Suture Patterns Flashcards
What are the features of a suture?
The suture loop, knot and ears (ends)
What are the rules of wound closure?
Close in same number of layers as incised
Appositional pattern unless good reason not to
Choose the simplest pattern
Avoid closure under tension
Careful suturing more important than choice of pattern
How can suture patterns be classified?
Simple vs. matress Interrupted vs continuous Appositional/inverting/everting Partial vs full-thickness 1-layer vs. 2-layer
What is the advantage of a mattress suture over a simple suture pattern?
Mattress gives a better grip on tissue.
What are the advantages/disadvantages of an inverting suture pattern?
Greater bursting strength and reduced risk of adhesions. However, there will be necrosis of the tissue cuff and possible luminal compromise.
What is the advantage of an everting pattern?
Has increased tensile strength
Why might is be a good idea to use a partial thickness suture pattern for the GIT? How can this problem be avoided if using a full thickness suture?
Partial thickness not exposed to luminal contents therefore less bacterial wicking. Can reduce this effect in full thickness sutures by using a monofilament suture. Could also use a 2 layer pattern
What are the different types of approximating suture pattern?
Simple interupted
Poth and Gold Crushing
Gambee
What are advantages of the cruciate mattress pattern compared with simple interrupted stiching?
Stronger, quicker to place, tension relieving and presents eversion.
What are the other types of matress suture pattern?
Horizontal mattress
Half-buried horizontal mattress
Vertical mattress
Mayo mattress
What tissues can a simple continuous stitch be used on and what is the difference with a baseball/running stitch?
Areas under low tension, fascia, subcutis, vessels etc.
The runnin stich is similar but the ‘bites’ are made at angles that are not opposite each other. It is quicker but yields less accurate approximation.
How does a subcutaneous stitch differ to a subcuticular stitch?
Subcut - perpendicular bites (like simple continuous)
Subcute - horizontal bites (continuous horizontal mattress)
What are the different types of inverting patterns?
Cushing Connel Lembert Halsted Czerny Parker-kerr Purse-string
What are inverting patterns (other than parker-kerr and purse-string) patterns used for?
Closure of hollow viscus.
n.b. Lembert - second layer
Connel - 1st layer
What are the follwing suture patterns used for?
a) Parker-kerr
b) Purse-string
a) Closure of a visceral stump
b) Inversion of a stump/feeding tube
