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Principles of Science BVetMed 3 > Suture patterns > Flashcards

Flashcards in Suture patterns Deck (68):
1

What are the 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

What is tissue bite?

the distance between the incision/wound and the suture

3

How are patterns classified?

simple versus mattress interrupted versus continuous appositional versus inverting versus everting partial versus full-thickness 1 layer versus 2 - layer

4

What is a mattress ligature?

include tissue that isn't in your bite

 

5

What is this?

 

Simple suture

6

What is this?

Mattress suture

7

What is this?

Mattress ligature

8

What are the benefits of interrupted sutures?

if 1 knot fails, the whole line won't fail More accurate approximation You can adjust tension at each suture

9

What are the benefits of continuous suture?

quicker less suture material in wound more even distribution of tensionmore air-tight and water-tight cheaper - economic use and shorter anaesthetic

10

What does an appositional suture do?

it brings tissues into close approximation

11

What does an inverting suture do?

turns tissue edges towards the patient, away from the surgeon or into a hollow cavity

12

What does an everting suture do?

turns tissue edges outward away from the patient, towards the patient. rarely used

13

What are two appositional (approximating sutures)?

Bennett and de Hoff

14

Why do appositional suturing?

easy accurate wall layer alignment quicker mucosa regeneration less inflammation and fibrous scar tissue

15

What is an example of an inverting suture pattern?

Lembert

16

What are the advantages of an inverting suture pattern?

greater bursting strength similar tensile strength reduced risk of adhesions necrosis of tissue cuff *luminal compromise possible*

17

What are examples of an everting suture?

Travers and Knowles

18

What are the benefits/disadvantages of everting sutures?

ease of placement increased tensile strength endothelial contraction reduces thrombosis BUT.... prolonged inflammation and vascular compromise increased incidence adhesions increased risk of stenosis increased risk of leakage

19

What are the advantages of a partial thickness suture?

not exposed to luminal contents reduces wicking from lumen

20

What are the advantages of a full thickness suture?

better apposition suture holding layer engaged

21

What is the most important layer in a suture?

submucosa - as this keeps the tensile strength

22

What are the advantages of a two layer closure?

more accurate apposition more watertight ? easier in some tissues stronger?

23

What is this?

one layer closure

24

What is this?

two layer closure

25

What is this?

1 layer, partial thickness

26

What is this?

1 layer, full thickness

27

What is this?

2 layers, partial thickness

28

What is this?

2 layers, full thickness and partial thickness

29

What are the features of a simple interrupted suture? Examples?

 

secure anatomical closure precise adjustment of tension possible easily applied (inversion if tight) EXAMPLES - skin, GIT, fascia

30

What are the features of an intradermal/subcuticular suture?

upside down simple interrupted (i.e. buried knot) EXAMPLE - intradermal/subcuticular closure

31

What is this?

intradermal/subcuticular suture

32

What is this?

Simple interrupted - layer apposition good

33

What is this?

Poth and Gold crushing (an approximating suture) More tissue necrosis Poorer apposition of layers

34

What is this?

a (modified) Gambee (an approximating suture) BUT: difficult to place risk of not engaging submucosa inverting?

35

What is this suture? What are its features? Examples?

CRUCIATE MATTRESS (figure of 8) FEATURES: stronger than simple interrupted resists tension prevents eversion quicker than simple interrupted ?poorer apposition placed too close EXAMPLES: Skin?, tail/digit amputation

36

What is this suture? What are its features? Examples?

HORIZONTAL MATTRESS FEATURES: appositional to everting strangulate tissue edge ischaemia EXAMPLES: skin, muscle, tendon

37

What is this suture? What are its features? Examples?

HALF-BURIED HORIZONTAL MATTRESS FEATURES: composite of: horizontal mattress and subdermal/subarticular, avoids trauma to tip of flap EXAMPLES: skin closure

38

What is this suture? What are its features? Examples?

VERTICAL MATTRESS FEATURES: appositional to everting resists tension

EXAMPLES: skin (tension relieving)

39

What is another name for a mayo mattress?

"vest over pants"

40

What are the features of a mayo mattress and what are examples?

FEATURES: will overlap or tighten tissue planes EXAMPLES: imbrication of fascia lata, hernia closure

41

List the appositional mattress patterns

cruciate mattress (figure of 8) horizontal mattress half-buried horizontal mattress vertical mattress mayo mattress (vest over pants)

42

List examples of APPOSITIONAL CONTINUOUS PATTERNS

simple continuous running suture (baseball stitch) subcutaneous or subcuticular Ford interlocking (Blanket stitch)

43

What is this? Features? Examples?

SIMPLE CONTINUOUS FEATURES: series of linked interrupted sutures, suture line advances on one side of the wound, good for areas under low tension EXAMPLES: subcutis, fascia, vessels, GIT

44

What is this? Features? Examples?

RUNNING SUTURE (BASEBALL STITCH) FEATURES: series of linked 'interrupted' sutures, suture lines advance on both sides of the wound rapid closure at the expense of accuracy of approximation

45

What are subcutaneous and subcuticular stitches?

SUBCUTANEOUS: modification of simple continuous (perpendicular bite) SUBCUTICULAR: modification of a continuous horizontal mattress (parallel bites) Accurate apposition - facilitates or obviates skin closure

46

What is this?

Subcutaneous suture (perpendicular bite)

47

What is this?

Subcuticuar suture (parallel bite)

48

What is this? Features? Example?

Ford interlocking (blanket stitch) FEATURES: greater security than simple continuous, better apposition than simple continuous, more difficult to place and finish EXAMPLE: skin

49

How are non-appositional patterns classified?

Inverting or everting

50

What are some examples of inverting patterns (i.e. non-appositional inverting patterns)?

Cushing

Connell

Lembert

Halsted

Czrny

Parker-Kerr

Purse-string

51

What are some examples of everting patterns (i.e. non-appositional inverting patterns)?

Horizontal mattress (don't pull too tight!)

52

What is this? Features? Example?

Lembert (interrupted)

FEATURES: variation of the vertical mattress (i.e. upside down), tissue bites are PERPENDICULAR to the wound edge, can be interrupted or continuous

EXAMPLE: hollow viscus (second layer)

53

What is this?

Lembert (continuous) - Dupuytren's (looks similar but fewer knots so less suture material needed)

54

What is this? Features? Example?

HALSTED FEATURES: modification of Lembert, two interrupted Lemberts as a mattress suture

EXAMPLE: hollow viscus

55

What is this? Features? Example?

CUSHING

FEATURES: variation of the continuous horizontal mattress (upside down), tissue bites PARALLEL to wound edge, penetrates submucosa but not lumen (partial thickness), less inversion

 

EXAMPLES: hollow viscus

56

What is this? Features? Example?

CONNELL FEATURES: like a Cushing but penetrates the lumen EXAMPLE: hollow viscus (first layer)

57

What is this? Features? Example?

CZERNY (or CZERNY-LEMBERT) FEATURES: generally simple continuous partial thickness, 1st layer: appostional (simple continuous, running), inverting (cushing, connell) 2nd layer: Lembert EXAMPLE: hollow viscus

58

What is this?

PARKER-KERR OVERSEW FEAUTRES: 1st layer - Cushing 2nd layer - Lembert EXAMPLE: closure of visceral stump (e.g. pyometra)

59

What is this?

PURSE-STRING FEATURES: circular Lembert (do a running stitch around the top of the tube and then pull tight) EXAMPLES: stump inversion, feeding tubes n.b. this is one on the more common sutures.

60

What is this? Features? Examples?

CONTINUOUS HORIZONTAL MATTRESS FEATURES: appositional to everting EXAMPLES: cardiac surgery, oversewn with SC

61

What are 2 solutions to tension?

Remove tension - reconstructive techniques Fight tension - tension-relieving sutures

62

What suture patterns are tension-relieving?

vertical mattress horizontal mattress far-near-near-far far-far-near-near Echelon sutures Quils, bolsters, stents and pledgets

63

What is this?

Far-near-near-far

64

What is this?

far-far-near-near

65

What is this? Features? Example?

SIMPLE INTERRUPTED ECHELON SUTURES FEATURES: alternating simple interrupted sutures, narrow bite - apposition, wide bite - tension, can use with quills/stents

66

What is this? Features? Examples?

Quills + horizontal mattress sutures FEAUTRES: quills or bolsters, distribute tension, everting EXAMPLE: relief of tension

67

What is this? Features? Example?

QUILLS + VERTICAL MATTRESS FEATURES: distribute tension EXAMPLES: relief of tension, with SI

68

What are the 2 most useful patterns?

Simple interrupted

Simple continuous

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