Suture review

Protrusion of bowel through separated edges of an abdominal wound closure (all layers of separation)

Evisceration

Suture for muscle tendon to bone?

Fiberwire or polyester.

Fibrin glue

Fibrinogen & thrombin in 2 separate tubes. When combined, chemical reaction forms a gel. Forms a clot, becomes the clot.

Fibrin sealants

Fibrinogen and thrombin (2 separate tubes). Mix together. Provide suture support. Seals tissue, suture lines, and stitch holes.

Bipolar

Forcep tip, Coagulates only. For delicate tissue.

Technique of placing a suture strand into the surgeon's hand

Free tie

Ligate a blood vessel

Free tie, stick tie, ligating clips, clamp.

Makeup of Gelfoam/Surgifoam/Gelfilm

Made of purified, sterile gelatin (gelatin composed of collagen)

Diffuse oozing:

May be a casual ooze or copious ooze. Large denuded areas and surfaces are usually to blame for this ooze. Difficult to control because of the large surfaces and because the patient's own clotting mechanisms may be failing as well.

Argon beam:

Monopolar beam that will 'spray' the area with a gas, like airbrush tanning or painting.

Pliability refers to :

Needs to slip through tissue with ease, suture must be able to bend freely and repeatedly without breaking, needs to hold knots securely without breaking, fraying or slipping.

Makeup of absorbable cellulose

Oxidized cotton or rayon cellulose

Which suture would last longer in the body? Chromic or PDS?

PDS

Monopolar

Pencil tip = active electrode Grounding pad = inactive electrode Cuts and coagulates.

5 outstanding features of a needle?

Point, eye, body, gauge, degree of curvature.

3 parts of a needle

Point, eye/swage, body

Coating on polyester

Polybutalate

The coating, specifically designed for polyester is called..... It is used to reduce

Polybutalate..... Tissue drag

2nd strongest suture material?

Polyester, because it is a multifilament nonabsorbable.

A suture designed to be removed with a quick pull is called

Pop-off/ Detach/ Control-release

What suture most likely would be used in the presence of infection to approximate skin? Indicate the suture classification.

Prolene because it is a nonabsorbable monofilament and does not adhere to tissue.

What are the purpose of bumpers and bolsters?

Protects the skin by providing even tension.

Long continuous suture strand from a reel device

Reel tie

2 kinds of cutting needles

Reverse or conventional

Describe a tapered needle:

Round body, comes to a point. Pierces and dilates.

The surgeon is behind schedule and is expected at another hospital. Name the suture technique for a primary closure that this surgeon can place quickly.

Running/continuous

A _______ ________ ______ is used to help support the primary suture line. The reinforcement is performed by placing suture which is ___________, _______, _______.

Secondary suture line.. Nonabsorbable, interrupted, large gauge.

Other solution used to keep suture pliable?

Silicone

The 'traditional' GI suture is

Silk

Type of needle that would be used in opthalmic... Why?

Spatula needle, because it is a side-cutter, so it cuts across a plane.

Describe the needle count procedure.

Visualize all needles in the package before taking them out. Take them out with a needle holder, spread them out on a sterile surface and then point with the instrument to count. Do not use fingers. Place in a numbered needle counter after use.

Maturation phase:

Wound gains in tensile strength, scab begins to fade

Disadvantages of stainless steel?

You have to have wire scissors to cut it, and it is not pliable enough when it is pulled out of the package. Hard to control.

Tannic acid

Used on mucous membranes.

Why are chemical hemostatics used?

Used to control diffuse oozing

Name one device that helps keep retention sutures from cutting into the skin

Bolsters, Bridges

4 advantages of a continuous stitch

Evenly distributed, placed evenly, tensile strength even, aesthetically pleasing.

Collagen makeup

Made from purified bovine dermis or chorium

Harmonic scalpel

'Coagulates from the outside in'

Proliferation phase:

(Lasts up to two weeks). Wound bridges (healing), Fibroblasts form collagen.

3 Phases of wound healing

1) Lag phase (inflammatory response) 2) Proliferation 3) Maturation

Avitene (Collagen Microfibrillar)

100% Collagen. Comes in powder or pad form. Effective controller of arterial bleeding. Activates the body's natural clotting mechanism. Again must be KEPT DRY and APPLIED DRY. After placement, PRESSURE MUST BE APPLIED

During what situation would a control release needle be used?

A control release needle would be used when you need rapid, efficient placement of interrupted sutures.

Explain a suture ligature and state another name for 'suture ligature'

A suture ligature is a needle in a needle holder with a suture in it. Also called a stick tie.

Explain the purpose of a 'tie on a passer'

A tie on a passer is used to tie a structure deep in a cavity where the surgeon's hands can't reach.

Instat MCH (Collagen microfibrillar)

Absorbable collagen hemostatic agent. Sponge-like pad. Collagen on sponge comes into contact with blood, and then the platelets aggregate on the collagen. Collagen, platelets, and fibrin together forms a clot.

Chemical hemostatic list:

Absorbable gelatin, absorbable cellulose, collagen, fibrin sealants, fibrin glue, thrombin, styptics.

How long does gelatin last in body?

Absorbs in about 30 days if left in.

Collagen

Actifoam, Helistat, Collastat, Superstat, Lyostypt, Instat

Advantages of a primary interrupted closure

Acts independently (does not wick), developed to help eliminate dead space, if 1 falls out they don't all fall out.

How is approximation performed?

Adson with teeth and stapler.

Most traumatic kind of needle

Any free needles (needles with an eye)

Uses of absorbable cellulose

Applied to bleeding area causing blood to clot, pressure may be applied. Once applied, forms a gel, fibrin and platelets adhere, can be left in the wound. Has some bacteriocidal properties.

List 2 collagen microfibrillars

Avitene, Instat MCH

Thrombin

Bovine blood enzyme. Comes in liquid, powder, spray. Aids in hemostasis for oozing and minor bleeding. Powder mixed with sterile 0.9% sodium chloride. Liquid and spray forms mixed on table. NEVER INJECTED. Topical only. Accelerates clotting.

Uses of absorbable gelatin:

Can be used dry or dipped in NaCl, thrombin, or epinephrine solution. Surface hemostatic placed on bleeding area to assist the formation of a blood clot, speeds clot reaction. Gelatin + fibrin proteins produce a matrix structure, gives support while protecting the forming clot.

Cryotherapy

Cold and will freeze from the inside out. Killing any life from inside out. Need sonography to determine borders.

Uses of collagen

Collagen dissolves, activates clotting. Application by powder, sheets, pads, or foam. ALL MICROFIBRILLAR COLLAGEN AGENTS MUST BE KEPT DRY

How does the laser work?

Cuts and coagulates with intense light beam. Area must be moist. Direct beam, high heat. FIELD IS WET

What type of needle used on skin?

Cutting needle.

Total or partial separation of wound edges is known as

Dehiscence

Gauge equals _______ which equals size of suture.

Diameter of a needle

Describe 3 differences between a Dexon and a Vicryl suture

Different packaging, different manufacturers (Davis&Geck, Ethicon), Suture color

A suture with a needle on each end of the suture strand is called

Double armed

Gross bleeding:

Easy to recognize, usually easy to repair. Severed vessels are the usual culprits of this kind of bleeding.

Thermal methods of hemostasis

Electrosurgery, laser, argon beam, ultrasonic, diathermy, cryosurgery

When using a _____ eyed needle, pull the suture into a V shaped area; there is ________(more/less) tissue damage than a swaged needle.

French, more

A type of stapler that delivers two double staple lines and contains a knife to transect tissue is called a ______ or ________

Gastrointestinal anastomoser, linear cutter

Absorbable gelatin

Gelfoam (powder or pad), Surgifoam, Gelfilm..

2 types of bleeding

Gross bleeding, Diffuse oozing

Causing little or no tissue damage is called

Inert

Lag phase:

Inflammatory response. Injured blood vessels constrict, platelets collect, plug formation begins. Fibrinogen converts to fibrin. Scab forms as proteins in the wound dry

List the suture technique a surgeon would use on a primary suture closure when infection is present

Interrupted (Halsted's)

Which cutting needle would be used on skin?

Keith needle because it's straight.

Mechanical hemostatics:

Sponges, ligating clips, suture ligature, pledgets, bonewax, tourniquets, packing/dressings, clamps, suture/suture ligatures, digital pressure.

Most inert of all the sutures is

Stainless steel

Suture strand with a needle attached to pass through tissue

Stick tie

Absorbable cellulose

Surgicel, Surgicel Nu-knit, Surgicel Fibrillar, Oxycel

Describe the difference between swaged needles and free needles

Swaged needles: Suture is preloaded and crimped on by the manufacturer. Free needles: Has an eye for the suture to be loaded on to.

Styptics

Tannic acid, silver nitrate. Makeup is by plant derivatives, considered a 'natural epinephrine.

When using a needle on delicate gastrointestinal tissue, you would typically use a ______ needle.

Tapered

The surgeon asks for a suture to repair gastric tissue. Knowing what you know now, what needle would you choose and why?

Tapered because it 'pierces and dilates' and there is NO LEAKAGE.

4 types of needle points

Tapered, cutting, trochar, blunt

When using a needle on a delicate GI tissue, which needle?

Tapered.

How much pull a suture strand can withstand without breaking is referred to as

Tensile strength

Michelle clips

Used for skin approximation, used mostly for thyroid closures

List the items needed for a 'tie on a passer'

The surgeon is asking for a strand of suture on a clamp.

If a muscle has been transversely incised and must be approximated, the surgeon most likely will use which characteristic type of suture and approximate by which suture technique?

The surgeon will most likely use a loosely approximated absorbable suture with an interrupted suture technique.

Define how the body breaks down absorbable suture

The suture is placed and the body will have enzymes come to the suture and create a barrier that will eat it, and encapsulate. Hydrolysis uses fluid/water to dissolve the suture.

Natural absorbable sutures, surgical plain and chromic gut are all packaged differently than other suture packs. Explain how it is packaged differently and why.

They are packaged in 'wet packs' which have a solution in them to keep them pliable.

A device used that delivers two straight, evenly placed, parallel rows of staples into tissue is called a ______ or ______

Thoracoabdominal anastomoser, linear stapler

Which chemical hemostatic controls capillary bleeding?

Thrombin

Suture strand attached to a clamp

Tie on a passer

Disadvantage of a primary interrupted closure

Time consuming

The ease of suture slipping through the tissue is known as

Tissue drag

Define ligature

To occlude by tying suture around structure

Silver nitrate

Topical, used for superficial bleeding, such as nosebleeds or cervical.

Suture that is used to retract a structure?

Traction suture

What is a surgeon going to do when he or she asks for a 'tag' ?

Use a Kelly clamp and use it to identify the end of a suture.

When using a needle on the skin, you would typically use a ________ needle.

conventional cutting

A device used to anastomose tubular structures such as the colon is called a/an

intraluminal stapler or circular end to end anastomoser.

Large vessels are typically occluded with suture ligatures or _____ and can be double ligated with a single applicator known as a ______ to prevent hemorrhage.

stick tie, ligating clip/ligaclip