Suture Patterns

Question 1

what is an interrupted pattern

Answer 1

series of individual sutures

Question 2

which is more secure interrupted or continuous

Answer 2

interrupted

Question 3

which allows for adjustment of tension interrupted or continuous

Answer 3

interrupted

Question 4

which uses more suture interrupted or continuous

Answer 4

interrupted – more expensive, increased foreign material in wound

Question 5

which takes longer interrupted or continuous

Answer 5

interrupted

Question 6

what is a continuous pattern

Answer 6

start with a knot than continue with pattern to end of incision prior to tying final knot

Question 7

how many knots in a continuous pattern

Answer 7

2

Question 8

how do you adjust tension in continuous

Answer 8

tension adjusted after each bite taken
difficult to adjust tension at the end

Question 9

which provides better air and watertight closure interrupted or contiuous

Answer 9

continuous

Question 10

where do you start a suture pattern

Answer 10

at or just beyond the corner of the incision (1-3mm)

Question 11

distance of bites from incision edge

Answer 11

3-5 mm

Question 12

distance between bites

Answer 12

5-8 mm

Question 13

which patterns are appositional

Answer 13

simple interrupted
simple continuous
cruciate
ford interlocking
intradermal

Question 14

what type of suturing allows for best anatomical approximation and brings edges of incision together

Answer 14

appositional patterns

Question 15

what results in fastest healing and gives best cosmetic results

Answer 15

appositional patterns

Question 16

classification of simple interrupted

Answer 16

interrupted and appositional

Question 17

is simple interrupted recommended if there is tension

Answer 17

no

Question 18

simple interrupted impact on blood supply to incision edges

Answer 18

minimal, unless overtightened

Question 19

uses of simple interrupted

Answer 19

close skin, subcutaneous layer, body wall
ligate blood vessels or nerves

Question 20

classification of simple continuous

Answer 20

continuous and appositional

Question 21

simple continuous effect on blood supply compared to simple interrupted

Answer 21

larger effect

Question 22

uses of simple continuous

Answer 22

close subcutaneous layer, body wall, hollow organ incisions
less common in skin

Question 23

classification of cruciate pattern

Answer 23

interrupted and appositional

Question 24

strength of closure compared to simple interrupted

Answer 24

stronger – covers greater distance along incision

Question 25

cruciate effect on blood supply compared to simple interrupted

Answer 25

larger effect

Question 26

should cruciate be used when there is a concern for tension

Answer 26

no

Question 27

uses of cruciate

Answer 27

close skin, body wall

Question 28

does cruciate help prevent inversion of skin

Answer 28

yes

Question 29

classification of ford interlocking pattern

Answer 29

continuous and appositional

Question 30

ford interlocking and knot failure

Answer 30

some security in case of knot failure

Question 31

ford interlocking effect on blood supply

Answer 31

same as simple continuous

Question 32

what can ford interlocking cause when placed under tension

Answer 32

pressure necrosis may become buried

Question 33

what species is ford interlocking commonly used in

Answer 33

bovine but can be used in small animals

Question 34

classification of intradermal pattern

Answer 34

continuous and appositional

Question 35

what does intradermal do

Answer 35

apposes skin and diminishes tension on skin closure

Question 36

how does intradermal run

Answer 36

horizontally through dermis

Question 37

intradermal impact on local blood supply

Answer 37

minimal

Question 38

what do you do to the knot in intradermal

Answer 38

bury it

Question 39

why is important to bury knot in intradermal

Answer 39

if knot sticks out patient may lick or chew it prevents access of dirt and bacteria to deepest layers

Question 40

in intradermal should bites backtrack

Answer 40

yes, about halfway

Question 41

what can tissue forceps cause in intradermal and why

Answer 41

post operative bruising due to excess pressure needed to stabilize skin

Question 42

what do inverting patterns do

Answer 42

turn incision edges inward

Question 43

where are inverting patterns used

Answer 43

larger lumen hollow organs

Question 44

what happens to lumen with inverting patterns

Answer 44

decreases lumen size

Question 45

what helps provide watertight seal in inverting patterns

Answer 45

serosa-serosa apposition

Question 46

where do you avoid using inverting and why

Answer 46

avoid when closing skin -- delays healing

Question 47

which patterns are inverting

Answer 47

lembert cushing purse string

Question 48

what is the holding layer when suturing hollow organs

Answer 48

tunica submucosa

Question 49

complications when suturing hollow organs

Answer 49

dehiscence calculi or stone formation adhesions

Question 50

what patterns are used with single layer closure

Answer 50

simple interrupted or simple continuous commonly used

Question 51

what type of pattern is used in double layer closure on the stomach

Answer 51

first layer -- appositional pattern second layer -- inverting pattern

Question 52

what type of pattern is used in double layer closure on the urinary bladder

Answer 52

first layer -- inverting pattern second layer -- similar to stomach (inverting??)

Question 53

what type of pattern is used in closure on the intestines

Answer 53

1 layer closure -- appositional pattern

Question 54

classification of lambert pattern

Answer 54

continuous and inverting

Question 55

is lambert partial or full thickness

Answer 55

partial thickness -- non penetrating pattern

Question 56

uses of lambert

Answer 56

GI surgery large lumen hollow organs colon, bladder, stomach, rumen

Question 57

is lambert continuous or interrupted

Answer 57

can be either

Question 58

what is penetrated in lambert

Answer 58

serosa muscularis submucosa

Question 59

what is not penetrated in lambert

Answer 59

mucosa of the hollow organ

Question 60

how to make tissue more inverted in lambert

Answer 60

place bites farther from incision edge

Question 61

classification of cushing pattern

Answer 61

continuous and inverting

Question 62

is cushing partial or full thickness

Answer 62

partial thickness -- non penetrating pattern

Question 63

what is and is not penetrated in cushing

Answer 63

penetrates submucosa does not penetrate organs lumen

Question 64

what is cushing commonly used with

Answer 64

2 layer closure

Question 65

uses of cushing

Answer 65

hollow viscera urinary bladder stomach uterus

Question 66

classification of connell pattern

Answer 66

continuous and inverting

Question 67

is connell partial or full thickness

Answer 67

full thickness -- penetrating

Question 68

can this be used in 2 layer closure

Answer 68

yes, but only as first (inner) layer

Question 69

uses of connell

Answer 69

hollow viscera urinary bladder stomach uterus

Question 70

purse string classification

Answer 70

continuous and inverting

Question 71

is purse string pattern partial or full thickness

Answer 71

partial thickness -- non penetrating

Question 72

what is purse string pattern commonly used on

Answer 72

hollow organ viscera

Question 73

what is purse string pattern used for

Answer 73

temporarily close anus during perianal surgery maintain rectal prolapse reduction close defect in hollow organ wall

Question 74

what is finger trap pattern used for

Answer 74

secure tubes to patient

Question 75

what is used in finger trap pattern

Answer 75

hand throws

Question 76

what do everting patterns do

Answer 76

turn incision edges outwards

Question 77

what is everting pattern used for what can it lead to

Answer 77

suturing edges under tension decrease tension on the suture line can lead to delayed healing

Question 78

what is tension

Answer 78

tendency of the incision to open up

Question 79

which patterns are everting

Answer 79

mattress -- horizontal and vertical walking sutures near-far patterns (surgeons stich) -- near-far-far-near and far-near-near-far

Question 80

classification of vertical mattress pattern

Answer 80

interrupted and tension relieving (everting)

Question 81

effect of vertical mattress on blood supply

Answer 81

less than horizontal mattress more than simple interrupted

Question 82

degree of eversion of vertical mattress compared to horizontal mattress

Answer 82

horizontal mattress has more eversion than vertical

Question 83

uses on vertical mattress

Answer 83

closure of high tension areas commonly used for skin closure

Question 84

how to differentiate horizontal and vertical mattress

Answer 84

vertical -- sutures are perpendicular to incision horizontal -- sutures are parallel to incision

Question 85

classification of horizontal mattress pattern

Answer 85

interrupted and tension relieving (everting)

Question 86

uses of horizontal mattress

Answer 86

closure of high tension areas commonly used for skin closure

Question 87

which patterns require backing the needle in

Answer 87

horizontal and vertical mattresses

Question 88

classification of near-far-far-near and far-near-near-far patterns

Answer 88

variation of vertical mattress interrupted and everting (tension relieving)

Question 89

what is the most appropriate pattern to use for considerable tension

Answer 89

near-far-far-near far-near-near-far

Question 90

uses of near-far-far-near and far-near-near-far patterns

Answer 90

closure of high tension areas commonly used for skin closure