Surgical Knots, Sutures And Staplers Flashcards
(27 cards)
Types of Surgical knots
- Square/Reef knot
- Granny’s knot/Slip knot
- Surgeon’s knot
What is Square/Reef knot?
Secure knot; does not open up
2 throws f/b a single throw
What is Surgeon’s knot?
2 throws f/b single throw
Types of Sutures
- Simple sutures
- Mattress sutures
- Subcuticular sutures
- Purse string sutures
Uses of Purse string sutures
- Rectal prolapse surgery (Thiersch wiring)
- Cervical encerclage injury in cervical incompetence
- Bury appendicular stump
Advantages of Subcuticular sutures
- No needle marks on skin
- Suture is buried from inside
- Cosmetically better
What is Hemostatic sutures?
Hemostatic sutures, causes eversion of edges
Disadvantage of Simple sutures
Fail to cause edge eversion
Skin suturing
Just study
- Edge should be everted
- Needle entry: 90 deg with skin
- Bite on each side: X
- Distance b/w 2 sutures: 2X
Needle to be held at
1/3rd from staged end and 2/3rd from pointed end
Types of Needles
- Round body needle
- Cutting/Reverse cutting needle
What is Round body needle?
Rounded cross section; atraumatic
What is Cutting/Reverse cutting needle?
Triangular cross section
Uses of Round body needle
Used for delicate structures (All B’s):
Bowel, Bladder, Common Bile Duct, Blood vessels
Uses of Cutting/Reverse cutting needle
Used for tough structures (All S’s):
Skin, Sheath, FaScia
Numbering of Sutures
Just study
No. 1 suture: Thickest
No. 11: Finest suture
Thick suture: Easier to handle
Finer suture: Difficult to handle (Break/fractures more common)
Types of Sutures
- Absorbable:
> Natural
> Synthetic - Non-absorbable:
> Natural
> Synthetic
Natural absorbable suture
E.g. Catgut
1. Sheep gut derived
2. Tensile strength: 21-28 days
3. Absorption (by enzyme degradation) time: 90 days
4. Chromic catgut (With chromic salt coating): No role in surgery
Synthetic absorbable sutures
Monocryl (Poliglecaprone):
1. Monofilament suture
2. Subcuticular suturing on cutting needle
Vicryl (Polyglactin):
1. Braided suture
2. Inc infection rate
3. Absorption (Hydrolysis): 60-90 days
4. Uses: Bowel, bladder and CBD
PDS (Polydioxanone):
1. Absorption time: 180 days
2. Monofilament suture
3. Same use as vicryl
Natural non-absorbable sutures
Silk
Used for:
1. Skin (3-0/cutting)
2. Fix drains (No 1/cutting)
3. Bowel anastomosis (3-0/RB)
Synthetic non-absorbable sutures
Proline (Polypropelene monofilament):
Uses:
1. Rectus sheath closure:
Jenkins theory: Min length required to close rectus sheath=4 times the length of wound
2. Vascular repair/anastomosis (RB needle):
> 2-0: Aorta
> 4-0: Femoral
> 6-0: Popliteal
3. Mesh (Hernia repair)
Nylon/Ethilon:
1. Monofilaments
2. Uses: Skin, fixing drains, nerve and tendon repair
Suture removal in non-absorbable sutures
Scalp: 5-7 days
Face: 3-5 days
Neck: 5-7 days
Thorax: 10-12 days
Abdomen: 12-14 days
Perineum: 10-12 days
Strongest layer in bowel anastomosis
Submucosa
What is Bowel anastomosis and its methods?
Inverted edges suturing
3 methods:
1. Single layer extra-mucosal
2. Two layer
3. Using staplers
