Suturing & I&D Flashcards
Tensile Strength
Knot Strength
Tensile Strength: Related to suture size and the weight required to break a suture
Knot Strength: force required for a knot to slip
Configuration
Monofilament - less risk of infection, more memory = harder to tie
Braided filament - less memory = easier to handle and tie
Elasticity
Memory
Tissue Reactivity
Elasticity: Degree suture stretches and returns to original length
Memory: High memory = more stiff suture, difficult to handle, unties
Tissue Reactivity: Reaction peaks in the first 2-7 days
Absorbable Suture
Breaks down over time in body
Breakdown depends on type of suture, suture size, and suture location
Used in patients who cannot return for removal, or in internal body tissues
Absorbable Suture Types
Catgut
Chromic
Vicryl
Monocryl
PDS - often used in bowel
Catgut and chromic are only natural sutures, rest are synthetic
Non-absorbable sutures and types
Defined by their resistance to degradation by living tissue
Silk - for tying off vessels
Nylon - for drains or closing
Ethibond - used for retention or tendon grafts
Prolene: for vessels, used in CV/AAA surgery
Surgical steel - to close sternotomy
Absorption rate & Tensile strength for:
Chromic
Vicryl
Monocryl
PDS
Chromic: Absorption 70 days, Tensile 10-14 days
Vicryl: Absorption 60-90 days, Tensile 3-4 weeks
Monocryl: 91-119 days, 21 days tensile
PDS: 182-238 days, 5-6 weeks tensile
Suture Size
The higher the number, the smaller the suture
Largest suture = 0 and #1
5-0 through 7-0 mainly used on face
Suture Removal
Scalp
Face
Eyelid
Chest/Abdomen
Back/Foot/Sole
Extremities
Penis
Delayed wound healing
Scalp: 10 days
Face: 5 days
Eyelid: 3 days
Chest/Abdomen: 8-10 days
Back/Foot/Sole: 12-14 (10-12 kids)
Extremities: 10-14 (8-10 in kids)
Penis: 8-10 days
Delayed wound healing: 14-21 days
- Chronic steroids, DM
Adhesive Advantages over Suture
Max bonding strength @ 2 1/2 minutes = equal to healed tissue @ 7 days strength
No needles
Faster
Water-resistant covering
No suture removal
Skin Adhesive Contraindications
Jagged/Stellate lacerations
Bites, puncture or crush wounds
Contaminated wound
Mucosal surface - Axillae and perineum (high moisture)
Hands, feet, and joints unless kept dry and immobilized
Folliculitis
Superficial infection of hair follicles
Hot-tub folliculitis = pseudomonas
Usually resolves spontaneously
Skin Abscess
Furuncle
Carbuncle
Skin Abscess: collection of pus within dermis and deeper skin tissues
Furuncle: infection of hair follicle - pus extends through dermis into subcutaneous tissue
Carbuncle: coalescence of several infected follicles into single mass with several draining sites
I&D indications
Most patients w/ skin abscesses need I&D
Aspiration is inadequate
If draining spontaneously, may follow with warm compress to promote drainage
Abscesses to refer to surgeon
Perirectal, neck, or breast near areola
Near vital nerves or major blood vessels
Hand abscess (except paronychia and felon)
Central triangle of face - possible sinus involvement
Recurrent, interconnected, or large (>5 cm)
