Tissue Approximation and Wound Closure Flashcards
how are synthetic sutures absorbed by the body?
they are hydrolyzed
what is the diameter of the suture referred to?
the gauge
what is the heaviest gauge United States Pharmacopeia (USP)
Heavy= #5 Fine= 6-0
what is the heaviest gauge Brown and Sharp (B&S)?
Heavy= 20g Fine= 50g
Monofilament Absorbable
- submucosa sheep/serosa beef intestine
- chromion salts delay absorption
- stays in body 7-21 days
Synthetic Monofilament Absorbable
- Polydioxanne (PDS)
- hydrolyzed in 180-240 days
all non absorbable sutures become encapsulated in tissue true or false?
true
monofilament non absorbable: polypropylene
- prolene/surgilene
- vascular anastomosis and repair
monofilament non absorbable: nylon
- tendon repair
- ophthalmic/microsurgery
which monofilament non absorbable is the most inert?
stainless steel (inert= least reactive with tissue)
multifilament absorbable: polyglactin 910
- polyglactin 910 (VICRYL)
- synthetic absorbable suture
- fair not security easy tie
multifilament non absorbable: surgical silk
- become encapsulated in body
- made from silkworm cocoons
multifilament absorbable: polyethylene terephthalate coated polybutilate
- ETHIBOND/DACRON
- synthetic suture
- used to close defects of the heart
what is a suture ligature referred to as?
- “stick tie”
- large vessel occlusion
instrument tie
-“tie on passer”
where should needle be placed when loading onto a needle holder?
1/4 to 1/2 the distance from swage to point of needle
how do you pass a loaded suture?
surgeon receives needle holder with the needle point facing toward his/her thumb
conventional cutting needles
- tough difficult to penetrate tissue (ligament attachment)
- 3 cutting edges along inner curve
- small cut in direction of pull of suture
tapered point needles
- gastrointestinal tissue
- penetrates without cutting
what is a ferguson needle a good example of?
half circle, delicate tapered shaft needle
blunt point needles
- kidney/liver surgeries
- friable tissues
- wont draw blood
what is another name for a straight needle body?
- keith*
- commonly used on skin
skin closure
- continuous locking stitch w/ suture running across incision
- polypropylene/nylon preferred suture
- wound scars, suture must be removed
traction sutures
- used to retract sutures that are not easily retracted
- nonabsorbable suture placed in or around structure w/ suture ends clamped by hemostat.
- allows for easy maneuvering of structure
what will a surgeon say to do when placing a stitch that he wants to cut or tie later?
tag stitch with a hemostat
retention sutures
- may be placed through all layers of skin tissue adding strength to closure*
- large gauge, interrupted, non-absorbable
- wounds expected of disruption, increase abdominal pressure, poor healing
accessory devices: Bridges & Bolsters
- employed to keep retention sutures from cutting skin
- Bolster= pieces of plastic/rubber threaded over retention sutures before ends are tied
pledgets:
- exert pressure to seal off bleeding
- friable tissue may tear ex. cardiac muscle
- cardiovascular surgery
- arteriotomy site
stapling devices
- minimal tissue trauma*
- stainless steel, titanium, absorbable
- used to ligate tissues
intraluminal staples
- EEA or CEEA*
- anastomose tubular structures within GI tract
- double row of staples fired then lumen cut by knife on stapler head
