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Flashcards in Suture patterns Deck (41):
1

rules for wound closure

Close tissue in the same number of layers as incised Appositional pattern unless good reason not to Choose the simplest pattern Avoid closure under tension Careful suturing more important than pattern choice

2

Classification of patterns

Simple vs mattress Interrupted vs continuous Appositional vs inverting vs everting Partial vs full-thickness 1-layer vs 2-layer

3

simple vs mattress

simple - on surface suture material runs across the wound mattres - on surface suture material is along side the wound

4

Interrupted vs Continuous - Interrupted

• If 1 knot fails, all line won’t fail • More accurate approximation • Adjust tension at each suture

5

Interrupted vs Continuous - Continuous

Quicker Less suture material in wound More even distribution of tension More air-tight & water-tight Cheaper - economical use

6

appositional closure

Easy to perform Accurate alignment of wall layers Quicker regeneration of mucosa Less inflammation & fibrous scar tissue

7

inverting closure

Greater bursting strength (24h) Similar tensile strength Reduced risk of adhesions Necrosis of tissue cuff Luminal compromise possible

8

everting closure

Ease of placement Increased tensile strength Endothelial contact reduces thrombosis Prolonged inflammation & vascular compromise Increased incidence of adhesions Increased risk of stenosis + leakage

9

Partial thickness pros

Not exposed to luminal contents Reduces wicking from lumen

10

Full thickness pros

Better apposition Suture holding layer engaged

11

simple interrupted - features

Secure anatomical closure Precise adjustment of tension possible Easily applied (Inversion if tight)

12

simple interrupted - examples of when to use

Skin, GI tract, fascia

13

Approximating sutures

Simple interrupted - Layer apposition good Poth & Gold crushing - buried suture, More tissue necrosis, Poorer apposition of layers (modified) Gambee (1951) - Difficult to place, Risk of not engaging submucosa

14

cruciate mattress - features

Q image thumb

Stronger than simple interrupted 
Resists tension 
Prevents eversion 
Quicker than simple interrupted 

 

15

cruciate mattress - examples of use

Q image thumb

skin?, tail, digit amp

16

Horizontal mattress - features + examples of use

Q image thumb

Features - Appositional to everting, Strangulate tissue, Edge ischaemia 
 

Examples - Skin, muscle, tendon

17

vertical mattress - features + examples of use

Q image thumb

Appositional to everting 
Resists tension 
Skin (tension relieving) 

18

Vertical vs Horizontal mattress - which cuts off blood flow to the skin more

 

horizontal 

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19

simple continous - features

Q image thumb

Series of linked “interrupted” sutures 
Suture line advances on one side of the wound 
Good for areas under low tension

20

simple continous - examples of use

Q image thumb

subcutis, fascia, vessels, GI tract

21

running suture - features

Q image thumb

Series of linked “interrupted” sutures 
Suture line advances on both sides of the wound 
rapid closure at the expense of accuracy of approximation 

 

22

Ford interlocking (Blanket stitch)

Q image thumb

Greater security than simple continuous 
Better apposition than simple continuous 
More difficult to place & finish 

used in skin

23

inverting patterns

Cushing 
• Connell 
• Lembert 
• Halsted 
• Czerny 
• Parker-Kerr 
• Purse-string

24

everting pattern

Horizontal mattress 

25

Lembert (interrupted) - features

Q image thumb

Variation of the vertical mattress, i.e. upside down 
Tissue bites perpendicular to wound edge 

 

26

Lembert (interrupted) - example of use

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Hollow viscus (second layer)

27

Lembert (continuous) - Dupuytren’s - pic only

A image thumb
28

Halsted

Q image thumb

Modification of the Lembert 
Two interrupted Lemberts as a mattress suture 
Examples - Hollow viscus 

29

cushing - features

Q image thumb

Variation of the continuous horizontal mattress (i.e. upside down) 
Tissue bites parallel to wound edge 
Penetrates submucosa but not lumen 
Less inversion 

 

30

cushing - examples of use

Q image thumb

hollow viscus

31

connell

Q image thumb

like cushing but penetrates the lumen

hollow viscus

32

czerny

simple continuous partial thickeness

hollow viscus

33

Parker-Kerr oversew 

 

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1st layer: Cushing 
2nd layer: Lembert 
Example - Closure of visceral stump e.g. pyometra

34

purse-string

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circular lembert

stump inversion, feeding tubes

35

continous horizontal mattress

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appositional to everting

cardiac surgery, oversewn with SC

36

suture patterns that relieve tension

• Vertical mattress 
• Horizontal mattress 
• Far-near-near-far 
• Far-far-near-near 
• Echelon sutures 
• Quills, bolsters, stents & pledgets 

37

far-near-near-far - pic only

tension on outside of the loop

A image thumb
38

far-far-near-near - pic only

A image thumb
39

Simple interrupted echelon suture

Q image thumb

Alternating simple interrupted sutures 
Narrow bite - apposition 
Wide bite - tension 
Can use with quills/stents

40

quills + horizontal mattress

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distribute tension - incr contact surface

everting

41

Quills + Vertical mattress 

 

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distribute + relieve tension