Suturing

Why is the number of throws given in a knott a balance?

Need to both ensure knott is tight AND minismise the suture material left in the patient

What is a gambee knott?

Appositional pattern for gut mucosa

What type of knott is this?

Interrupted intradermal / subcuticular

What type of suture is this?

Ford interlocking

What type of suture is this?

Interrupted vertical mattress

What type of suture is this?

interrupted horizonal mattress

What is the name of an interrupted inverted stitch

Interrupted lambert

What type of contious inverting stitch is this?

Continous lembert

What type of stitch is this (continuos inverting)

Halstead

What type of stitch is this? (continuos inverted)

Cushing / Connell

What is the difference between a cushing / connel suture?

What three layers need closing in the abdmonial wall?

1. muscle

2. sub-cutaneous

3. skin

How should we close the muscle layer when closing the abdomen?

Usually simple continuous (or interrupted)

Knots facing out of abdomen (not buried)

How should we close the suncutaneous layer when closing the abdomen

Usually simple continuous

• need to eliminate the dead and bring skin edges together

Want knots to be facing downwards do they dont poke through the skin layer (buired knot)

How should we close the skin layer when closing the abdominal wall

Usually a cruciate mattress

• could be simple interrupte but requires more sutures

MUST BE LOOSE

• allow for sweling

• purely cosmetic

What equipment should be used for hollow organs

Hollow organs (intestine/uterus/bladder etc) require the use of atraumatic forceps and round bodied

needles.

What equipment should be used for dense tissue such as skin / tendons?

Forceps that can cause more tissue trauma e.g. Treves should only be used for dense tissue,

such as skin and fascia.