Suture and Suturing

Question 1

what is a caveat of surgical tape on instrument packs

Answer 1

only tells you it reached a certain temperature on the outside, not internally (and it doesn’t guarantee is was that hot for long enough to sterilize)

Question 2

if right handed, where do you want your scalpel blade/ other commonly used instruments

Answer 2

to the right

Question 3

the small metal bowl is for ___________ and the large metal bowl is for _______________

Answer 3

saline; garbage

Question 4

after scrubbing in, what two “extras” do you need to get for your bowls

Answer 4

1) saline for small bowl
2) chlorhexidine for beaker

Question 5

when do you use the following grip for a scalpel

1) finger/dinner knife
2) pencil

Answer 5

1) initial/longer incisions
2) stab/short incisions

Question 6

if I needed to make a stab incision I would use _____ grip but if i needed to make my long, initial incision I would use _______ grip

Answer 6

pencil; finger/dinner knife

Question 7

what technique do you want to use for making your incision through the linea

Answer 7

stab (pencil grip) while tenting tissues; reverse press cut (cutting edge is facing upwards)

Question 8

what forcep do we use for general tissue handling

Answer 8

Adson tissue

Question 9

what are examples of tissues we can use Adson tissue forceps on

Answer 9

SQ fat, linea alba during closure

Question 10

how does Adson brown differ from Adson tissue

Answer 10

Adson brown allows a stronger grasp of tissues

Question 11

to tent the linea during initial abdominal approach you would use _______ forceps and for closure of the linea you would use _______ forceps

Answer 11

Adson brown; Adson tissue

Question 12

what would you use debakey forceps for

Answer 12

handling gentle tissues like vessels, GI, bladder

Question 13

what grip do we use for all forceps

Answer 13

pencil grip

Question 14

what grip do we use for needle drivers

Answer 14

tripod (thumb and ring finger)

Question 15

what type of scissors are used on suture

Answer 15

sharp-blunt

Question 16

you would use _______ scissors for the linea alba and _______ scissors for fat and soft tissue

Answer 16

mayo; metzembaum

Question 17

when would you use tip clamping vs jaw clamping

Answer 17

tip clamping: single vessel
jaw clamping: vascular pedicle

Question 18

what is a benefit of carmalt hemostats and why

Answer 18

prevents tissue slippage due to longitudinal striations down entire length and cross-striations at bottom

Question 19

what is a perfect use for carmalt hemostats

Answer 19

ovariohysterectomy -> used to clamp large vascular pedicles

Question 20

you can use ________ hemostats for large vascular pedicles, _________ for small vascular pedicles, and ________ for single vessels and very small vascular pedicles

Answer 20

carmalt; kelly/crile; mosquito

Question 21

swaged needles are more _______ but less _________ compared to eyed needles

Answer 21

expensive; traumatic

Question 22

what is the difference between absorbable and non-absorbable suture

Answer 22

absorbable: loses significant tensile strength within 60 days of implantation

non-absorbable: maintains 100% of tensile strength for at least 60 days

Question 23

how are natural vs synthetic absorbable sutures absorbed

Answer 23

natural: enzymatic processes of cellular proteases and collagenases

synthetic: hydrolysis

Question 24

rate of absorption should be proportional to….

Answer 24

rate of returning strength of healing tissue

Question 25

what is the following healing time (approximate): - stomach/bladder - GI - fascia - tendons

Answer 25

stomach/bladder: 2 weeks GI: 3 weeks fascia: 6-7 weeks tendons: >>

Question 26

multifilament can be (2)

Answer 26

braided or twisted

Question 27

when do we use knotless/barbed suture

Answer 27

laproscopy

Question 28

coated sutures are created to improve __________, improve _________, reduce ________ and reduce __________

Answer 28

pliability; knot formation; drag; infection

Question 29

what is elasticity

Answer 29

the degree to which suture will deform under stress or load and return to its original form when the load is removed

Question 30

what is capillarity

Answer 30

the degree to which a suture will absorb fluid following immersion

Question 31

T/F suture metric and standard sizes are inconsistent and can vary between materials and manufacturers

Answer 31

T

Question 32

what is catgut made from

Answer 32

sheep intestinal submucosa or cattle intestinal serosa

Question 33

what can we use catgut on

Answer 33

vessel ligations

Question 34

why is catgut not commonly used

Answer 34

rapid and inconsistent absorption and lots of tissue reaction

Question 35

Vicryl maintains _____ of its tensile strength within _____ weeks

Answer 35

50%; 2-3 weeks

Question 36

what type of suture is Vicryl (Polyglactin 910)

Answer 36

synthetic braided, multifilament, absorbable suture

Question 37

what is Vicryl (Polyglactin 910) a good option for

Answer 37

intradermal; used often in large animals

Question 38

what type of suture is Monocryl (Polyglecaprone 25)

Answer 38

synthetic monofilament, absorbable suture

Question 39

what are the absorption characteristics of Monocryl

Answer 39

loses 50% of its tensile strength within 1 week and 70-80% within 2 weeks; gone by 90-120 days with little tissue reaction

Question 40

when might we use Monocryl

Answer 40

subq, intradermal, urinary tract (if no infection)

Question 41

what type of suture is PDS II

Answer 41

monofilament, synthetic, absorbable

Question 42

how is PDS II absorbed

Answer 42

approx 50% of tensile strength remains at 5-6 weeks

Question 43

what tissues is PDS II great for

Answer 43

the linea alba (heals in 6-7 weeks)

Question 44

put the following suture in order from fastest to slowest absorption: - Vicryl - Monocryl - PDS II

Answer 44

Monocryl, Vicryl, PDS II

Question 45

what type of suture is Prolene

Answer 45

non-absorbable, synthetic, monofilament, polyolefin

Question 46

why is Prolene very resistant to degradation

Answer 46

lacks hydrolyzable bonds

Question 47

what is Prolene good to use for

Answer 47

skin closure (must remove later)

Question 48

T/F Prolene can be used intradermally

Answer 48

F; need to be able to go back and remove it

Question 49

what type of suture is Nylon

Answer 49

non-absorbable, synthetic, monofilament, polyamide

Question 50

T/F nylon is a great option for permanent implantation

Answer 50

F; susceptible to degradation

Question 51

what type of knots do we want to see while suturing

Answer 51

square

Question 52

how many throws to form a secure simple interrupted knot

Answer 52

5

Question 53

when would you want to use a surgeons throw

Answer 53

1) fatty ovarian pedicle ligature 2) linea would NOT want to use on a small vessel (larger loop so not as tight)

Question 54

T/F surgeons throws are safer than simple throws

Answer 54

F

Question 55

what are the rules for performing a continuous suture line? when do we forget the rules?

Answer 55

first knot should have 1 extra throw (6) and the last knot should have 2 extra throws (7); does not apply to a buried SQ or intradermal (not enough space)

Question 56

how big should suture tags be

Answer 56

2-4mm

Question 57

T/F you should stabilize the needle with the teeth of your forceps

Answer 57

F; behind the teeth

Question 58

when suturing, you always want to keep your hands

Answer 58

parallel to the table

Question 59

what is the most common way to lose a square not

Answer 59

not maintaining even tension and not keeping hands parallel

Question 60

how big should your suture tags be for skin sutures

Answer 60

6-10 mm

Question 61

what type of suture pattern is more likely to prevent slippage off of the pedicle cut end

Answer 61

Miller knot