Suturing

Question 1

Describe a swaged needle

Answer 1

Passes through tissue with less drag than eyed needle
As a new needle is used each time, it is sharp
Suture is secured to the needle
Relatively expensive
Useful for delicate tissue as less traumatic

Question 2

Describe an eyed needle

Answer 2

Greater bulk at eye increases drag (needle should not be double threaded)
Needles are commonly re-used and therefore cheaper
Care must be taken to keep needle joined to the suture

Question 3

The choice of needle shape is often governed by…

Answer 3

the accessibility of the tissue to be sutured. The more confined the operative site, the greater the curvature needed

Question 4

What are the most commonly used needles in practice?

Answer 4

1/2 curved
1/2 circle
curved needle
straight needle

Question 5

Round bodied needles are designed to…

Answer 5

separate tissue fibres rather than cut them. Leak proof suture line.

Question 6

Describe a taper point needle

Answer 6

Needle body is rounded and tapers to a point

Combines initial penetration of a cutting needle with the minimised trauma of a round bodied needle.

Question 7

Describe a blunt point needle

Answer 7

Designed for suturing extremely friable tissue such as the liver

Question 8

.

Answer 8

.

Question 9

What are cutting needles used for?

Answer 9

Required for suturing fibrous or dense tissues

Question 10

Describe a reverse cutting needle

Answer 10

Body of needle is triangular with apex on outside of needle curvature

Question 11

Describe a regular cutting needle

Answer 11

Body of needle is triangular with apex on inside of the needle curvature

Question 12

Describe absorbable suture material

Answer 12

Undergo degradation and loss of strength after 60 days

Used internally where long term support is not required

Question 13

Describe non-absorbable suture material

Answer 13

Maintain their tensile strength for longer than 60 days

Neither phagoctosed or hydrolysed, encapsulated within fibrous tissue

Question 14

Describe natural suture materials

Answer 14

Come from naturally occurring organic fibres

Question 15

Describe synthetic suture materials

Answer 15

Made from ‘man made’ fibres

Synthetic materials are hydrolysed and tend to produce minimal tissue reaction

Question 16

What are suture materials described as monofilament or multi-filament?

Answer 16

Depends if they are made from multiple strands or single strand

Question 17

Describe capillarity

Answer 17

Extent to which tissue fluids are attracted along a length of suture material

Question 18

Describe chatter

Answer 18

The lack of smoothness as a throw of knot is tightened down

smoothness = no chatter

Question 19

Describe coated

Answer 19

Secondary coating over primary material to modify

Question 20

Describe knot security

Answer 20

Relates to the surface frictional characteristics of the material

Question 21

Describe memory

Answer 21

The tendency of the material to return to its original shape

Often mono-filaments that have good memory

Question 22

Describe tensile strength

Answer 22

Breaking strength per unit area of tissue

Question 23

Describe tissue drag

Answer 23

The degree of frictional force as the material is pulled through the tissue

Question 24

Describe tissue reaction

Answer 24

The response of the tissue to the suture material involved

Question 25

Synthetic suture materials cause…

Answer 25

less tissue reaction

Question 26

Mono-filament materials are…

Answer 26

less reactive and much less likely to harbour bacteria

Question 27

Braided materials…

Answer 27

have more tissue drag and cause more tissue tension

Question 28

Bacteria harbour in between…

Answer 28

the fibres of braided materials

Question 29

Most braided materials are now…

Answer 29

coated to reduce tissue drag, but this reduces knot security

Question 30

Mono-filaments have…

Answer 30

significant memory and can be difficult to handle

Question 31

Describe interrupted sutures

Answer 31

Sutures that are individually tied giving this suture pattern the ability to maintain strength and tissue apposition if part of the suture line fails

Question 32

What is a disadvantage of interrupted sutures?

Answer 32

More time consuming so animal anaesthetised longer

Can work out more expensive as using more suture material

Question 33

Describe continuous sutures

Answer 33

One length of suture material tied at the beginning and end of the suture line only. Quicker to place and distribute wound tension

Question 34

What is a disadvantage of continuous sutures?

Answer 34

If it breaks, the whole stitch breaks

Question 35

Describe a simple interrupted suture

Answer 35

Easiest suture to place

Provides a secure closure through the complete layer of skin

Care should be taken not to place too tightly

Needle should enter the skin around 3-5mm away from the wound edge

Can be used for skin suturing and GI tract

Question 36

Describe cruciate sutures

Answer 36

Covers a greater length of wound than the simple interrupted suture so making it quicker to suture

Cruciate sutures improve apposition

It can be easy to make these sutures too tight causing them to cut into the skin and also make removal difficult

Can be used for skin suturing and in muscle and fascia

Question 37

Describe horizontal mattress sutures

Answer 37

Quick to apply

Over tightening sutures will results in wound eversion and reduction in blood supply to the wound edges

Eversion can be avoided by not allowing the needle to go much deeper than the dermis

This type of suture is placed some way from the wound edge, useful in reducing wound tension

Can be used for skin suturing and in muscle and fascia

Question 38

Describe simple continuous sutures

Answer 38

Difficult to tension this pattern correctly and avoid puckering of the wound edges

Can be used for skin suturing and in muscle and fascia

Question 39

Describe ford interlocking sutures

Answer 39

With practice, a very quick stitch to perform giving excellent apposition

Works best on straight wounds

Used in skin suturing and muscle and fascia