Suture Patterns

Question 1

what direction do you suture if you are right-handed?

Answer 1

right to left

Question 2

what direction do you suture?

Answer 2

towards yourself! From point most distant to point closest to you

Question 3

what are the interrupted suture patterns?

Answer 3

1. simple
2. cruciate
3. mattress
4. pulley

Question 4

what are the continuous suture patterns?

Answer 4

1. simple
2. ford interlocking
3. intradermal
4. cushing/connell
5. lembert

Question 4

what are advantages of interrupted suture patterns?

Answer 4

• ease of placement
• adjustable tension
• loss of knot less disastrous
• strength, tissue mobility

Question 5

what are disadvantages of interrupted suture patterns?

Answer 5

more time and material

Question 6

what are the 2 types of pulley sutures?

Answer 6

1. far far near near
2. far near near far

Question 7

what suture is a single passage thru each side of the incision, then tied?

Answer 7

simple interrupted

Question 7

what suture is two opposite passages through each side of the incision, then tied?

Answer 7

mattress (interrupted suture)

Question 8

what sutures are multiple passages through tissue in the same direction, varying distance from the wound edge?

Answer 8

pulley

Question 9

cruciate suture (details)

Answer 9

• appositional, moderate “tension” suture
• applications: skin, body wall closure

Question 10

what do you use cruciate sutures for?

Answer 10

skin, body wall closure

Question 10

what suture:
Two passages on each side in same ‘horizontal’ plane
Forms a ‘square’ with both suture ends exiting same side

Answer 10

horizontal mattress

Question 11

what is horizontal mattress used for?

Answer 11

tension-relieving: buttons, rubber tubing
may interfere with blood supply to edges
applications: skin, fascia
useful for stents

Question 11

what suture?
Two passages on each side of incision in same ‘vertical’ plane; perpendicular to incision
1st > 1 cm, 2nd 0.5 cm from edge Not the same as far-far-near-near

Answer 11

vertical mattress

Question 11

what are vertical mattress sutures used for?

Answer 11

• apposition to slight eversion
• tension-relieving: buttons, rubber tubing
• applications: skin, fascia
  the tighter you pull, the more the skin will evert

Question 12

near and far sutures

Answer 12

1. pulley sutures
2. tension relieving
3. variation of vertical mattress
4. all forehand bites
5. far far near near
6. far near near far

Question 12

continuous sutures: pros vs cons

Answer 12

Advantages
Speed of placement
Less suture material
Ease of removal
Better initial seal

Disadvantages
Loss of knots or suture breakage, potentially more disastrous

Question 13

simple continuous uses

Answer 13

Appositional
Too tight will necrose, invert or evert, or
wrinkle
Widely used and versatile
Any tissue where apposition is desired
Minimal to moderate tension
Use if good seal desired

Question 14

what type of needle do you use with an intradermal suture?

Answer 14

cutting: because the dermis has such dense collagen

Question 15

intradermal suture details

Answer 15

• placed within dermis: “subcuticular”
• begin with buried interrupted knot
• pass sutures in dermis parallel to incision
• continuous horizontal mattress
• absorbable suture
• cutting needle

Question 15

what is deeper: intradermal or subcutaneous?

Answer 15

subcutaneous: below the dermis, internal
intradermal is through the dermis, internal

Question 16

what needle do you use for intradermal sutures?

Answer 16

cutting

Question 17

what needle do you use for subcutaneous sutures?

Answer 17

taper or cutting

Question 18

describe cutting sutures

Answer 18

- across the incision - external - nonabsorbable suture - needs removed! - CUTTING NEEDLE

Question 19

what kind of needle do you use with a cutaneous suture?

Answer 19

cutting !

Question 20

what are the benefits of inverting suture patterns?

Answer 20

- hollow organ closure - minimize mucosal eversion - minimize adhesion risk

Question 21

what are the 3 types of inverting social patterns?

Answer 21

- cushing - connell - lembert

Question 22

cushing/connell suture

Answer 22

- for closing hollow viscera - continuous pattern - suture passed parallel to incision

Question 23

is cushing partial or full thickeness?

Answer 23

partial- "cushing... stop pushing"

Question 24

is connell full or partial thickness?

Answer 24

full- Connell, with an "L", into the Lumen

Question 25

cushing and connell are both types of what sutures?

Answer 25

inverting suture patterns

Question 26

lembert is what type of suture pattern?

Answer 26

inverting suture pattern

Question 27

lembert details

Answer 27

- for closure of hollow viscous - second layer - suture passed perpendicular to incision! (difference between this and connell/cushing) - suture enters and exits tissue on same side of incision - partial thickness

Question 28

ford interlocking

Answer 28

- similar to simple continuous - needle passed thru previous suture loop before taking next bite - pattern ended by tying to a loop - backhand last bite? - skin is most common application - not commonly used in small animals- requires tight skin sutures

Question 29

what species are ford interlocking sutures most commonly used in?

Answer 29

large animal- requires tight sutures so not often used in small animals

Question 31

decision making for suture patterns

Answer 31

1. tissue type/location 2. tension: cruciate vs mattress vs pulley 3. species: apposition, eversion, inversion 4. interrupted vs continuous