avoid multifilament material in contaminated wounds - Avoid non-absorbable in hollow organs - Use inert material for skin - Avoid reactive material for stoma creation (opening) - Use slow or non-absorbable material in fascia/tendons - Avoid catgut in inflammed, infected or acidic wounds
When choosing the size of suture material, what should you always aim to do? Why?
Choose smallest size possible - Reduce trauma, smaller knots, greater security
What would the metric measurement of suture material which is 0.02mm be?
0.2
What is the advantages of a reverse cutting needle over a normal cutting needle?
Point is reversed so they - are stronger -reduce the danger of tissue cutout -leave a hole which leaves wide wall of tissue for suture to be attached
What are the advantages of interrupted suturing against continuous?
If one knot fails they don’t all fail - More accurate approximation (bringing skin together uniformly) - Adjust tension at each suture
What are the advantages of continuous suturing against interrupted?
Quicker - Less suture material in wound - Even distribution of tension - More air and water tight - Cheaper
What is appositional suturing? Why is it beneficial?
Suturing two sides in approximation - Easy, Accurate alignment, Quicker muscosal regeneration - Less inflammation and scar tissue
What is inverted suturing? What is good and bad about it?
Two sides invert back into the tissue Good - greater bursting strength, reduced risk of adhesions Bad - Necrosis of tissue cuff, possible luminal compomise
What is everted suturing? What is good and bad about it?
Two sides everted out of the tissue Good - Ease of placement, increased tensile strength, thrombosis reduction Bad - Prolonged inflammation, vascular compromise, increased adhesion, increased stenosis and leakage
What are the advantages of a) partial thickness suture b) full thickness suture?
a) not exposed to luminal contents - reduces wicking from lumen b) better apposition - suture holding layer engaged
Where would you find a simple interupted appositional pattern of suturing?
Skin - GIT - fascia
What suture pattern is this?
Buried knot - intradermal/subcuticular closure
What are two other types of approximating suture pattern other than the simple? Why are they not used?
Poth and Gold crushing - more necrosis and poor apposition
Gambee - difficult to place and risk of not engaging the submucosa
What sort of suture pattern is this? What is good about it?
Cruciate mattress pattern
Stronger than simple - resists tension - prevents eversion - quicker than simple
What is this suture pattern? What does it tend to do?
Horizontal mattress suture
Strangulates the tissue and causes edge ischemia
What kind of suture pattern is this? What advantage does it have over a similar suture pattern?
Vertical matress suture - Resists tension and doesn’t cause edge ischemia
What is the difference between the mayo mattress suture pattern and a horizontal mattress suture pattern?
A mayo mattress will cause layers to overlap and tighten tissues planes - whereas a horizontal mattress causes eversion of tissue
Name and describe the features of this suture pattern
Simple continous - series of linked ‘uniterrupted’ sutures, suture line advances only on one side of wound, good for low tension areas
Name this type of suture. What is the main advantage of this suture?
Runnning suture - Quick and rapid closure
What is this suture pattern is this? Why is it better than simple continuous stitching?
Ford interlocking (blanket stitch) - Greater security, better apposition
Name the non-appositional suturing patterns used on inverting tissue
Cushing - Connell - Lembert - Halsted - Czemy - Parker-Kerr - Purse-string
