Suture Patterns

Question 1

In which direction should you suture?

Answer 1

Right to left
Distal to proximal (towards you)

Question 2

Advantages: Interrupted Suture Patterns

Answer 2

Ease of placement
Adjustable tension
Loss of knot less disastrous
Strength, tissue mobility

Question 3

Disadvantages: Interrupted Suture Patterns

Answer 3

More time and material

Question 4

Simple Interrupted

Answer 4

Single passage through each side of incision, then tied

Question 5

Mattress

Answer 5

Two opposite passages through each side of incision, then tied

Question 6

Pulley

Answer 6

Multiple passages through tissue in the same direction, varying distance from the wound edge
Far-far-near-near, far-near-near-far

Question 7

Cruciate

Answer 7

First pass though each side, perpendicular to incision
Second pass parallel an 5-10mm from 1st
Tie to form X across incision
Appositional (moderate tension suture)
Skin, body wall closure

Question 8

Answer 8

Cruciate

Question 9

Horizontal Mattress

Answer 9

Two passages on each side in the same horizontal plane
Forms a square with both suture ends exiting same
Tension-relieving
May interfere with blood supply to skin edges
Skin, fascia

Question 10

Answer 10

Horizontal Mattress

Question 11

Vertical Mattress

Answer 11

Two passages on each side of incision in same ‘vertical’ plane, perpendicular to incision
Not the same as far-far-near-near
Apposition to slight eversion
Tension-relieving
Skin, fascia

Question 12

Answer 12

Vertical Mattress

Question 13

Near and Far Sutures

Answer 13

Pulley
Tension-relieving
All forehand bites

Question 14

Advantages: Continuous Suture Patterns

Answer 14

Speed
Less suture material
Ease of removal
Better initial seal

Question 15

Disadvantages: Continuous Suture Patterns

Answer 15

Loss of knots or suture breakage potentially more disastrous

Question 16

Simple Continuous

Answer 16

Single passage through each side, perpendicular across incision
Appositional
Widely used, versatile
Any tissue where apposition is desired
Minimal to moderate tension
Use if good seal desired

Question 17

Intradermal Suture

Answer 17

Placed within dermis
Begin with buried interrupted knot
Pass sutures in dermis parallel to incision (continuous horizontal mattress)
Absorbable suture, cutting needle

Question 18

Answer 18

Intradermal suture

Question 19

What is the difference in needles when suturing intradermal vs subcutaneous?

Answer 19

Intradermal = cutting
Subcutaneous = taper (or cutting)
Cutaneous = cutting

Question 20

What are examples of inverting suture patterns?

Answer 20

Cushing, connell, lembert

Question 21

When are inverting suture patterns used?

Answer 21

Hollow organ closure
Minimize mucosal eversion
Minimize adhesion risk

Question 22

Cushing/Connell

Answer 22

Inverting
Closing hollow viscera
Suture passed parallel to incision
Cushing = partial thickness
Connell = full thickness

Question 23

Answer 23

Cushing/Connell

Question 24

Lembert

Answer 24

Inverting
Closure of hollow viscera
Second-layer
Partial thickness
Suture passed perpendicular to incision

Question 25

Answer 25

Lembert

Question 26

Ford Interlocking

Answer 26

Backhand last bite
Skin most common

Question 27

Answer 27

Ford interlocking