Flashcards in Sutures and Stitches Chapter7 P53-60 Deck (46)
1. What is a suture?
Any strand of material used to ligate blood vessels or to approximate tissues
2. How are sutures sized?
By diameter; stated as a number of O’s: the higher the number of O’s, the smaller the diameter (e.g., 2-O suture has a larger diameter than 5-O suture)
3. Which is thicker, 1-O suture or 3-O suture?
1-O suture (pronounced “one oh”)
1. What are the two most basic suture types?
Absorbable and nonabsorbable
2. What is an absorbable suture?
Suture that is completely broken down by the body (dissolving suture)
3. What is a nonabsorbable suture?
Suture is not broken down (permanent suture)
a) What are “catgut” sutures made of?
Purified collagen fibers from the intestines of healthy cows or sheep (sorry, no cats)
b) What are the two types of gut sutures?
Plain and chromic
c) What is the difference between plain and chromic gut?
Chromic gut is treated with chromium salts (chromium trioxide), which results in more collagen crosslinks, making the suture more resistant to breakdown by the body
2. Vicryl® Suture
a) What is it?
Absorbable, braided, multifilamentous copolymer of lactide and glycoside
b) How long does it retain its strength?
60% at 2 weeks, 8% at 4 weeks
c) Should you ever use PURPLE-colored Vicryl® for skin closure?
NO—it may cause purple tattooing
a) What is it?
Absorbable, monofilament polymer of polydioxanone (absorbable fishing line)
b) How long does it maintain its tensile strength?
70% to 74% at 2 weeks, 50% to 58% at 4 weeks, 25% to 41% at 6 weeks
c) How long does it take to complete absorption?
180 days (6 months)
d) What is silk?
Braided protein filaments spun by the silkworm larva; known as a nonabsorbable suture
e) What is Prolene?
Nonabsorbable suture (used for vascular anastomoses, hernias, abdominal fascial closure)
f) What is nylon?
Nonabsorbable “fishing line”
g) What is monocryl?
h) What kind of suture should be used for the biliary tract
or the urinary tract?
ABSORBABLE—otherwise the suture will end up as a nidus for stone formation!
1. What is the purpose of a suture closure?
To approximate divided tissues to enhance wound healing
2. What are the three types of wound healing?
1. Primary closure (intention)
2. Secondary intention
3. Tertiary intention (Delayed Primary Closure DPC)
3. What is primary intention?
When the edges of a clean wound are closed in some manner immediately (e.g., suture, Steri-Strips®, staples)
4. What is secondary intention?
When a wound is allowed to remain open and heal by granulation, epithelization, and contraction—used for dirty wounds, otherwise an abscess can form
5. What is tertiary intention?
When a wound is allowed to remain open for a time and then closed, allowing for débridement and other wound care to reduce bacterial counts prior to closure
(i.e., delayed primary closure)
6. What is another term for tertiary intention?
DPC = Delayed Primary Closure
7. Classic time to wait before closing an open abdominal
wound by DPC?
8. What rule is constantly told to medical students about
“Approximate, don’t strangulate!” Translation: If sutures are pulled too tight, then the tissue becomes ischemic
because the blood supply is decreased, possibly resulting in necrosis, infection, and/or scar
1. What is a taper-point needle?
Round body, leaves a round hole in tissue
(spreads without cutting tissue)
2. What is it used for?
Suturing of soft tissues other than skin
(e.g., GI tract, muscle, nerve, peritoneum, fascia)
3. What is a conventional cutting needle?
Triangular body with the sharp edge toward the inner circumference; leaves a triangular hole in tissue
4. What are its uses?
Suturing of skin
5. What is a simple interrupted stitch?
6. What is a vertical mattress stitch?
Simple stitch is made, the needle is reversed, and a small bite is taken from each wound edge; the knot ends up on
one side of the wound
7. What is the vertical mattress stitch also known as?
Far-far, near-near stitch—oriented perpendicular to wound
8. What is it used for?
Difficult-to-approximate skin edges; everts tissue well
9. What is a horizontal mattress stitch?
Simple stitch is made, the needle is reversed, and the same size bite is taken again—oriented parallel to wound
10. What is a simple running (continuous) stitch?
Stitches made in succession without knotting each stitch
11. What is a subcuticular stitch?
Stitch (usually running) placed just underneath the epidermis, can be either absorbable or nonabsorbable (pull-out stitch if nonabsorbable)
12. What is a pursestring suture?
Stitch that encircles a tube perforating a hollow viscus (e.g., gastrostomy tube), allowing the hole to be drawn tight and
thus preventing leakage
13. What are metallic skin staples?
14. What is a staple removal device?
15. What is a gastrointestinal anastomosis (GIA) device?
Stapling device that lays two rows of small staples in a hemostatic row and automatically cuts in between them
16. What is a suture ligature (a.k.a. stick tie)?
Suture is anchored by passing it through the vessel on a needle before wrapping it around and occluding the vessel; prevents slippage of knot-use on larger vessels
17. What is a retention suture?
Large suture (#2) that is full thickness through the entire abdominal wall except the peritoneum; used to buttress
an abdominal wound at risk for dehiscence