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Chapter 7 / Sutures and Stitches 55 |
What is silk? |
Braided protein filaments spun by the |
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silkworm larva; known as a nonabsorb- |
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able suture |
What is Prolene? |
Nonabsorbable suture (used for vascular |
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anastomoses, hernias, abdominal fascial |
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closure) |
What is nylon? |
Nonabsorbable “fishing line” |
What is monocryl? |
Absorbable monofilament |
What kind of suture should |
ABSORBABLE—otherwise the suture |
be used for the biliary tract |
will end up as a nidus for stone formation! |
or the urinary tract? |
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WOUND CLOSURE |
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GENERAL INFORMATION |
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What is the purpose of a |
To approximate divided tissues to |
suture closure? |
enhance wound healing |
What are the three types of |
1. Primary closure (intention) |
wound healing? |
2. Secondary intention |
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3. Tertiary intention (Delayed Primary |
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Closure DPC) |
What is primary intention? |
When the edges of a clean wound are |
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closed in some manner immediately |
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(e.g., suture, Steri-Strips®, staples) |
What is secondary intention? |
When a wound is allowed to remain open |
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and heal by granulation, epithelization, |
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and contraction—used for dirty wounds, |
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otherwise an abscess can form |
What is tertiary intention? |
When a wound is allowed to remain open |
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for a time and then closed, allowing for |
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débridement and other wound care to |
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reduce bacterial counts prior to closure |
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(i.e., delayed primary closure) |
What is another term for |
DPC Delayed Primary Closure |
tertiary intention? |
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56 Section I / Overview and Background Surgical Information
Classic time to wait before |
5 days |
closing an open abdominal |
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wound by DPC? |
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What rule is constantly told to medical students about wound closure?
SUTURE TECHNIQUES
“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
What is a taper-point |
Round body, leaves a round hole in tissue |
needle? |
(spreads without cutting tissue) |
What is it used for?
Suturing of soft tissues other than skin (e.g., GI tract, muscle, nerve, peritoneum, fascia)
What is a conventional |
Triangular body with the sharp edge |
cutting needle? |
toward the inner circumference; leaves a |
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triangular hole in tissue |
What are its uses? |
Suturing of skin |
What is a simple interrupted stitch?
What is a vertical mattress stitch?
What is the vertical mattress stitch also known as?
What is it used for?
What is a horizontal mattress stitch?
What is a simple running (continuous) stitch?
Chapter 7 / Sutures and Stitches 57
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
Far-far, near-near stitch—oriented perpendicular to wound
Difficult-to-approximate skin edges; everts tissue well
Simple stitch is made, the needle is reversed, and the same size bite is taken again—oriented parallel to wound
Stitches made in succession without knotting each stitch
58 Section I / Overview and Background Surgical Information
What is a subcuticular |
Stitch (usually running) placed just |
stitch? |
underneath the epidermis, can be either |
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absorbable or nonabsorbable (pull-out |
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stitch if nonabsorbable) |
What is a pursestring |
Stitch that encircles a tube perforating a |
suture? |
hollow viscus (e.g., gastrostomy tube), |
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allowing the hole to be drawn tight and |
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thus preventing leakage |
What are metallic skin staples?
Chapter 7 / Sutures and Stitches 59
What is a staple removal device?
What is a gastrointestinal Stapling device that lays two rows of anastomosis (GIA) device? small staples in a hemostatic row and automatically cuts in between them
60 Section I / Overview and Background Surgical Information
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
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
What is a pop-off suture?
Suture that is not permanently swaged to the needle, allowing the surgeon to “pop off” the needle from the suture without cutting the suture