Sutures and Stitches Chapter7 P53-60 Flashcards Preview

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Flashcards in Sutures and Stitches Chapter7 P53-60 Deck (46)
1

GENERAL INFORMATION
1. What is a suture?
P53

Any strand of material used to ligate blood vessels or to approximate tissues

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2. How are sutures sized?
P53

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)

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3. Which is thicker, 1-O suture or 3-O suture?
P53

1-O suture (pronounced “one oh”)

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CLASSIFICATION
1. What are the two most basic suture types?
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Absorbable and nonabsorbable

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2. What is an absorbable suture?
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Suture that is completely broken down by the body (dissolving suture)

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3. What is a nonabsorbable suture?
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Suture is not broken down (permanent suture)

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SUTURES
1. Catgut
a) What are “catgut” sutures made of?
P54

Purified collagen fibers from the intestines of healthy cows or sheep (sorry, no cats)

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b) What are the two types of gut sutures?
P54

Plain and chromic

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c) What is the difference between plain and chromic gut?
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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

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2. Vicryl® Suture
a) What is it?
P54

Absorbable, braided, multifilamentous copolymer of lactide and glycoside

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b) How long does it retain its strength?
P54

60% at 2 weeks, 8% at 4 weeks

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c) Should you ever use PURPLE-colored Vicryl® for skin closure?
P54

NO—it may cause purple tattooing

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3. PDS®
a) What is it?
P54

Absorbable, monofilament polymer of polydioxanone (absorbable fishing line)

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b) How long does it maintain its tensile strength?
P54

70% to 74% at 2 weeks, 50% to 58% at 4 weeks, 25% to 41% at 6 weeks

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c) How long does it take to complete absorption?
P54

180 days (6 months)

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d) What is silk?
P55

Braided protein filaments spun by the silkworm larva; known as a nonabsorbable suture

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e) What is Prolene?
P55

Nonabsorbable suture (used for vascular anastomoses, hernias, abdominal fascial closure)

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f) What is nylon?
P55

Nonabsorbable “fishing line”

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g) What is monocryl?
P55

Absorbable monofilament

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h) What kind of suture should be used for the biliary tract
or the urinary tract?
P55

ABSORBABLE—otherwise the suture will end up as a nidus for stone formation!

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WOUND CLOSURE
GENERAL INFORMATION
1. What is the purpose of a suture closure?
P55

To approximate divided tissues to enhance wound healing

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2. What are the three types of wound healing?
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1. Primary closure (intention)
2. Secondary intention
3. Tertiary intention (Delayed Primary Closure DPC)

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3. What is primary intention?
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When the edges of a clean wound are closed in some manner immediately (e.g., suture, Steri-Strips®, staples)

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4. What is secondary intention?
P55

When a wound is allowed to remain open and heal by granulation, epithelization, and contraction—used for dirty wounds, otherwise an abscess can form

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5. What is tertiary intention?
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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)

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6. What is another term for tertiary intention?
P55

DPC = Delayed Primary Closure

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7. Classic time to wait before closing an open abdominal
wound by DPC?
P56

5 days

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8. What rule is constantly told to medical students about
wound closure?
P56

“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

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SUTURE TECHNIQUES
1. What is a taper-point needle?
P56 (pictures)

Round body, leaves a round hole in tissue
(spreads without cutting tissue)

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2. What is it used for?
P56

Suturing of soft tissues other than skin
(e.g., GI tract, muscle, nerve, peritoneum, fascia)

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3. What is a conventional cutting needle?
P56 (pictures)

Triangular body with the sharp edge toward the inner circumference; leaves a triangular hole in tissue

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4. What are its uses?
P56

Suturing of skin

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5. What is a simple interrupted stitch?
P56 (pictures)

see picture

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6. What is a vertical mattress stitch?
P57 (pictures)

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

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7. What is the vertical mattress stitch also known as?
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Far-far, near-near stitch—oriented perpendicular to wound

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8. What is it used for?
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Difficult-to-approximate skin edges; everts tissue well

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9. What is a horizontal mattress stitch?
P57 (pictures)

Simple stitch is made, the needle is reversed, and the same size bite is taken again—oriented parallel to wound

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10. What is a simple running (continuous) stitch?
P57 (pictures)

Stitches made in succession without knotting each stitch

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11. What is a subcuticular stitch?
P58 (picture)

Stitch (usually running) placed just underneath the epidermis, can be either absorbable or nonabsorbable (pull-out stitch if nonabsorbable)

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12. What is a pursestring suture?
P58 (picture)

Stitch that encircles a tube perforating a hollow viscus (e.g., gastrostomy tube), allowing the hole to be drawn tight and
thus preventing leakage

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13. What are metallic skin staples?
P58 (picture)

see picture

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14. What is a staple removal device?
P59 (pictures)

see picture

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15. What is a gastrointestinal anastomosis (GIA) device?
P59 (pictures)

Stapling device that lays two rows of small staples in a hemostatic row and automatically cuts in between them

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16. What is a suture ligature (a.k.a. stick tie)?
P60 (pictures)

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

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17. What is a retention suture?
P60 (pictures)

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

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18. What is a pop-off suture?
P60

Suture that is not permanently swaged to the needle, allowing the surgeon to “pop off” the needle from the suture without cutting the suture