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Oral Surgery I > EXAM I Basic Suturing Skills > Flashcards

EXAM I Basic Suturing Skills Flashcards

1
Q

the needle holder is not a ___

A

hemostat

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2
Q

the beaks of the needle holder have a ___ texture to allow a secure grip of the needle

A

cross-hatched

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3
Q

what is the proper handling of the needle holder?

A

thumb and ring finger are inserted through the rings. the index finger is held along the length of the needle holder to steady and direct it. the second finger aids in controlling the locking mechanism.

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4
Q

what is another name for tissue forceps?

A

adsens

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5
Q

tissue proceps can have pickups with or without ___

A

teeth

tooth forceps allow tissue to be held more delicately

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6
Q

grasping tissue too tight with tissue forceps can cause what?

A

the tissue to be crushed

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7
Q

tissue forceps are handled in a ___ fashion

A

pen grip

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8
Q

the most common suture scissors are the ___ scissors

A

Dean

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9
Q

suture scissors are held in the same fashion as ___

A

the needle holder; this provides proper stabilization

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10
Q

what are the most common types of suture needles?

A

3/8 circle or 1/2 circle cutting needles

allow easy passage of needle through tough mucoperiosteium

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11
Q

the needle is held approximately ___ of the distance between the tip and the base of the needle, suing the tips of the needle holder for best control

A

2/3

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12
Q

as the suture diameter gets smaller, the number gets ___

A

larger

think of it like needle gauges - the large the “gauge number”, the smaller the diameter

so a 4-0 suture is going to have a larger diameter than a 7-0 suture

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13
Q

what size suture is commonly used for suturing oral mucosa? which sizes are used for suturing on the face?

A
  • 3-0 for oral mucosa
  • 5-0 and 6-0 for the face
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14
Q

braided sutures are also called ___, and non-braided sutures are also called ___

A
  • multi
  • mono
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15
Q

what classification of suture material causes a tissue reaction due to enzymatic degradation?

A

natural

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16
Q

what are 3 examples of natural suture materials?

A

catgut, chromic gut, silk

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17
Q

all ___ suture materials are absorbable, but only some ___ materials are absorbable

A
  • natural
  • synthetic
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18
Q

___ suture materials provide temporary wound support

A

absorbable

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19
Q

how does absorption of natural vs synthetic suture materials occur? which one causes less tissue reaction?

A
  • by enzymatic degradation in natural materials, and by hydrolysis in synthetic materials
  • hydrolysis causes less tissue reaction than enzymatic degradation
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20
Q

what are 4 examples of absorbable suture materials?

A

catgut, chromic gut (these two are both natural), vicryl, and monocryl (these two are both synthetic)

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21
Q

___ suture material is a single strand

A

monofilament

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22
Q

monofilament suture materials help avoid ___

A

infection

this is because it is a single strand and is resistant to harboring microorganisms

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23
Q

___ suture materials provide less resistance to passage through tissue due to their smooth surface

A

monofilament

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24
Q

why are monofilament suture materials harder to tie?

A

due to more memory-poor knot security

they are also difficult to handle

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25
Q

what are 3 examples of monofilament suture materials?

A

polypropylene (prolene), monocryl, and nylon

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26
Q

are synthetic suture materials stronger or weaker than natural ones?

A

stronger

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27
Q

what are 2 examples of synthetic suture materials?

A

vicryl and monocryl

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28
Q

nonabsorbable suture materials provide longer ___ and are primarily used on ___ or ___

A
  • mechanical support
  • skin or internal ligature
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29
Q

nonabsorbable suture materials should be removed after ___ days on the face and in the mouth

A

5-7

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30
Q

what are 2 examples of nonabsorbable suture materials?

A

prolene and nylon

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31
Q

___ suture materials are braided

A

multifilament

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32
Q

multifilament suture materials have greater ___ and ___

A

tensile strength and flexibility

they are easier to handle and tie better than monofilaments

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33
Q

multifilament suture materials can introduce pathogens due to ___

A

increased capillarity that may act as a tract for introduction of pathogens

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34
Q

of multifilament and monofilament suture materials, which provides more tissue reaction?

A

multifilament

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35
Q

what are 2 examples of multifilament suture materials?

A

silk and vicryl

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36
Q

which suture is a natural, absorbable, multifilament?

A

silk

37
Q

which suture is a synthetic, absorbable, monofilament?

A

monocryl

38
Q

which suture is a synthetic, absorbable, multifilament?

A

vicryl

39
Q

which sutures are nonabsorbable monofilaments (2)?

A

prolene (polypropylene) and nylon

40
Q

which suture is natural, lasts for 5-7 days, and is used for mucosal closures?

A

gut

41
Q

which suture is natural, lasts 10-14 days, and is used in mucosa and perineal?

A

chromic gut

42
Q

which suture is braided, lasts 28 days, and is used for mucosal closures?

A

vicryl

43
Q

proper suturing technique involves the needle entering the tissue at least ___mm from the edge of the flap and at a ___ degree angle, rotating the wrist following the curvatures of the needle

A
  • 3
  • 90
44
Q

once the needle has entered tissue on one flap, it should enter the opposing flap at the same ___ and come out of the tissue at the same ___ from the tissue edge.

A
  • depth
  • distance
45
Q

once the needle and suture material has been correctly insterted into both flaps of tissue, the suture is pulled through the tissue until a short tail of ___cm is left

A

2

46
Q

what should you never do when demonstrating proper suturing techniques?

A

you should never blindly pass the needle through both sides of the tissue without visualizing the needle depth

47
Q

what can you use when suturing on skin to help evert tissue?

A

tissue forceps

this aids in penetrating the tissue at a right angle and it can also help visualize depth before making the pass through the opposing tissue

48
Q

why is it important to make sure the suture is symmetrical on both sides in regards to distance from the edge of the tissue and depth of the suture?

A

it allows for proper approximation and healing

49
Q

what is a common mistake made when tying off a suture?

A

you want to pull on the needle end of the suture only when cinching down on the FIRST knot so that your suture tail doesn’t get any longer

50
Q

what is a good rule of thumb for how many knots to make? why is this a good rule to follow?

A
  • do as many knots as the size of the suture
    • for example, if you are using a 3-0, do 3 knots; 4-0, do 4 knots, etc.
  • this will help prevent unraveling, especially monofilament sutures such as prolene, nylon, or monocryl
51
Q

what can happen if you tighten sutures too tight?

A

it can cause ischemia

you only want them tight enough to approximate the wound edge

52
Q

in general, you want to cut sutures leaving a ___mm tail. what are some exceptions?

A
  • 2-3
  • if suturing on the face in a place with hair, leave tails longer for ease of removal
  • you can also cut the tails shorter if they are in an irritating spot like the labial mucosa
53
Q

T or F:

when tying off a suture, you should wrap the suture around the needle drivers twice, lay the knot down and tighten it, then repeat the same step but wrap the suture around the needle drivers in the opposite direction and only once

A

true

you want to alternate the direction you wrap the suture around the needle drivers each time you make a knot

after the initial knot, where the suture is wrapped around the needle drivers twice, you just want to wrap it a single time for the rest of the knots

54
Q

what are 8 types of suture knots?

A
  • simple interrupted
  • simple continuous or running
  • continuous locking
  • horizontal mattress
  • vertical mattress
  • figure eight
  • deep interrupted
  • running subcuticular
55
Q

what is the most common closure performed?

A

simple interrupted

56
Q

what are two advantages of the simple interrupted suture?

A
  • allows adjustment of tension throughout the suture line
  • failure of one knot is often inconsequential
57
Q

what are two disadvantages of the simple interrupted suture?

A
  • more time needed to tie individual knots
  • more suture wasted
58
Q

which suture can be placed very quickly and is best in short lacerations with no tension?

A

the simple continuous suture aka running suture

59
Q

the simple continuous suture helps with ___

A

hemostasis

60
Q

in a simple continuous suture, what happens if one knot fails?

A

the entire closure is compromised

61
Q

what situation is the simple continuous suture contraindicated and why?

A

in infected tissues as infection can propogate along the suture line

62
Q

the continuous locking suture has similar concerns with knot security and integrity of closure as what other suture?

A

simple continuous suture

63
Q

the continuous locking suture is used in wounds closed with ___ tension

A

moderate

64
Q

the ___ suture is helpful in obtaining hemostasis but has a greater risk of tissue strangulation

A

continuous locking suture

65
Q

which suture is indicated for fragile tissue?

A

horizontal mattress suture

66
Q

what are the advantages of the horizontal mattress suture?

A
  • distributes tension over a wider area
  • helps evert skin edges
  • used for fragile tissues
    • commonly used intraorally
67
Q

the ___ suture tends to leave small “railroad” scars

A

horizontal mattress suture

68
Q

what is the horizontal mattress suture used for?

A

closure of angle skin flaps or wounds

69
Q

the ___ suture is used for maximal edge eversion (used on tissues that tend to invert)

A

vertical mattress suture

70
Q

the vertical mattress suture minimizes ___ in deeper tissues

A

deadspace

71
Q

how does the vertical mattress suture help minimize tension?

A

by approximating both deep and superficial tissues

72
Q

which suture tends to cause more scarring?

A

the vertical mattress suture

73
Q

what are the instructions for the placement of the vertical mattress suture?

A

far-far-near-near

74
Q

with intraoral suturing, you want to suture from ___ tissue to ___ tissue

A

mobile (usually buccal or facial) to attached tissue

75
Q

when doing intraoral sutures, what is necessary to do to keep the needle holder oriented correctly?

A

suture backhand

not suturing backhand is a common mistake

76
Q

in intraoral sutures, where should the knots be placed and why?

A

keep knots on the buccal or facial to prevent tongue irritation and longevity of the suture

77
Q

the ___ suture can be used for re-approximating papillas or mucosa. if it is difficult to penetrate the lingual tissue from the buccal, and ___ suture can be used to pass the suture through the lingual tissue

A
  • simple interrupted
  • modified figure eight interrupted suture
78
Q

which sutures are commonly used following full mouth extraction and alveoplasty, and where is a good place to tie off?

A
  • simple continuous or continuous locking
  • the midline on both sides
79
Q

the ___ suture decreases the amount of sutures placed and slightly compresses the wound together and everts tissue

A

horizontal mattress

80
Q

in an extraction case, the ___ suture is placed over the top of the socket to aid in hemostasis. it helps to maintain a piece of oxidized cellulose in the tooth socket.

A

figure eight

81
Q

when suturing a 3rd molar envelope incision, where should you always suture first to approximate tissues to correct anatomical position (good landmark)? the ___ and ___ can be sutured if necessary

A
  • distal papilla of the 2nd molar
  • the distal incision and the mesial papilla of the 2nd molar can be sutured if necessary
82
Q

what is the correct technique when suturing a 3-cornered flap?

A
  • slightly elevate the non-flap side of the incision using a periosteal elevator, freeing the margin to facilitate passage of the needle through the tissue
  • first suture is placed across the papilla where the vertical release incision was made (easy identifiable landmark makes the remaining sutures easy to place)
83
Q

what type of suture is this?

A

simple interrupted suture

84
Q

what type of suture is this?

A

simple continuous suture

85
Q

what type of suture is this?

A

continuous locking suture

86
Q

what type of suture is this?

A

horizontal mattress suture

87
Q

what type of suture is this?

A

vertical mattress suture

88
Q

what type of suture is this?

A

figure eight

Oral Surgery I (13 decks)

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