Tissue Closure And Suturing Flashcards

Question

Hemostat

Answer 1

-Used for blunt dissection of tissue | – Curved or straight

Answer 2

-Only intended to cut sutures | – No role in dissection or removal of tissue

Answer 3

– Used in place of forceps – They do not crush the tissue – Careful: • Always anchor deeper within the tissue • Avoid piercing the epidermis with the points of the hook • Avoid twisting which can decrease blood flow

Answer 4

– Allows you to create counter traction and control skin edge • Also used to grasp needle when repositioning the needle holder – Fine toothed • Toothed are better for tissue gripping = less traumatizing • 0.3mm for periocular skin – Tying platform • Some tissue forceps have a tying platform in order to grasp suture – Careful: • Use as a retractor and not as a claw • Grasp the subcutaneous tissue instead of the epidermis at the margin

Answer 5

– Straight or curved – Have a tying platform for grasping the suture – May be in combination with tissue forceps

Answer 6

– Required to grasp and advance the curved needle – Special textures within the jaws allowing for no slippage – Will not damage the suture material itself – Grip needle 2/3rds of the way back – Types • Conventional • Micro- or Ophthalmic – Held like a pencil between thumb and index finger – Very little wrist action

Answer 7

``` – Broken down by the body (enzymatic) – Used for deep tissue and tissue that heals rapidly • Small bowl anastomosis • Urinary/biliary tracs • Tying off small vessels near the skin • Entropion repair ```

Answer 8

``` – Provide long-term tissue support – Used for tissue that heals slowly • Fascia or tendons • Closure of abdominal wall • Vascular anastomose • Skin ```

Answer 9

``` Synthetic -monocryl -vicryl -PDS Natural -collagens ```

Answer 10

``` Synthetic -ethilon -proline Natural -surgical cotton -surgical steel -surgical silk ```

Answer 11

Pour away If you get a couple drops thats ok If you spill the whole bottle, not ok

Answer 12

Conventional Micro- or Ophthalmic – Held like a pencil between thumb and index finger – Very little wrist action

Answer 13

– Man-made – More predictable • dont lose tensile strength and absorption – PDS or nylon

Answer 14

– Natural fibers – Provoke greater tissue reaction since made with natural materials – Silk or catgut

Answer 15

– Single strand – Lower infection risk – Poor knot security/ease of handling – Nylon, PDS, prolene

Answer 16

– Several filaments twisted together – Higher infection risk – Better knot security – Braided silk or vicryl

Answer 17

• Affects tensile strength and handling properties • Larger the size = smaller the diameter – 7-0 suture is smaller than a 4-0 suture Periorbital=6-0 to 7-0 conj=7-0

Answer 18

``` Needle point Needle body Swaged end (eye) ```

Answer 19

Attached needle tp suture

Answer 20

Abdominal wall closure/friable tissue

Answer 21

Pierce and spread tissue/minimal cutting | Prevents leakage

Answer 22

Friable tissue: liver/kidney

Answer 23

• Triangle in shape with 3 cutting edges • Cutting surface on concave (inside) edge • Penetrates tough tissue – Skin and sternum

Answer 24

What we use - decreased risk o cutting through - cutting surface on the convex edge (outside curve) - penetrates tough tissue. Tendons and subcuticular suturing, periorbital

Answer 25

``` • Measured by the amount of circle the needle fills • Periorbital – ¼ t, 3/8, or compound curved ```

Answer 26

• Changes in needle radius • Periorbital – Smaller needle radius • 26-23

Answer 27

1. History and physical assessment & informed consent 2. Non-sterile gloves 3. Drawing and injecting local anesthetic 4. Donning sterile gloves 5. Cleaning and irrigating the wound 6. Draping 7. Simple interrupted suture 8. Disposing of sharps 9. Patient post-op instruction 10. Suture removal

Answer 28

Blunt vs sharp | Potential adjacent injury

Answer 29

>8 hours=high risk of infection | -animal bites/farm injuries=best to leave open

Answer 30

Healing factors

Answer 31

Evaluate nerves, blood vessels, tendons before local injections

Answer 32

Used during inital physical exam and injection of local

Answer 33

Injected into wound wall | -if you didnt make the cut yourself, never use epinephrine

Answer 34

Scrub in and don sterile gloves to prevent spread of bacterial

Answer 35

- prep the area with betadine or providence iodine from sterile bowl. Non overlapping circular pattern - use sterile saline and splash cup to forcefully (but not violently) irrigate wound to dislodge bacterial and foreign material

Answer 36

– Place fenestrated sterile drape over wound in order to isolate lesion – Provides location for suture to rest

Answer 37

– Pain should subside significantly after 24-

Answer 38

– Clean area with betadine – Gently grab knot and lift, snipping underneath the knot close to the skin – Gently pull strand towards the knot (over the wound) as to not decrease pull wound apart • Do not pull any part that was OUTSIDE the skin back THROUGH the skin!! – Time frame • Face: 4-5 days • Scalp and trunk: 7-10 days • Arms and legs: 10-14 days • Joints: 14 days

Answer 39

– Basics of suturing – Must be mastered before attempting to suture – variation of a square knot – When properly tied it will not slip

Answer 40

One- or two-handed tie | – Not for the face

Answer 41

``` • Faster than hand ties • More accurate/precision • Use: – Eyelid – Periorbital skin – Skin of the face ```

Answer 42

``` – Interrupted percutaneous (simple interrupted suture) – Continuous percutaneous – Interrupted dermal – Continuous dermal – Special cases • Vertical mattress • Horizontal mattress • Half-buried, horizontal mattress ```

Answer 43

• Most commonly used technique • Individual stitches which are not connected – Easily removed without damaging closure • High tensile strength • Excellent approximation • Used for low-tension wounds – Used in combo with deep sutures for high-tension wounds

Answer 44

* Take a long time to place * Higher risk for infection * Possible strangulation of tissue

Answer 45

– First suture is placed at center of wound • Bisect the remaining section – Subsequent sutures are placed midway between center of wound and corners – Gently grasp and evert skin edge (non-dominant hand) – Pronate dominant hand so needle will pierce perpendicular to skin (90*) and drive needle through skin by supinating the hand before picking up the needle with the needle holders (do not touch the needle tip) pulling through following the natural curve of the needle and then repeating the process on the opposite side of the wound edge – Carefully gather thread to create long thread (with needle) and short thread fore instrument tie

Answer 46

• The needle will be protruding from the subcutaneous tissue • MAINTAIN the position of the skin with the forceps – Most people let go of the skin since the needle is through → this could cause skin retraction and needle movement under the skin edge • Release the needle from the needle holder and then re-grasp the needle → complete the bite

Answer 47

* Swelling subsides→ everted edges flatten → scar becomes flush * If inverted → large depression/divot scar * Take larger and deeper bites with each suture

Answer 48

• The knots should be tied tight enough to close edges but NOT strangulating the tissue – Must have space for swelling! • All knots must be over to one side – If left in the middle, the knot will push on the tissue and inhibit healing

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Tissue Closure And Suturing Flashcards

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