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Clinical Procedures > Wounds And Closure > Flashcards

Wounds And Closure Flashcards

1
Q

What does suture material choice depend on?

A
  1. Surgeon’s preference
  2. Type and specialty of surgery
  3. Depends on location
  4. Absorbable vs. non-absorbable
  5. Multifilament vs monofilament
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2
Q

What are the general characteristics of suture size?

A
  1. Reflexes diameter
  2. use the smallest size possible that still securely holds the mending wounded tissue
  3. This minimizes trauma as the needle passes through
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3
Q

How is suture sized?

A
  1. Numerically
    A. numbers alone indicate a larger suture size
  2. Number of zeros indicates progressively smaller diameter
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4
Q

What is knot tensile strength?

A

Measured by force, in lbs, which the suture strand can withstand before it breaks when knotted

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5
Q

What predetermines the tensile strength needed by the suture?

A

The tensile strength of the tissue to be mended (its ability to withstand stress) predetermines the size and tensile strength of the suture needed

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6
Q

What are the characteristics of monofilament suture?

A
  1. Single strand of material
  2. Resists harboring bacteria
  3. Easily tie down
  4. Crushing or crimping of material can create a weak spot, which may result in suture breakage
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7
Q

What are the characteristics of multifilament suture?

A
  1. Two or more strands twisted or braided together
  2. Greater tensile strength, flexibility, and pliability
  3. May be coated, which helps it pass through tissue, especially intestine
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8
Q

What are absorbable sutures?

A

Holds wound edges together in approximation temporarily until they have healed enough to withstand stress

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9
Q

What are examples of absorbable sutures?

A
  1. Prepared by collage of healthy animals or prepared synthetic material
    A. Surgical gut suture: plain, chromic or fast absorbing
    B. Raw material is sheep intestine submucosa or beef intestine serosa
  2. Polyglactin 910 (vicyrl), coated or uncoated
    A. Copolymer of glycolide or lactide with polyglactin 370 and Ca stearate if coated
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10
Q

How are absorbable suture absorbed?

A
  1. Natural sutures are broken down by the body enzymes which attack and digest the suture strand
  2. Synthetic sutures are hydrolyzed: process by which water gradually enters the suture filaments causing a breakdown of the polymer’s strands
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11
Q

How many stages are present in the absorption process?

A
  1. 2 stages
  2. Both stages cause leukocytic cellular responses, which serve to remove the cellular debris and suture material from the line of tissue approximation
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12
Q

Define non-absorbable suture

A

Not digestable by the body or unable to be hydrolyzed

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13
Q

When are non absorbable sutures used?

A
  1. Exterior closure of a wound where sutures can be easily removed after sufficient healing
  2. Body cavity: will remain permanently embedded in the tissue
    A. Indicated when there is a hx of pt rxn to absorbable sutures, keloidal tendency, or possible tissue hypertrophy
  3. Temporary prosthesis attachment (defibrillators, pacemakers, drug delivery system)
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14
Q

What are the non-absorbable suture material?

A
  1. Metal
  2. Synthetic
  3. Organic materials
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15
Q

True/false: any type of suture material can be mono/multifilament, coated or uncoated, dyed or undyed

A

True

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16
Q

True/false: sutures can expire

A

True

17
Q

What are the indications for wound closure?

A
  1. Most superficial wounds can heal without intervention

2. Superficial wounds extending into the subcutaneous tissue should be closed in order to avoid complications

18
Q

What materials are used to close wounds?

A

Sutures, staples, surgi strips

19
Q

What are the contraindications for wound closure?

A
  1. Wounds greater than 8 hrs post injury
    A. Some ares can be closed up to 24 hrs after injury (face, neck scalp)
  2. FB in underlying tissue
  3. extensive wounds involving tendons, nerves, or arteries need a specialist consult
  4. Wounds that have a high likelihood of infection or that are likely already contaminated are not sutured initially
20
Q

What are the potential complications from wound closure?

A
  1. Infection
    2, Scarring, keloid formation
  2. Loss of function and structure
  3. Loss of cosmetically desirable appearance
  4. Wound dehiscence
  5. Tetanus
    A. Always check pt status
    B. Tetanus-prone wound: Tdap and TD greater than 5 yrs, give pt tD shot that day
    C. Non-tetanus prone wound in a pt 19-64 with a Tdap or Td greater than 10 yr, give a TD shot that day
    D. Tetanus-prone wound in an adult with inadequate immunization passive and active immunity (TIG) and Tdap
21
Q

What is a clean wound?

A

Surgical incisions

22
Q

What is a clean contaminated wound?

A
  1. Surgical procedures where GI, resp, or GU systems are involved
  2. Most skin lacerations are in this category
23
Q

What is a contaminated wound?

A
  1. Gross spillage (bile, stool) or traumatic wound
24
Q

What is an infected wound?

A
  1. Established infection before wound is made (I and D abscess) or heavily contaminated wound (stool)
25
Q

What materials are used for wound closure?

A
  1. Sterile gloves and eye protection
  2. 60 ml syringe
  3. 21 gauge plastic IV catheter or irrigation blunted needle for fluid irrigation
  4. Saline solution
  5. Sterile laceration tray
    A. Lidocaine 1% plain
    B. 25 gauge needle with 10 cc syringe
    C. Instruments and suture material
    D. Betadine
    E. Sterile drape
26
Q

What is a ligature?

A
  1. Freehand ligature (free tie)

2. Suture ligature (stick tie)

27
Q

What the types of primary suture lines?

A
  1. Continuous Sutures

2. Interrupted sutures

28
Q

What are the continuous sutures?

A
  1. Subcuticular stitch
  2. Interlocking stitch
  3. Running stitch
  4. Purse string stitch: inverts tissue
29
Q

What are the interrupted sutures?

A
  1. Simple
  2. Vertical mattress
    A. everts tissue
  3. Horizontal mattress
    A. Everts tissue
30
Q

What are the general rules for stitch placement?

A
  1. Needle inserted 1/2 - 1.0 cm from edge of wound

2. Skin edges need good approximation and slight eversion to heal well

31
Q

How are sutures removed?

A
  1. Make sure tips of scissors are visible before cutting to avoid inadvertently cutting skin tissue
  2. The ends of the surgical gut are left 1/4 in (6mm) from the knot
  3. Other materials are cut closer to the knot 1/8 in or 3 mm, to decrease tissue reaction and minimize the amount of foreign material that passes through the tissue
32
Q

What are the follow-up care instructions for wound closure?

A
  1. Keep wound clean and dry for 48 hrs
  2. Elevate area if applicable
  3. Instruct pt verbally and in writing regarding dressing removal and changes, if applicable
  4. Instruct pt verbally and in writing on the sxs of infection to watch for
  5. Activity restrictions
  6. Analgesics
  7. Return for wound check/ suture removal
  8. Educate pts that scars take a full year to mature
  9. ABX
33
Q

What does suture removal timing depend on?

A

Location of wound

34
Q

When can sutures in the face or neck be removed?

A

4-5 days, sometimes 3

35
Q

When can sutures in the skin (besides face and neck), including the scalp be removed?

A

7-10 days

36
Q

When can sutures in the skin over a joint be removed?

A

14 days

37
Q

When can sutures in the skin on the feet be removed?

A

10-14 days

38
Q

When can retention sutures be removed?

A

2-6 wks

Clinical Procedures (15 decks)

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