Suture Technique- Exam 1

Question 1

What are the 4 goals of suturing?

Answer 1

stop bleeding
close any dead space
approximate the wound edges
minimize scar formation

Question 2

What size suture is the thickest?

Answer 2

0 is the thickest

Question 3

for superficial wounds and delicate tissues what are the sutures of choice? What sutures are good for deeper tissues?

Answer 3

absorbable sutures such a vicryl or polyglycolic acid

non-absorbable sutures like nylon or polypropylene

Question 4

What type of suture would you use in a contaminated area and why?

Answer 4

monofilament sutures like nylon or polypropylene are preferred because they are LESS likely to harbor bacteria

Question 5

When are multifilament sutures used commonly?

Answer 5

on the scalp because you need a more flexible suture on the scalp

Question 6

When would you want to use a braided polyester suture?

Answer 6

in high tension areas such as a joint or wounds constantly under stress

Question 7

How are chromic gut sutures differ than catgut sutures?

Answer 7

catgut are derived from the submucosal layer of the small intestine of sheep or cattle

chromic are gut sutures that are treated with chromium salts to delay absorption and prolong tensile strength

Question 8

Closing the abdominal fascia in an open bowel resection.
4-0
2-0
0
5-0

What would you choose?

Answer 8

0

Question 9

Closing the skin of an incision following carpal tunnel repair.
0- vicryl
2-0 monocryl
6-0 catgut
4-0 nylon

Answer 9

4-0 nylon because it is non-absorbable

Question 10

Closure of an incision on the scalp.
0- vicryl
2-0 silk
4-0 monocryl
4-0 prolene

Answer 10

4-0 prolene

bright blue suture

Question 11

A 15-year-old male presents to the ED with a 2cm laceration just above his right eyebrow.
6-0 nylon
2-0 nylon
0 vicryl
2-0 vicryl

Answer 11

6-0 nylon

Question 12

What 3 things would you base the STYLE of closure on?

Answer 12

Wound size

Location

Amount of stress/tension the wound will undergo while healing

Question 13

_____ is the MC type of suture and easiest to perform. When should they be used? What is the MC type of material use?

Answer 13

simple interrupted

Must ONLY be used in Low Tension lacerations/wounds

Nonabsorbable - Nylon or Prolene

Question 14

When starting to suture using simple interrupted sutures, where should you stand?

Answer 14

stand in the middle with the linear wound facing horizontal in front of you

Question 15

After placing the first suture using the simple interrupted technique, where should you do your next one? What is it called?

Answer 15

Each subsequent stitch is then placed halfway between the previous stitch and the wound edge on that side.

the rule of halves

Question 16

Where should you stand in the simple running stitch?

Answer 16

stand at the top and the wound should be verticle

Question 17

_____ is the technique of choice to help stop bleeding from the skin edge

Answer 17

simple running/continuous stitch

Question 18

______are a good choice when the skin edges are difficult to evert. What does it provide? What are the 2 types?

Answer 18

Mattress sutures

Provide relief of wound tension while still allowing skin edge approximation

vertical and horizontal mattress

Question 19

What are the indications for a vertical mattress suture? What are the CIs?

Answer 19

Lacerations around joints or areas with significant tension

Think wounds that occur on a surface that is concave or posterior neck surfaces.

CI: Face, Palms, Soles, Areas where blind, deep suture should not be performed

Question 20

What is the technique for a vertical mattress suture?

Answer 20

“Far, Far; Near, Near”

Question 21

What type of suture?

Answer 21

vertical mattress

Question 22

What are the indications for a horizontal mattress?

Answer 22

Excellent for wounds under tension and very fragile wounds

Spreads the tension out over the length of wound edge

Question 23

What is the technique for a horizontal mattress?

Answer 23

Question 24

What type of suturing technique?

Answer 24

horizontal mattress

Question 25

When would you want to use a subcuticular (Buried) suture? Where are they commonly used?

Answer 25

Wounds under little tension Pts who are prone to keloid formation Used very commonly to close small laparoscopic incisions with absorbable suture (Vicryl or monocryl)

Question 26

What are the pros for using a subcuticular suture technique?

Answer 26

No Suture removal required and better cosmetic result

Question 27

What is the technique for an interrupted subcuticular suture?

Answer 27

“Deep to superficial; superficial to deep”

Question 28

What is the MC suture technique used in plastic surgery? What is the technique?

Answer 28

running subcuticular Suture is ran along the incision in the subq tissue parallel to the incision line. Suture then tied with knot buried. Needle then pulled through skin and suture is cut at skin surface. Skin is then covered with glue or steri-strips

Question 29

What is the MC used method of securing sutures? Why is it different?

Answer 29

The square knot, or surgeon’s knot, is traditionally preferred. The first throw in the knotting sequence is often looped or twisted twice, producing the surgeon’s knot.

Question 30

An absolute minimum of _____ are needed for knot security, but some sutures require more throws to remain tied. When in doubt, ______ will hold almost all sutures securely.

Answer 30

three throws five throws

Question 31

When is a free hand tie helpful? What hand?

Answer 31

when tying a knot deep in the abdomen aka when ligating a vessel Most often performed with the non-dominant hand

Question 32

What is the main advantage of staples over sutures? What is the con?

Answer 32

staples can be placed quickly aka close a bleeding scalp wound quickly to decrease blood loss mores scarring

Question 33

What is the technique for placing staples? How far apart should staples be placed?

Answer 33

about 1 cm apart

Question 34

Name 2 situations that skin glue can be used?

Answer 34

primary closure in low tension, easy to approximate wounds in conjunction with low tension wounds

Question 35

When is skin glue CI?

Answer 35

Contraindicated in wound with active infection or on mucosal surfaces, and areas of high moisture

Question 36

When are steri-strips (adhesive tape) used?

Answer 36

Often are placed after sutures are removed to help keep the skin closure from separating. Can be used as a means of closure for relatively small wounds whose edges easily come together.

Question 37

What is the technique for applying steri-strips?

Answer 37

Cut the tape so that at least 2–3 cm are on each side of the skin edge once the tape is in place. Place tape strips one at a time, several millimeters apart. The tapes should be placed across (perpendicular to) the long axis of the wound. Tapes stay in place for several days and should be allowed to fall off on their own. The patient can wash the area but should do so gently.

Question 38

Besides applying pressure, name an additional way to stop the skin edges from bleeding? Need to make sure the pt is ______

Answer 38

Use Electrocautery device - AKA Bovie pt is grounded first before using Bovie

Question 39

What are the 2 different options for using Bovie?

Answer 39

coag and cut can be used to cut through tissue and to stop bleeding

Question 40

What type of tissue is bovie NOT a good option for?

Answer 40

Can remove lesions but does vaporize tissue so NOT to be used when removing suspicious lesions that could be cancerous or pre-cancerous.

Question 41

How long should you apply pressure to a vessel first before moving on to alt options?

Answer 41

Try this technique for at least 5–7 minutes.

Question 42

What is 2nd line in bleeding from a vessel if the vessel is small (1-2mm)?

Answer 42

Electrocautery unit

Question 43

When would you want to tie off a vessel? What are your 2 options?

Answer 43

If you do not have access to an electrocautery unit or if the vessel is a larger vein or larger (3–4 mm) artery regular or stick tie

Question 44

When should a regular tie be used when trying to stop a vessel from bleeding? What is the step by step procedure?

Answer 44

Adequate for most veins and small arteries (2-3mm)

Question 45

What am I?

Answer 45

regular tie a bleeding vessel

Question 46

____ is the more secure technique to control bleeding from a blood vessel. What type of vessel especially?

Answer 46

Stick Tie It is especially useful for arteries, because the thicker wall and increased interior pressure of an artery can cause a regular tie to come off of the vessel.

Question 47

What am I?

Answer 47

stick tie used to control bleeding in a vessel

Question 48

**What should you NOT due to when assisting a bleed during sx?

Answer 48

Use care not to wipe or remove the eschar from site that has been cauterized