Suture Patterns

Question 1

What are the advantages of an interrupted pattern?

Answer 1

If one knot fails, all won’t

More accurate approximation

Adjust tension at each suture

Question 2

What are the advantages of a continuous suture pattern?

Answer 2

Quicker

Less suture material in wound

More even distribution of tension

More air-tight and water-tight

Cheaper - economical use

Question 3

What are the advantages of an appositional suture pattern?

Answer 3

Easy to perform

Accurate alignment of wall layers

Quicker regeneration of mucosa

Less inflammation and fibrous scar tissue

Question 4

What are the pros and cons of an inverting pattern?

Answer 4

Greater bursting strength (24h)
Reduced risk of adhesions

Necrosis of tissue cuff
Luminal compromise possible

Question 5

What are the pros and cons of an everting pattern?

Answer 5

Increased tensile strength
Endothelial contact reduces thrombosis

Prolonged inflammation and vascular compromise
Increased incidence of adhesions
Increased risk of stenosis and leakage

Question 6

What are the advantages of a partial thickness suture?

Answer 6

Not exposed to luminal contents so reduces wicking from lumen

Question 7

What are the advantages of full thickness suture?

Answer 7

Better apposition

Suture holding layer engaged

Question 8

What are the advantages of one layer closure?

Answer 8

Simple
Quick
Less suture material

Question 9

What are the advantages of two layer closure?

Answer 9

More accurate apposition
More water tight
Easier in some tissues
Stronger?

Question 10

Give examples of appositional interrupted patterns

Answer 10

Simple interrupted

Intradermal - upside down simple interrupted - buried knot

Question 11

What are the benefits of simple interrupted?

Answer 11

Secure anatomical closure
Precise adjustment of tension possible
Easily applied

(INVERSION IF TIGHT)

Question 12

What are the mattress patterns?

Answer 12

Cruciate mattress 
Horizontal mattress
Half buried horizontal mattress
Vertical mattress 
Mayo mattress

Question 13

What are the pros and cons of cruciate mattress?

When would you use it?

Answer 13

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

POORER APPOSITION

Skin, tail/digit amputation

Question 14

What are the pros and cons of horizontal mattress?

Answer 14

Appositional to everting
Can strangulate tissue
Edge ischaemia

Question 15

What are the pros and cons of half buried horixontal mattress ?

Answer 15

Avoids trauma to tip of skin flap

Question 16

What are the pros and cons of vertical mattress?

Answer 16

Resists tension

Better than horizontal mattress as less disruption to blood supply

Skin

Question 17

What are the features of the mayo mattress pattern?

When is it indicated?

Answer 17

Will overlap or tighten tissue planes

Hernia closure, imbrication of fascia lata

Question 18

What is the difference between simple continuous and running suture ?

Answer 18

Simple continuous advances on one side of the wound

Running stitch advances on both sides

Question 19

What is another name for a purse string suture?

Answer 19

Circular lembert

Question 20

What is a Parker-Kerr oversew?

Answer 20

1st layer Cushing

2nd layer lembert

Question 21

What are quills used for?

Answer 21

To distribute tension

Question 22

What is a simple interrupted eschelon suture?

Answer 22

Alternating simple interrupted
-wide and narrow bites

Can be used with quills/stents

Question 23

What are some tension relieving sutures?

Answer 23

Vertical and horizontal mattress,
Far-near-near-far
Far far near near
Echelon sutures