Suture and suturing techniques

What is dihiscence and what is it caused by

-Breakdown of surgically closed wounds -caused by technique (tight suturing) or insufficient time for debridement of contaminated wounds leading to necrosis of tissue

suture removal technique

-hold one side of suture thread with forceps -cut suture on one side of exposed knot with suture scissors -pull suture thread through skin with forceps -don't leave any suture inside skin

Where is edema seen during would healing and why does this occur

-large wounds and distal limbs -result of decreased lymph and venous drainage

Suturing technique

-needle placed perpendicular to surface being entered -pushed through following curvature of needle -Enters and exits 2-3mm from margin of flap -sutures evenly placed, not under tension

Types of continuous suture patterns

-simple continupus -ford interlocking

Types of Interrupted Suture patterns

-simple interrupted (time consuming) -cruciate (decreased tension areas) -horizontal/vertical mattress (quick, high tension areas)

4 factors to consider with suture needles

1) shape of needle 2) size of needle 3) how needle pierces (point) 4) attachment of suture material

Examples of multi filament sutures

1. Catgut 2. Vicryl 3. Silk

Examples of monofilament sutures

1. Monocryl 2. Prolene 3. Maxon

Swaged needle

A length of surgical material with a needle attached

This type of suture behavior has a variable loss of strength

Absorbable

2 types of suture behavior

Absorbable Non absorbable

This alternative closure option has poor apposition and should be used in conjunction with other closure

Adhesive strips (steri strips)

This suture pattern is used when tissues are close together (simple interrupted)

Appositional suture patterns

In this suture pattern, if one suture breaks, the whole suture line is ruined

Continuous

What is a finger trap suture

Continuous suture with knots around a tube Ex: urinary catheter, nasogastric tube

This type of needle: -has 2 or more cutting edges —used for skin, fascia, ligament, tendons, and cartilage (tough tissue)

Cutting needle

How are suture sizes measured and what is the unit

Diameter USP

This suture pattern turns the edges outward (continuous mattress). It's a tension relieving pattern

Everting suture pattern

T/F knots are placed on the incision line

False, NEVER placed on incision line: will delay healing

T/F suture selection should be the largest size to get the job done

False, SMALLEST: reduces tissue trauma

This type of suture pattern: -quick -each passing is locked to avoid breakdown -increases distribution and decreases tension

Ford interlocking

In this suture pattern, if one suture is undone, the rest of the sutures will still be intact

Interrupted

This suture pattern brings the tissue away from the surgeon (cushing or purse string) it's used when you are closing around a tube

Inverting

When are larger vs smaller suture sizes used

Larger: high stress areas Smaller: areas needing little retention

a suture used in tying a ductal structure such as a blood vessel

Ligature

the ability of suture to return to or maintain its original shape

Memory (suture)

This type of suture structure: -Single strands -Less tissue drag/trauma -Decreased adherence of bacteria

Monofilament

Which type of suture structure will you use if bacteria is already present like during sepsis

Monofilament

2 types of suture structure

Monofilament Multifilament

This type of suture structure: -Multiple strands braided -Can wick bacteria via capillarity process -Easy handling -Increased tissue drag -Coated and non-coated

Multifilament

This type of suture material: -may cause inflammatory reactions in the tissue -has varying absorption -cheaper -made from animals or silk

Natural

2 types of suture material

Natural Synthetic

examples of absorbable sutures

Natural: catgut Synthetic: vicryl, monocryl, dexon, PSD11

How does absorbable suture disappear

Natural: enzymatic degradation Synthetic: hydrolysis

Examples of non-absorbable sutures

Natural: silk (avoid using in contaminated sites Synthetic: ethibond, ethilon, braunamid, flexon

How is needle grasped during suturing

Needle grasped using needle holder, 1/3 distance from eye, 2/3 distance from point

This type of suture behavior has a strength of over 60 days and is good when you need it to last a long time

Non absorbable

How can edema be prevented during wound healing

PROM massage Compression bandage

What is the most common mistake in suturing

Placing them too tight- skin swelling needs to be accounted for

the ability to adjust knot tension and secure the knot

Pliability

Cons of tissue adhesive

Poor adherence Potential for infection

Signs of infection during wound healing

Redness Swelling Fever Pain Lethargy Anorexia

This type of needle has an outside cutting edge (away from wound)

Reverse cutting

This type of suture pattern: -suture is continuous between knots: fast -used in closure of linea alba or SQ tissue -airtight and fluid tight

Simple continuous

What is the smallest and largest suture size

Smallest: 10-0 Largest: 7

This alternative closing option is quick and easy but expensive

Staples

Different needle shapes

Straight- skin Half curved- skin Curved

When sutures are placed in this location: -it eliminates dead space that will otherwise lead to fluid accumulation -provides less tension on skin -placed as simple continuous or interrupted -absorbable material -not seen -eliminates scarring

Subcutaneous

When sutures are placed in this location: -it's used in place of skin suture to reduce scarring -it's in the dermis -absorbable suture

Subcuticular

Any strand of material used to approximate tissue or structures

Surure

This type of suture material: -has predictable absorption -minimal tissue reaction -is manmade

Synthetic

What type of suture material would you use when you don't want a premature breakdown of suture? Ex: in a heart surgery or an area of high tension like an orthopedic surgery on the knee

Synthetic

This type of needle: -has a fine point tip -used on intestines, blood vessels, and less dense tissues (delicate tissues)

Taper

This alternative closing option: -Sets in <60 seconds -applied on top of skin (good at apposition, not strength) -used on cutaneous wounds and incisions

Tissue adhesive

What is a seroma

collection of serous fluid in dead space

wound healing complications

hemorrhage and hematoma Seroma infection dehiscence Edema Infection

the ability of tissue or material to resist breakage

tensile strength