Wound Closure

Question 1

Suture physical characteristics

Answer 1

Physical configuration

Capillarity (the ability to soak up fluid along a strand)

Diameter

Knot tensile strength (the force, measured in pounds, that the suture strand can withstand before it breaks when knotted)

Elasticity (the ability to regain original form and length after being stretched)

Memory (the capacity to take back former shape after being tied)

Coefficient of friction (the ability to glide through tissue and retain a knot)

Pliability (the ability to bend easily)

Question 2

Sutures are classified into two main types:

Answer 2

Absorbable sutures

• derived from the collagen of healthy animals or from a synthetic polymer
• material can be digested, hydrolyzed and/or assimilated by tissue during the healing process

Nonabsorbable sutures

• derived from natural or synthetic material
• No change to the suture during the healing process
• Sutures become encapsulated or must be removed.

Question 3

Examples of synthetic absorbable sutures:

Answer 3

Monocryl, Vicryl, PDS/PDS II

Question 4

Monocryl facts

Answer 4

Monofilament

Dyed (violet)/Undyed

Available in control release (CR)

Good for:
Wound closure, bowel surgery (mucosa), cosmetic closure

Specialties: General, plastics

Question 5

Vicryl facts

Answer 5

Used for ophthalmic procedures and when absorption is desired

Available in:

• Uncoated monofilament or “vicryl” suture
• Dyed violet and comes in sizes 9-0 to 10-0 (TINY!!)

Question 6

Maxon facts

Answer 6

Indicated for soft tissues EXCEPT cardiovascular, neural and ophthalmic tissues

Suture comes dyed green or clear, sizes 2 to 7-0

Coated vicryl is not to be used on eyes, but can be used for general soft tissue

Question 7

PDS/PDS II facts

Answer 7

May be used in slow healing tissues and for extended wound support

Applications may include abdominal and thoracic closure, subcutaneous tissue and colorectal surgery

Question 8

Plain catgut (Type A) use:

Answer 8

Ligation of small vessels and to suture subcutaneous fat and tissue under tension while healing

Question 9

Chromic gut (Type C) use:

Answer 9

Infected tissues and slow-healing tissue and ligation of larger vessels, biliary, urinary tracts and muscle and fascia closure

Question 10

PDS use:

Answer 10

Abdominal and thoracic closure, subcutaneous tissue and colorectal surgery

Question 11

Maxon use:

Answer 11

Soft tissue except CV, neural and ophthalmic tissues

Question 12

Vicryl use:

Answer 12

Ophthalmic procedures and when absorption is desired

Question 13

Dexon use:

Answer 13

Peritoneal, fascial, and subcutaneous closure

Question 14

Three types of silk used as suture material:

Answer 14

Dermal, Virgin, Surgical

Question 15

Stainless steel uses

Answer 15

Closure of the abdominal wall or sternum

Retention sutures

Secondary repairs

Respiratory tract

Orthopedics

Neurosurgery

*Can be used in presence of infection but NOT in the presence of another alloy [titanium])

Question 16

Natural nonabsorbable sutures:

Answer 16

Silk

Surgical cotton

Linen

Stainless steel

Question 17

Dermal silk:

Answer 17

Differs in that the strands are encased in gelatin or protein substance

Prevents the in-growth of tissue cells and facilitates removal

Used for skin sutures

Comes in black in sizes 0 to 5-0

Question 18

Virgin silk:

Answer 18

Composed of natural fibers

Used for ophthalmic surgery

Comes in white or black in sizes 8-0 and 9-0

Question 19

Surgical silk:

Answer 19

Animal product made from silkworm

Fibers are braided or twisted into a multifilament suture strand and treated to render it noncapillary

Gives good support during early ambulation and promotes rapid healing

Used in the serosa of the GI tract and to close fascia when no infection is present

Comes dyed black or white in sizes 5 to 9-0.

Question 20

Surgical cotton:

Answer 20

Weakest of the nonabsorbable material choices; gains strength when wet

Question 21

Linen:

Answer 21

Tensile strength is inferior to other nonabsorbables; used for gastrointestinal surgery

Question 22

Advantages/Disadvantages of synthetic polymers

Answer 22

Advantages:

Higher tensile strength

Less tissue reaction

Material retains its strength in tissue

Disadvantage:

Knot tying is somewhat difficult because the material is slick

Question 23

Most commonly used surgical nylon sutures

Answer 23

Monofilament

Coated

Uncoated

Question 24

Monofilament nylon

Answer 24

Ethilon/Dermalon

Smooth, single strand of noncapillary material that is used for

• microsurgery
• ophthalmic procedures
• plastic/cosmetic skin closure

Comes in clear, black, blue and green and in sizes from 2 to 11-0

Question 25

Coated multifilament nylon

Answer 25

Surgilon Braided strand treated with silicone- enhances passage through tissue similar to silk and uncoated multifilament nylon

Question 26

Uncoated multifilament nylon

Answer 26

Neurolon Strand is tightly braided to prevent capillary action, handles much like silk, is strong, causes less reaction and may be used on all tissues for which multifilament nonabsorbable sutures are acceptable Comes in black and white with sizes ranging from 1 to 7-0

Question 27

Polyester fiber sutures

Answer 27

Coated: - surface is lubricated to provide a smooth passage through tissues - Used mainly for CV anastomosis and prostheses placement - Retains its strength - Ticron, ETHIBOND, Teflon Uncoated: - Braided flexible, pliable strands that are easy to handle - May cause drag - Cardiovascular/respiratory surgery - Mersilene and Dacron

Question 28

Monofilament nylon example:

Answer 28

Ethilon and Dermalon

Question 29

Coated multifilament nylon example:

Answer 29

Surgilon

Question 30

Uncoated polyester fiber example:

Answer 30

Mersilene and Dacron

Question 31

Coated polyester fiber example:

Answer 31

Ticron, Ethibond, Teflon, Polydek and Tevdek

Question 32

Polybutester example:

Answer 32

Novafil

Question 33

Polyethylene example:

Answer 33

Dermalene

Question 34

Polypropylene example:

Answer 34

Prolene and surgilene

Question 35

Three types of needle points:

Answer 35

Cutting point Taper point Blunt point

Question 36

Conventional cutting point:

Answer 36

Cutting edge on inside of curvature creating a small path that heals quickly Conventional points are used for ligaments, in the nasal/oral cavities and in pharynx, skin, tendon applications

Question 37

Reverse cutting point:

Answer 37

Curved needles with cutting edges on outer curvature Used for fascia, ligaments and in the nasal/oral cavities for oral mucosa, skin and tendon sheath

Question 38

Side cutting point:

Answer 38

Do not penetrate underlying tissues but rather split tissue layers Used for ophthalmic surgery

Question 39

Trocar point:

Answer 39

Used to penetrate tough tissues

Question 40

Taper point needles:

Answer 40

Smooth point with no cutting edges Pushes the tissue aside when passing through. Used for aponeurosis, biliary tract, dura, fascia, GI tract, muscle, myocardium, nerve, peritoneum, pleura, subcutaneous fat, vessels (Vascular anastomosis)

Question 41

Taper cut:

Answer 41

Cutting edges at the point only Used for bronchus, calcified tissue, fascia, ligament, nasal cavity, oral cavity, ovary, perichondrium, periosteum, pharynx, tendon, trachea, uterus, and vessels.

Question 42

Blunt point needle:

Answer 42

Rounded blunt tip and will not cut tissue making it the point of choice for use on organs bc it is less apt to puncture the vessels in organs used for dissection of FRIABLE tissue (kidney, liver, spleen, uterine cervix ligation)

Question 43

Suture material can be attached to eyeless or swaged needles in 4 ways:

Answer 43

Single (One needle is swaged to one end of the strand) Double (2 needles are swaged, one to each end of strand. do not have to be the same size and shape) Permanent (secured so the needle will not separate from the strand under normal use, has to be cut off) Control (does not release inadvertently, but will release when intentionally pulled "pop-offs!"

Question 44

Advantages of using surgical staples:

Answer 44

Rapid method to ligate, anastomose, and approximate tissues In-depth healing is accelerated with minimal trauma and a nonreactive nature Result produces an even surface and an airtight, leak-proof closure

Question 45

Skin staplers are used to

Answer 45

Approximate skin edges

Question 46

Linear staplers are used:

Answer 46

Throughout the alimentary tract and in thoracic procedures

Question 47

Intraluminal circular staplers are used for:

Answer 47

Intraluminal anastomosis of a tubular hollow organ, usually the GI tract

Question 48

Ligating and dividing staplers are used to:

Answer 48

ligate and divide mental vessels or soft tubular structures

Question 49

Skin clips are used to:

Answer 49

secure stockinet or towels to the skin

Question 50

Skin closure strips are used to:

Answer 50

approximate the edges of superficial lacerations or as a primary closure