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Periop 101 > Wound Closure > Flashcards

Wound Closure Flashcards

1
Q

Suture physical characteristics

A

Physical configuration

Capillarity (the ability to soak up fluid along a strand)

Diameter

Knot tensile strength (the force, measured in pounds, that the suture strand can withstand before it breaks when knotted)

Elasticity (the ability to regain original form and length after being stretched)

Memory (the capacity to take back former shape after being tied)

Coefficient of friction (the ability to glide through tissue and retain a knot)

Pliability (the ability to bend easily)

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2
Q

Sutures are classified into two main types:

A

Absorbable sutures

  • derived from the collagen of healthy animals or from a synthetic polymer
  • material can be digested, hydrolyzed and/or assimilated by tissue during the healing process

Nonabsorbable sutures

  • derived from natural or synthetic material
  • No change to the suture during the healing process
  • Sutures become encapsulated or must be removed.
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3
Q

Examples of synthetic absorbable sutures:

A

Monocryl, Vicryl, PDS/PDS II

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4
Q

Monocryl facts

A

Monofilament

Dyed (violet)/Undyed

Available in control release (CR)

Good for:
Wound closure, bowel surgery (mucosa), cosmetic closure

Specialties: General, plastics

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5
Q

Vicryl facts

A

Used for ophthalmic procedures and when absorption is desired

Available in:

  • Uncoated monofilament or “vicryl” suture
  • Dyed violet and comes in sizes 9-0 to 10-0 (TINY!!)
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6
Q

Maxon facts

A

Indicated for soft tissues EXCEPT cardiovascular, neural and ophthalmic tissues

Suture comes dyed green or clear, sizes 2 to 7-0

Coated vicryl is not to be used on eyes, but can be used for general soft tissue

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7
Q

PDS/PDS II facts

A

May be used in slow healing tissues and for extended wound support

Applications may include abdominal and thoracic closure, subcutaneous tissue and colorectal surgery

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8
Q

Plain catgut (Type A) use:

A

Ligation of small vessels and to suture subcutaneous fat and tissue under tension while healing

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9
Q

Chromic gut (Type C) use:

A

Infected tissues and slow-healing tissue and ligation of larger vessels, biliary, urinary tracts and muscle and fascia closure

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10
Q

PDS use:

A

Abdominal and thoracic closure, subcutaneous tissue and colorectal surgery

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11
Q

Maxon use:

A

Soft tissue except CV, neural and ophthalmic tissues

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12
Q

Vicryl use:

A

Ophthalmic procedures and when absorption is desired

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13
Q

Dexon use:

A

Peritoneal, fascial, and subcutaneous closure

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14
Q

Three types of silk used as suture material:

A

Dermal, Virgin, Surgical

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15
Q

Stainless steel uses

A

Closure of the abdominal wall or sternum

Retention sutures

Secondary repairs

Respiratory tract

Orthopedics

Neurosurgery

*Can be used in presence of infection but NOT in the presence of another alloy [titanium])

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16
Q

Natural nonabsorbable sutures:

A

Silk

Surgical cotton

Linen

Stainless steel

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17
Q

Dermal silk:

A

Differs in that the strands are encased in gelatin or protein substance

Prevents the in-growth of tissue cells and facilitates removal

Used for skin sutures

Comes in black in sizes 0 to 5-0

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18
Q

Virgin silk:

A

Composed of natural fibers

Used for ophthalmic surgery

Comes in white or black in sizes 8-0 and 9-0

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19
Q

Surgical silk:

A

Animal product made from silkworm

Fibers are braided or twisted into a multifilament suture strand and treated to render it noncapillary

Gives good support during early ambulation and promotes rapid healing

Used in the serosa of the GI tract and to close fascia when no infection is present

Comes dyed black or white in sizes 5 to 9-0.

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20
Q

Surgical cotton:

A

Weakest of the nonabsorbable material choices; gains strength when wet

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21
Q

Linen:

A

Tensile strength is inferior to other nonabsorbables; used for gastrointestinal surgery

22
Q

Advantages/Disadvantages of synthetic polymers

A

Advantages:

Higher tensile strength

Less tissue reaction

Material retains its strength in tissue

Disadvantage:

Knot tying is somewhat difficult because the material is slick

23
Q

Most commonly used surgical nylon sutures

A

Monofilament

Coated

Uncoated

24
Q

Monofilament nylon

A

Ethilon/Dermalon

Smooth, single strand of noncapillary material that is used for

  • microsurgery
  • ophthalmic procedures
  • plastic/cosmetic skin closure

Comes in clear, black, blue and green and in sizes from 2 to 11-0

25
Q

Coated multifilament nylon

A

Surgilon

Braided strand treated with silicone- enhances passage through tissue

similar to silk and uncoated multifilament nylon

26
Q

Uncoated multifilament nylon

A

Neurolon

Strand is tightly braided to prevent capillary action, handles much like silk, is strong, causes less reaction and may be used on all tissues for which multifilament nonabsorbable sutures are acceptable

Comes in black and white with sizes ranging from 1 to 7-0

27
Q

Polyester fiber sutures

A

Coated:

  • surface is lubricated to provide a smooth passage through tissues
  • Used mainly for CV anastomosis and prostheses placement
  • Retains its strength
  • Ticron, ETHIBOND, Teflon

Uncoated:

  • Braided flexible, pliable strands that are easy to handle
  • May cause drag
  • Cardiovascular/respiratory surgery
  • Mersilene and Dacron
28
Q

Monofilament nylon example:

A

Ethilon and Dermalon

29
Q

Coated multifilament nylon example:

A

Surgilon

30
Q

Uncoated polyester fiber example:

A

Mersilene and Dacron

31
Q

Coated polyester fiber example:

A

Ticron, Ethibond, Teflon, Polydek and Tevdek

32
Q

Polybutester example:

A

Novafil

33
Q

Polyethylene example:

A

Dermalene

34
Q

Polypropylene example:

A

Prolene and surgilene

35
Q

Three types of needle points:

A

Cutting point

Taper point

Blunt point

36
Q

Conventional cutting point:

A

Cutting edge on inside of curvature creating a small path that heals quickly

Conventional points are used for ligaments, in the nasal/oral cavities and in pharynx, skin, tendon applications

37
Q

Reverse cutting point:

A

Curved needles with cutting edges on outer curvature

Used for fascia, ligaments and in the nasal/oral cavities for oral mucosa, skin and tendon sheath

38
Q

Side cutting point:

A

Do not penetrate underlying tissues but rather split tissue layers

Used for ophthalmic surgery

39
Q

Trocar point:

A

Used to penetrate tough tissues

40
Q

Taper point needles:

A

Smooth point with no cutting edges

Pushes the tissue aside when passing through.

Used for aponeurosis, biliary tract, dura, fascia, GI tract, muscle, myocardium, nerve, peritoneum, pleura, subcutaneous fat, vessels (Vascular anastomosis)

41
Q

Taper cut:

A

Cutting edges at the point only

Used for bronchus, calcified tissue, fascia, ligament, nasal cavity, oral cavity, ovary, perichondrium, periosteum, pharynx, tendon, trachea, uterus, and vessels.

42
Q

Blunt point needle:

A

Rounded blunt tip and will not cut tissue making it the point of choice for use on organs bc it is less apt to puncture the vessels in organs

used for dissection of FRIABLE tissue (kidney, liver, spleen, uterine cervix ligation)

43
Q

Suture material can be attached to eyeless or swaged needles in 4 ways:

A

Single (One needle is swaged to one end of the strand)

Double (2 needles are swaged, one to each end of strand. do not have to be the same size and shape)

Permanent (secured so the needle will not separate from the strand under normal use, has to be cut off)

Control (does not release inadvertently, but will release when intentionally pulled “pop-offs!”

44
Q

Advantages of using surgical staples:

A

Rapid method to ligate, anastomose, and approximate tissues

In-depth healing is accelerated with minimal trauma and a nonreactive nature

Result produces an even surface and an airtight, leak-proof closure

45
Q

Skin staplers are used to

A

Approximate skin edges

46
Q

Linear staplers are used:

A

Throughout the alimentary tract and in thoracic procedures

47
Q

Intraluminal circular staplers are used for:

A

Intraluminal anastomosis of a tubular hollow organ, usually the GI tract

48
Q

Ligating and dividing staplers are used to:

A

ligate and divide mental vessels or soft tubular structures

49
Q

Skin clips are used to:

A

secure stockinet or towels to the skin

50
Q

Skin closure strips are used to:

A

approximate the edges of superficial lacerations or as a primary closure

Periop 101 (15 decks)

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