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EM/Surgery > Suturing/Skin Stapling > Flashcards

Suturing/Skin Stapling Flashcards

1
Q

How do you describe the size of sutures?

A

As the number of zeros or O’s increases, the diameter of suture decreases or become smaller. Accordingly, tensile strength of a particular suture type increases as the number of O’s decreases.

  • For example, a 6-O is smaller than a 4-O.
  • EX: 1-0 is larger than 7-0.
  • 2, 1, 0, 00, (2-0)…12-0 (Microsurgery).
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2
Q

What is the suture tensile strength?

A

The force with which the suture strand can withstand before breakage.

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3
Q

What is the difference between Monofilament and Multifilament sutures?

A

Monofilament is a single stranded suture.

Multifilament is several strands, often braided together.

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4
Q

What are the adv/disadv. of Monofilament sutures?

A

Disadv – less tensile strength.

Adv – less resistance; passes easier thru tissue, resists harboring organisms, they tie down easily.

Ex. Nylon, used for vascular surgery.

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5
Q

How do we classify absorbable vs nonabsorbable sutures?

A

How it degrades in the body.

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6
Q

What makes up an absorbable suture?

A

Generally, the tensile strength is lost within 60 days.

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7
Q

What makes up a non-absorbable suture?

A

Generally, the tensile strength is maintained for longer than 60 days.

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8
Q

When do we use non-absorbable sutures?

A

Exterior placement as require removal or remain permanently within the body (Cardiac valve replacement).

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9
Q

Name some examples of non-absorbable sutures?

A

Silk, stainless steel, NYLON, Prolene (Polypropylene), Ethibond (polyester fiber), Ethilon, Nurolon, Mersilene.

  • SILK = excellent handling, considered nonabsorbable, but usually gone by 2 yrs, use when dry.
  • Stainless steel = high tensile strength, low tissue reaction, difficult handling, safety for surgical team.
  • Nylon = good handling, lose 15-20% tensile strength per year, may require tail as “memory.”
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10
Q

What are the different parts of the suture needle?

A

Swage, Body, Point.

  • Swage is where the needle is connected to the suture material.
  • Body is the middle, curved part of the needle.
  • Point is the tip of the needle.
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11
Q

What are the different needle types?

A
  1. Conventional Cutting
    - 3 cutting edges, ONE ON THE INSIDE CONCAVE CURVE.
    - ex. used for skin.
  2. Reverse Cutting
    - 3 cutting edges, ONE ON THE OUTER CONCAVE CURVE.
    - more strength than conv. cutting.
    - may be harsh on delicate tissue.
    - useful for fascia, ligament, skin.
  3. Control Release or “pop-off,” for rapid placement of sutures.
    - where the needle breaks from the swage with a pop of the wrist.
  4. BLUNT for FRIABLE tissue, such as liver, spleen and kidney.
  5. TAPER for easily penetrated tissue (ex. Peritoneum); sharp point with rounded body.
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12
Q

When are staplers used for suturing purposes?

A

Useful for LINEAR lacerations of scalp, trunk, extremities.

*Avoid face, hands or over joints.

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13
Q

What is the indication for use of a stapler?

A

Temporary, rapid closure of superficial lacerations in patient’s requiring immediate surgery for life-threatening trauma.

*Avoid if area may require CT or MRI – ex. head trauma.

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14
Q

What are the adv/disadv of staples for suturing?

A

Adv – decreased wound inflammation, increased tensile strength, quick, cosmetic outcome same as sutures.

Disadv – more costly; but when compared with time factor, often justified.
-slightly more uncomfortable with removal.

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15
Q

How far apart should sutures be and how long to cut the tail?

A

8mm - 1cm apart; don’t put too many, too close together.

The tail – don’t make longer than the gap b/t each suture.

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16
Q

What are the adv/disadv of wound adhesives?

A

Adv – fast, possibly less pain, antimicrobial barrier, no need for suture/stapler removal, no need for dressing.

Disadv – generates heat during bonding, may seal before best position is attained, can get adhesive in wound delaying healing.

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17
Q

Name some examples of wound adhesives?

A

Dermabond, Indermil; High Viscosity Dermabond, which is available in ProPen/ProPen XL for longer incisions.

Topical skin adhesive – can use superglue.

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18
Q

What are the indications for wound adhesive?

A
  • For easily approximated skin edges (surgical incisions).

- SIMPLE, thoroughly cleaned Traumatic wounds.

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19
Q

What is the recommendation on suture size?

A

Use the smallest diameter suture that will adequately hold the tissue as this will minimize tissue trauma and minimize the mass of foreign material left in the body.

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20
Q

What are the adv/disadv. of Multifilament sutures?

A

Adv – greater tensile strength, better pliability and flexibility.

Disadv. – more resistance (harder to get thru tissue, but may be coated to enhance passage thru tissue), may harbor organisms.

Ex: Silk.
Indication Ex: intestinal procedures.

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21
Q

When are absorbable sutures suitable?

A
  • Temporary or of short duration (Bowel surgery).
  • Deep tissue structures such as dermis and fascia.
  • When avoiding the need for suture removal is desired.
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22
Q

What are the most commonly used suture sizes?

A

3-0, 4-0, 5-0.

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23
Q

What are some general considerations when placing sutures?

A
  1. Suture SLOW-HEALING TISSUE W/NONABS, such as skin, fascia, tendons.
  2. Suture FAST-HEALING TISSUE W/ABS, such as mucosa, stomach, colon, bladder.
  3. Foreign bodies (FBs)/Contamination = avoid braided.
  4. Minimize Scarring = think smallest, inert, monofilament/close SubQ tissue, steri-strips.
24
Q

Name some desirable needle characteristics?

A
  1. Strength = how it resists deformation during repeated passes thru tissue.
  2. Ductility = the needle’s resistance to breaking under given amount of bending.
  3. Sharpness and Stability in needle holder.
25
Q

What are some contraindications for wound adhesives?

A
  1. Contaminated (ex. infection).
  2. Mucosal surfaces or mucocutaneous junctions (ex. oral cavity, lips).
  3. Skin that may be exposed to body fluids or with dense natural hair (Scalp).
  4. Pt’s w/sensitivity to Formaldehyde.
  5. Avoid the eye (use petroleum jelly barrier).
  6. High tension areas (ex. knuckles, knees, elbows), unless plan to immobilize the site.
  7. Keep out of the wound as can cause a FB reaction.
26
Q

What is the AFTER CARE instructions for patients after wound adhesive applied?

A
  1. Transient wet to site ok, but no prolonged wetness for 5-10 days.
  2. Do NOT apply ointment.
  3. Do not pick at site!!
  4. Bandage is not necessary after 5 minutes, once tackiness is gone.
  5. Achieves full strength at 2.5 minutes.
27
Q

What are the 3 classifications of wound healing?

A
  1. Primary Intention – the fastest type of closure.
  2. Secondary Intention – the healing of a wound in which the wound edges cannot be approximated.
  3. Tertiary Intention.
28
Q

What is another name for Tertiary Intention? Define it.

A

Delayed Primary Closure.

A combination of healing by primary and secondary intention and is usually instigated to reduce the risk of infection; the wound is first cleaned and observed for a few days to ensure no infection is apparent before it is surgically closed.

29
Q

What is healing by Primary Intention?

A

The IMMEDIATE suturing/stapling/taping/wound adhesive of a CLEAN SURGICAL INCISION or a sharp linear lacerations w/in 8-12 hrs (from glass, knife, sharp metal).

*There is NO tissue loss and minimal contamination.

30
Q

Why is healing by Secondary Intention chosen over healing by Primary Intention?

A
  1. Wound has large tissue loss.
  2. Heavily contaminated or infected.
  3. GRANULATION – tissue matrix that is to be built to fill the wound defect; creates more scar tissue.
  4. Poor cosmetic outcome.
31
Q

Give some examples of wounds that are healed by Tertiary Intention.

A

Examples of wounds that are closed in this way include traumatic injuries such as dog bites or lacerations involving foreign bodies.

32
Q

What is healing by Tertiary Intention?

A
  1. INITIAL SURGERY for debridement of nonviable tissue, then leave wound open and packed secondary to contamination and high risk for infection.
  2. Pack with sterile dressings BID.
  3. BACK TO OR in 3-5 days for further irrigation and debridement, and loosely approximated closure.
33
Q

What is the Operative Wound Classification?

A

The degree of contamination and potential for infection; completed Post-Op (after wound is closed).

34
Q

What are the classifications of Operative Wounds?

A
  1. Clean
  2. Clean-contaminated.
  3. Contaminated.
  4. Dirty or Infected.
35
Q

What is the ‘CLEAN’ classification of Operative Wounds?

A

Surgical incision, WOUND MADE UNDER STERILE CONDITIONS in an area w/o infection.

*No Resp, GI, Genital or Urinary Tract entered (risk potential areas).

36
Q

What is the ‘CLEAN-CONTAMINATED’ classification of Operative Wounds?

A

Operative wounds in which the RESP, GI, GENITAL or URINARY TRACT ARE ENTERED UNDER CONTROLLED CONDITIONS W/O UNUSUAL CONTAMINATION OR SPILLAGE.

**The wound is clean but has experienced a potential source of contamination.

Ex: Appendectomy, Cholecystectomy, Opening of the colon during bowel anastomosis.

37
Q

What is the ‘CONTAMINATED’ classification of Operative Wounds?

A

Open/Traumatic wounds/injuries or operative procedures in which GROSS SPILLAGE FROM GI TRACT OR INFECTED URINE OR BILE IS ENCOUNTERED.

There has been a major break in aseptic technique, may have begun as a clean wound or may have been made under non-sterile conditions placing the wound at a GREATER incidence of infection.

Ex. Open Fx.

38
Q

What is the ‘DIRTY OR INFECTED’ classification of Operative Wounds?

A

Heavily contaminated or CLINICALLY INFECTED PRIOR TO START OF THE SURGICAL PROCEDURE.

Ex: Abscess.

39
Q

Used to hold an incision or wound open during surgical procedures. They aid in holding back underlying organs or tissues, allowing doctors/nurses better visibility and access to the exposed area?

A

Retractors

40
Q

Name some retractors.

A 
Army-Navy.
Senn.
Skin Hook.
Rake.
Richardson.
Deaver.
Harrington (Sweetheart).
Ribbon (Malleable).
41
Q

A retractor that allows for hands free operation during surgery?

A

Self-retaining Retractors; good in ortho surgery.

*Weitlaner, Gelpie, Balfour.

42
Q

Define Towing-In vs Towing-Out?

A

While holding a retractor, towing in refers to rolling the retractor in and downward. Towing out refers to roling the retractor out and down.

43
Q

Name the 3 most common scalpel blades?

A

No. 10, No. 11, No. 15.

No. 10: large curved cutting edge, one of the more traditional blade shapes; used for making large incisions and cutting soft tissue.

No. 11: an elongated triangular blade sharpened along the hypotenuse edge with a strong pointed tip making it ideal for stab incisions needed when lancing an abscess or inserting a chest drain.

No. 15: small curved cutting edge; is the most popular blade shape for making short and precise incisions. It is utilised in a variety of surgical procedures including the excision of a skin lesion or recurrent sebaceous cyst and for opening coronary arteries.

44
Q

What are the two main types of scissors used in surgery?

A

Straight or Mayo Suture Scissors.

Curved or Metzenbaum, “Mets.”

45
Q

What are the Mayo and Metz scissors used for?

A

Mayo scissors are used for cutting thick structures and sutures.

  1. Metz scissors are used for cutting delicate tissue or for dissecting, transecting vessels and opening viscera.
46
Q

What is the most important points for utilizing scissors and the cutting technique?

A
  1. Screw FACE up.

2. DON’T PASS THE POINT – only cut with the tips of the scissors.

47
Q

Name some suction blades?

A
  1. Poole – abdominal surgery.
  2. Yankauer/Tonsil tip.
  3. Frazier/Neuro – used in brain and spinal cord surgery.
48
Q

Are Forceps tweezers?

A

NO!

49
Q

Name some forceps w/ and w/o teeth.

A

With Teeth: Bonney, Rat-tooth, Adsons (most delicate type).

WO teeth: DeBakey.

50
Q

Name some different clamps.

A
  1. Hemostats (straight vs curved).
  2. Mosquito – small clamp.
  3. Kelly – big clamp.
  4. Kocher – big clamp.
  5. Right Angle – great for going around things like vessels or tube structures.
  6. Others – Pennington, Allis, Babcock, Sponge Stick/Peanut, Adson, Towel clamp (penetrating vs non-penetrating).
51
Q

What is the First Assistant’s main responsibility?

A

To make the surgeon look good!

-Build rapport so that you are able to anticipate him.

52
Q

What are drains used for?

A
  1. Prophylactic to prevent fluid accumulation.
  2. Therapeutically to promote escape of fluids that have already accumulated.
  • Brought out through a separate skin incision.
  • Fixed (sutured) to the skin.
  • ALWAYS release suction before pulling, be ready for drip.
53
Q

Name some drain types.

A
  1. SUMP = ex. nasogastric tube, 2 lumens.
  2. Self-Suction = closed system (vacuum device, wall suction, bulb); ex: hemovac, jackson-pratt, blake.
  3. Straight = use of gravity; ex: penrose (flat latex tube).
  4. Chest tube = connected to water seal.
54
Q

The use of high frequency electrical energy to cut or coagulate bleeding?

A

Electrocautery/Bovie.

55
Q

What are the two different types of electrocautery?

A
  1. Bipolar – foot control used for microsurgery or neurosurgery.
  2. Monopolar (common) – held like a pencil, pt grounded by pad; do not place pad over a prosthesis or over bony prominence.
    - 2 button: continuous = cut or pulses = coagulation.
56
Q

Fun fact about electrocautery?

A

Can touch it to an instrument to coag whatever is in jaws of the cautery.

DO NOT lean instrument on other tissues (skin), as will burn.

EM/Surgery (4 decks)

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