Suturing

Question 1

What are the functions of suture material?

Answer 1

Wound closure - Ligation - Attachment of tubes - Stay sutures

Question 2

What are the ideal properties of suture material in relation to tissue interaction?

Answer 2

Maintains strength until healing - Rapid resorption after use - Easily removed - Minimal tissue reaction - Doesn’t favour bacterial growth - Minimal drag - Suitable for all wounds

Question 3

What are the ideal properties of suture material in relation to the surgeon?

Answer 3

Easy to handle - Pliable - Good knot security

Question 4

What are the ideal properties of suture material?

Answer 4

Easy to sterilise - Non-capillary - Non-electrolytic - Non-corrosive - Non-allergenic - Non-carcinogenic

Question 5

What suture materials are synthetic absorbable multifilament?

Answer 5

Vicryl - Dexon - Polysorb - Panacryl

Question 6

For synthetic absorbable multifilament suture materials, how long does it take for it to be absorbed?

Answer 6

60 to 90 days

Question 7

What are the main uses of synthetic absorbable suture material?

Answer 7

Vessel ligation - General soft tissue closure (skin & mouth)

Question 8

What are the two suture materials that are synthetic absorbable monofilaments?

Answer 8

Monocryl - Caprosyn (short duration) PDS II - Maxon - Biosyn (long duration)

Question 9

What are the uses of synthetic absorbable monofilament suture materials?

Answer 9

General soft tissue closure - Visceral closure (monocryl) (short duration) Soft tissues needing a lot of support - Muscle, fascia, linea alba, viscera (long duration)

Question 10

What materials are non-absorbable monofilament?

Answer 10

Prolene (surgi pro) - Ethilon (monosof) - Flexon

Question 11

What’s the use for non-absorbable monofilament suture material?

Answer 11

Inert (skin, stoma, vessels) - Prolonged support (hernia/tendon)

Question 12

What materials are non-absorbable multifilament?

Answer 12

Mersilene - Ethibond - Novafil - Supramid

Question 13

What are the uses of non-absorbable multifilament suture materials?

Answer 13

Ligament prosthesis - Skin closure

Question 14

What are the natural suture materials? Are they multifilament or monofilament?

Answer 14

Catgut - Collagen (absorbable) Mersilk - PermaHand (non-absorbable) Mutifilament

Question 15

What are natural suture materials used for? Which type does what?

Answer 15

Vessel ligation Absorbable for small - Non-absorbable for large

Question 16

What general rules should be followed to avoid suture complications?

Answer 16

Avoid multifilament material in contaminated wounds - Avoid non-absorbable in hollow organs - Use inert material for skin - Avoid reactive material for stoma creation (opening) - Use slow or non-absorbable material in fascia/tendons - Avoid catgut in inflammed, infected or acidic wounds

Question 17

When choosing the size of suture material, what should you always aim to do? Why?

Answer 17

Choose smallest size possible - Reduce trauma, smaller knots, greater security

Question 18

What would the metric measurement of suture material which is 0.02mm be?

Answer 18

0.2

Question 19

What is the advantages of a reverse cutting needle over a normal cutting needle?

Answer 19

Point is reversed so they - are stronger -reduce the danger of tissue cutout -leave a hole which leaves wide wall of tissue for suture to be attached

Question 20

What are the advantages of interrupted suturing against continuous?

Answer 20

If one knot fails they don’t all fail - More accurate approximation (bringing skin together uniformly) - Adjust tension at each suture

Question 21

What are the advantages of continuous suturing against interrupted?

Answer 21

Quicker - Less suture material in wound - Even distribution of tension - More air and water tight - Cheaper

Question 22

What is appositional suturing? Why is it beneficial?

Answer 22

Suturing two sides in approximation - Easy, Accurate alignment, Quicker muscosal regeneration - Less inflammation and scar tissue

Question 23

What is inverted suturing? What is good and bad about it?

Answer 23

Two sides invert back into the tissue Good - greater bursting strength, reduced risk of adhesions Bad - Necrosis of tissue cuff, possible luminal compomise

Question 24

What is everted suturing? What is good and bad about it?

Answer 24

Two sides everted out of the tissue Good - Ease of placement, increased tensile strength, thrombosis reduction Bad - Prolonged inflammation, vascular compromise, increased adhesion, increased stenosis and leakage

Question 25

What are the advantages of a) partial thickness suture b) full thickness suture?

Answer 25

a) not exposed to luminal contents - reduces wicking from lumen b) better apposition - suture holding layer engaged

Question 26

Where would you find a simple interupted appositional pattern of suturing?

Answer 26

Skin - GIT - fascia

Question 27

 What suture pattern is this?

Answer 27

Buried knot - intradermal/subcuticular closure

Question 28

What are two other types of approximating suture pattern other than the simple? Why are they not used?

Answer 28

Poth and Gold crushing - more necrosis and poor apposition Gambee - difficult to place and risk of not engaging the submucosa

Question 29

What sort of suture pattern is this? What is good about it? 

Answer 29

Cruciate mattress pattern Stronger than simple - resists tension - prevents eversion - quicker than simple

Question 30

What is this suture pattern? What does it tend to do? 

Answer 30

Horizontal mattress suture Strangulates the tissue and causes edge ischemia

Question 31

What kind of suture pattern is this? What advantage does it have over a similar suture pattern? 

Answer 31

Vertical matress suture - Resists tension and doesn't cause edge ischemia

Question 32

What is the difference between the mayo mattress suture pattern and a horizontal mattress suture pattern?

Answer 32

A mayo mattress will cause layers to overlap and tighten tissues planes - whereas a horizontal mattress causes eversion of tissue

Question 33

Name and describe the features of this suture pattern 

Answer 33

Simple continous - series of linked 'uniterrupted' sutures, suture line advances only on one side of wound, good for low tension areas

Question 34

Name this type of suture. What is the main advantage of this suture? 

Answer 34

Runnning suture - Quick and rapid closure

Question 35

What is this suture pattern is this? Why is it better than simple continuous stitching? 

Answer 35

Ford interlocking (blanket stitch) - Greater security, better apposition

Question 36

Name the non-appositional suturing patterns used on inverting tissue

Answer 36

Cushing - Connell - Lembert - Halsted - Czemy - Parker-Kerr - Purse-string