Test 6 Basic incisions, closure, and sutures Flashcards
Incision approaches vary by…
Target anatomy
surgeon preference
patient factors
Name the vertical incisions
Median/midline- down the middle
paramedian- lateral to the midline
Name the transverse incisions
midabdominal
Pfannenstiel- “bikini line”
Name the oblique incisions
subcostal- liver, gallbladder
McBurney’s- appendix
Inguinal- hernia, testicle
Where is the thoracoabdominal incision
along the side
thoracic and descending aorta
kidneys
lower esophagus
What are port sites?
small incisions for trocar placement
What are the 9 abdominal regions
1 R hypochondriac
2 Epigastric
3 L Hypochondriac
4 R Lumbar
5 Umbilical
6 L Lumbar
7 R Iliac
8 Hypogastric
9 L Iliac
Define suturing
the process of joining or approximating tissues with a needle and thread so tissues can bind together and heal
Define sutures
the materials used to close a wound to maximize the opportunity for wound healing
What are the functions of sutures
-hold tissues together
-provide strength to wound
-provide approximation
-method of hemostasis
-tie off tissues to be removed
Factors for choosing suture
-surgeon preference
-tissue type
-presence of infection
-disease processes affecting wound healing
What is suture gauge
diameter of suture
#7 thickest
0 middle diameter
11-0 thinnest
Tensile strength
amount of tension a suture can withstand before it breaks
Elasticity
ability to stretch or expand
Memory
ability to return to former position
capillarity/ capillary action
-pulls tissue fluids to move along the suture strand
-may cause microorganisms to migrate along the suture
pliability/ malleability
able to bend freely and repeatedly without breaking
tissue drag
“rope burn”
how easily a suture passes through a tissue
knot strength
resistance to a knot failure
knot is the weakest part
what are barbed sutures
they have spikes running along the length of the suture
Brands: v-loc and stratafix
What is tissue reaction
how the body will react to it
looking for inert suture (low reaction)
What are the 6 main classifications of sutures?
absorbable
nonabsorbable
synthetic (manmade)
nonsynthetic (natural)
monofilament
multifilament (braided)
Describe monofilament sutures
-single thread
-passes through tissue easily
-for skin closure
-resist harboring bacteria
Describe multifilament (braided) sutures
2 or more threads
twisted together
can harbor bacteria
can maintain fluid
What are 2 types of absorbable- nonsynthetic sutures (surgical gut)
plain gut
chromic gut
made from sheep or beef intestine
What are the 4 types of absorbable- synthetic sutures
Monocryl-
Vicryl-
Dexon
PDS
Describe Monocryl sutures
=polyglicaprone
monofilament
used in GYn, general, GU, and plastics
Describe Vicryl sutures
=polyglactin 910
multifilament
used in GU
Describe Dexon sutures
=polyglycolic acid
used in GU
Describe PDS sutures
=polydioxanone
monofilament
abdominal fascia closures
What are absorbable sutures
-digested by tissue enzymes
- not used long term
mono or multifilament
Wha tare nonabsorbable sutures
not absorbed by body
permanent or removable
support for long term
encapsulated by tissue over time
mono or multifilament
Name 2 nonabsorbable- nonsynthetic sutures
silk
surgical stainless steel
Describe silk sutures
from silkworm cocoons
multifilament
Gi tract and bowel
*contraindicated in urinary tract- encourages stones
Describe surgical stainless steel sutures
chromium and nickel alloys
*most inert
can be used with infection
not near other metals
mono or multifilament
used in abdomin, sternum, hernia repair, tendon, and bone repair
What are the three types of nonabsorbable- synthetic sutures
polyester
prolene
nylon
What are the 2 types of polyester sutures
Ethibond, Dacron, Ticron- has lubricant coating
Mersilene- uncoated
-multifilament
-strongest
used in tendons
Describe prolene suture
=polypropylene
monofilament
most inert
used in cardiovascular and abdominal closure
What are the 2 types of Nylon
Ethilon
Nurolon/ Surgilon
Describe Ethilon sutures
monofilament
inert
used in eye, plastic, and microsurgery
Describe Nurolon/ Surgilon sutures
multifilament
coated to reduce drag
used in neurosurgery and hernia repair
*4-0 most commonly used
What are the parts of a surgical needle
-point (reverse/skin; blunt/liver; taper most common)
-shaft
-eye
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