EXAM I Basic Suturing Skills

Question 1

the needle holder is not a ___

Answer 1

hemostat

Question 2

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

Answer 2

cross-hatched

Question 3

what is the proper handling of the needle holder?

Answer 3

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.

Question 4

what is another name for tissue forceps?

Answer 4

adsens

Question 5

tissue proceps can have pickups with or without ___

Answer 5

teeth

tooth forceps allow tissue to be held more delicately

Question 6

grasping tissue too tight with tissue forceps can cause what?

Answer 6

the tissue to be crushed

Question 7

tissue forceps are handled in a ___ fashion

Answer 7

pen grip

Question 8

the most common suture scissors are the ___ scissors

Answer 8

Dean

Question 9

suture scissors are held in the same fashion as ___

Answer 9

the needle holder; this provides proper stabilization

Question 10

what are the most common types of suture needles?

Answer 10

3/8 circle or 1/2 circle cutting needles

allow easy passage of needle through tough mucoperiosteium

Question 11

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

Answer 11

2/3

Question 12

as the suture diameter gets smaller, the number gets ___

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

• multi
• mono

Question 15

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

Answer 15

natural

Question 16

what are 3 examples of natural suture materials?

Answer 16

catgut, chromic gut, silk

Question 17

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

Answer 17

• natural
• synthetic

Question 18

___ suture materials provide temporary wound support

Answer 18

absorbable

Question 19

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

Answer 19

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

Question 20

what are 4 examples of absorbable suture materials?

Answer 20

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

Question 21

___ suture material is a single strand

Answer 21

monofilament

Question 22

monofilament suture materials help avoid ___

Answer 22

infection

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

Question 23

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

Answer 23

monofilament

Question 24

why are monofilament suture materials harder to tie?

Answer 24

due to more memory-poor knot security

they are also difficult to handle

Question 25

what are 3 examples of monofilament suture materials?

Answer 25

polypropylene (prolene), monocryl, and nylon

Question 26

are synthetic suture materials stronger or weaker than natural ones?

Answer 26

stronger

Question 27

what are 2 examples of synthetic suture materials?

Answer 27

vicryl and monocryl

Question 28

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

Answer 28

* mechanical support * skin or internal ligature

Question 29

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

Answer 29

5-7

Question 30

what are 2 examples of nonabsorbable suture materials?

Answer 30

prolene and nylon

Question 31

\_\_\_ suture materials are braided

Answer 31

multifilament

Question 32

multifilament suture materials have greater ___ and \_\_\_

Answer 32

tensile strength and flexibility they are easier to handle and tie better than monofilaments

Question 33

multifilament suture materials can introduce pathogens due to \_\_\_

Answer 33

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

Question 34

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

Answer 34

multifilament

Question 35

what are 2 examples of multifilament suture materials?

Answer 35

silk and vicryl

Question 36

which suture is a natural, absorbable, multifilament?

Answer 36

silk

Question 37

which suture is a synthetic, absorbable, monofilament?

Answer 37

monocryl

Question 38

which suture is a synthetic, absorbable, multifilament?

Answer 38

vicryl

Question 39

which sutures are nonabsorbable monofilaments (2)?

Answer 39

prolene (polypropylene) and nylon

Question 40

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

Answer 40

gut

Question 41

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

Answer 41

chromic gut

Question 42

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

Answer 42

vicryl

Question 43

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

Answer 43

* 3 * 90

Question 44

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.

Answer 44

* depth * distance

Question 45

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

Answer 45

2

Question 46

what should you never do when demonstrating proper suturing techniques?

Answer 46

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

Question 47

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

Answer 47

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

Question 48

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?

Answer 48

it allows for proper approximation and healing

Question 49

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

Answer 49

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

Question 50

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

Answer 50

* 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

Question 51

what can happen if you tighten sutures too tight?

Answer 51

it can cause ischemia you only want them tight enough to approximate the wound edge

Question 52

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

Answer 52

* 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

Question 53

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

Answer 53

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

Question 54

what are 8 types of suture knots?

Answer 54

* simple interrupted * simple continuous or running * continuous locking * horizontal mattress * vertical mattress * figure eight * deep interrupted * running subcuticular

Question 55

what is the most common closure performed?

Answer 55

simple interrupted

Question 56

what are two advantages of the simple interrupted suture?

Answer 56

* allows adjustment of tension throughout the suture line * failure of one knot is often inconsequential

Question 57

what are two disadvantages of the simple interrupted suture?

Answer 57

* more time needed to tie individual knots * more suture wasted

Question 58

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

Answer 58

the simple continuous suture aka running suture

Question 59

the simple continuous suture helps with \_\_\_

Answer 59

hemostasis

Question 60

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

Answer 60

the entire closure is compromised

Question 61

what situation is the simple continuous suture contraindicated and why?

Answer 61

in infected tissues as infection can propogate along the suture line

Question 62

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

Answer 62

simple continuous suture

Question 63

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

Answer 63

moderate

Question 64

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

Answer 64

continuous locking suture

Question 65

which suture is indicated for fragile tissue?

Answer 65

horizontal mattress suture

Question 66

what are the advantages of the horizontal mattress suture?

Answer 66

* distributes tension over a wider area * helps evert skin edges * used for fragile tissues * commonly used intraorally

Question 67

the ___ suture tends to leave small "railroad" scars

Answer 67

horizontal mattress suture

Question 68

what is the horizontal mattress suture used for?

Answer 68

closure of angle skin flaps or wounds

Question 69

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

Answer 69

vertical mattress suture

Question 70

the vertical mattress suture minimizes ___ in deeper tissues

Answer 70

deadspace

Question 71

how does the vertical mattress suture help minimize tension?

Answer 71

by approximating both deep and superficial tissues

Question 72

which suture tends to cause more scarring?

Answer 72

the vertical mattress suture

Question 73

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

Answer 73

far-far-near-near

Question 74

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

Answer 74

mobile (usually buccal or facial) to attached tissue

Question 75

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

Answer 75

suture backhand not suturing backhand is a common mistake

Question 76

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

Answer 76

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

Question 77

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

Answer 77

* simple interrupted * modified figure eight interrupted suture

Question 78

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

Answer 78

* simple continuous or continuous locking * the midline on both sides

Question 79

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

Answer 79

horizontal mattress

Question 80

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.

Answer 80

figure eight

Question 81

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

Answer 81

* distal papilla of the 2nd molar * the distal incision and the mesial papilla of the 2nd molar can be sutured if necessary

Question 82

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

Answer 82

* 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)

Question 83

what type of suture is this?

Answer 83

simple interrupted suture

Question 84

what type of suture is this?

Answer 84

simple continuous suture

Question 85

what type of suture is this?

Answer 85

continuous locking suture

Question 86

what type of suture is this?

Answer 86

horizontal mattress suture

Question 87

what type of suture is this?

Answer 87

vertical mattress suture

Question 88

what type of suture is this?

Answer 88

figure eight