Wounds And Closure Flashcards
(38 cards)
What does suture material choice depend on?
- Surgeon’s preference
- Type and specialty of surgery
- Depends on location
- Absorbable vs. non-absorbable
- Multifilament vs monofilament
What are the general characteristics of suture size?
- Reflexes diameter
- use the smallest size possible that still securely holds the mending wounded tissue
- This minimizes trauma as the needle passes through
How is suture sized?
- Numerically
A. numbers alone indicate a larger suture size - Number of zeros indicates progressively smaller diameter
What is knot tensile strength?
Measured by force, in lbs, which the suture strand can withstand before it breaks when knotted
What predetermines the tensile strength needed by the suture?
The tensile strength of the tissue to be mended (its ability to withstand stress) predetermines the size and tensile strength of the suture needed
What are the characteristics of monofilament suture?
- Single strand of material
- Resists harboring bacteria
- Easily tie down
- Crushing or crimping of material can create a weak spot, which may result in suture breakage
What are the characteristics of multifilament suture?
- Two or more strands twisted or braided together
- Greater tensile strength, flexibility, and pliability
- May be coated, which helps it pass through tissue, especially intestine
What are absorbable sutures?
Holds wound edges together in approximation temporarily until they have healed enough to withstand stress
What are examples of absorbable sutures?
- Prepared by collage of healthy animals or prepared synthetic material
A. Surgical gut suture: plain, chromic or fast absorbing
B. Raw material is sheep intestine submucosa or beef intestine serosa - Polyglactin 910 (vicyrl), coated or uncoated
A. Copolymer of glycolide or lactide with polyglactin 370 and Ca stearate if coated
How are absorbable suture absorbed?
- Natural sutures are broken down by the body enzymes which attack and digest the suture strand
- Synthetic sutures are hydrolyzed: process by which water gradually enters the suture filaments causing a breakdown of the polymer’s strands
How many stages are present in the absorption process?
- 2 stages
- Both stages cause leukocytic cellular responses, which serve to remove the cellular debris and suture material from the line of tissue approximation
Define non-absorbable suture
Not digestable by the body or unable to be hydrolyzed
When are non absorbable sutures used?
- Exterior closure of a wound where sutures can be easily removed after sufficient healing
- Body cavity: will remain permanently embedded in the tissue
A. Indicated when there is a hx of pt rxn to absorbable sutures, keloidal tendency, or possible tissue hypertrophy - Temporary prosthesis attachment (defibrillators, pacemakers, drug delivery system)
What are the non-absorbable suture material?
- Metal
- Synthetic
- Organic materials
True/false: any type of suture material can be mono/multifilament, coated or uncoated, dyed or undyed
True
True/false: sutures can expire
True
What are the indications for wound closure?
- Most superficial wounds can heal without intervention
2. Superficial wounds extending into the subcutaneous tissue should be closed in order to avoid complications
What materials are used to close wounds?
Sutures, staples, surgi strips
What are the contraindications for wound closure?
- Wounds greater than 8 hrs post injury
A. Some ares can be closed up to 24 hrs after injury (face, neck scalp) - FB in underlying tissue
- extensive wounds involving tendons, nerves, or arteries need a specialist consult
- Wounds that have a high likelihood of infection or that are likely already contaminated are not sutured initially
What are the potential complications from wound closure?
- Infection
2, Scarring, keloid formation - Loss of function and structure
- Loss of cosmetically desirable appearance
- Wound dehiscence
- Tetanus
A. Always check pt status
B. Tetanus-prone wound: Tdap and TD greater than 5 yrs, give pt tD shot that day
C. Non-tetanus prone wound in a pt 19-64 with a Tdap or Td greater than 10 yr, give a TD shot that day
D. Tetanus-prone wound in an adult with inadequate immunization passive and active immunity (TIG) and Tdap
What is a clean wound?
Surgical incisions
What is a clean contaminated wound?
- Surgical procedures where GI, resp, or GU systems are involved
- Most skin lacerations are in this category
What is a contaminated wound?
- Gross spillage (bile, stool) or traumatic wound
What is an infected wound?
- Established infection before wound is made (I and D abscess) or heavily contaminated wound (stool)
