Tissue Approximation and Wound Closure

Question 1

how are synthetic sutures absorbed by the body?

Answer 1

they are hydrolyzed

Question 2

what is the diameter of the suture referred to?

Answer 2

the gauge

Question 3

what is the heaviest gauge United States Pharmacopeia (USP)

Answer 3

Heavy= #5
Fine= 6-0

Question 4

what is the heaviest gauge Brown and Sharp (B&S)?

Answer 4

Heavy= 20g
Fine= 50g

Question 5

Monofilament Absorbable

Answer 5

• submucosa sheep/serosa beef intestine
• chromion salts delay absorption
• stays in body 7-21 days

Question 6

Synthetic Monofilament Absorbable

Answer 6

• Polydioxanne (PDS)

- hydrolyzed in 180-240 days

Question 7

all non absorbable sutures become encapsulated in tissue true or false?

Answer 7

true

Question 8

monofilament non absorbable: polypropylene

Answer 8

• prolene/surgilene

- vascular anastomosis and repair

Question 9

monofilament non absorbable: nylon

Answer 9

• tendon repair

- ophthalmic/microsurgery

Question 10

which monofilament non absorbable is the most inert?

Answer 10

stainless steel (inert= least reactive with tissue)

Question 11

multifilament absorbable: polyglactin 910

Answer 11

• polyglactin 910 (VICRYL)
• synthetic absorbable suture
• fair not security easy tie

Question 12

multifilament non absorbable: surgical silk

Answer 12

• become encapsulated in body

- made from silkworm cocoons

Question 13

multifilament absorbable: polyethylene terephthalate coated polybutilate

Answer 13

• ETHIBOND/DACRON
• synthetic suture
• used to close defects of the heart

Question 14

what is a suture ligature referred to as?

Answer 14

• “stick tie”

- large vessel occlusion

Question 15

instrument tie

Answer 15

-“tie on passer”

Question 16

where should needle be placed when loading onto a needle holder?

Answer 16

1/4 to 1/2 the distance from swage to point of needle

Question 17

how do you pass a loaded suture?

Answer 17

surgeon receives needle holder with the needle point facing toward his/her thumb

Question 18

conventional cutting needles

Answer 18

• tough difficult to penetrate tissue (ligament attachment)
• 3 cutting edges along inner curve
• small cut in direction of pull of suture

Question 19

tapered point needles

Answer 19

• gastrointestinal tissue

- penetrates without cutting

Question 20

what is a ferguson needle a good example of?

Answer 20

half circle, delicate tapered shaft needle

Question 21

blunt point needles

Answer 21

• kidney/liver surgeries
• friable tissues
• wont draw blood

Question 22

what is another name for a straight needle body?

Answer 22

• keith*

- commonly used on skin

Question 23

skin closure

Answer 23

• continuous locking stitch w/ suture running across incision
• polypropylene/nylon preferred suture
• wound scars, suture must be removed

Question 24

traction sutures

Answer 24

• 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

Question 25

what will a surgeon say to do when placing a stitch that he wants to cut or tie later?

Answer 25

tag stitch with a hemostat

Question 26

retention sutures

Answer 26

• 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

Question 27

accessory devices: Bridges & Bolsters

Answer 27

• employed to keep retention sutures from cutting skin

- Bolster= pieces of plastic/rubber threaded over retention sutures before ends are tied

Question 28

pledgets:

Answer 28

• exert pressure to seal off bleeding
• friable tissue may tear ex. cardiac muscle
• cardiovascular surgery
• arteriotomy site

Question 29

stapling devices

Answer 29

• minimal tissue trauma*
• stainless steel, titanium, absorbable
• used to ligate tissues

Question 30

intraluminal staples

Answer 30

• EEA or CEEA*
• anastomose tubular structures within GI tract
• double row of staples fired then lumen cut by knife on stapler head