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suture
all materials used to bring severed body tissue together and to hold these tissues in there normal position until healing takes place
ligatures
a strand of suture material used to “tie off” blood vessels to prevent hemorrhage and simple bleeding or to isolate a mass of tissue to be excised
3 types of ligatures
free tie, ligature reel, and instrument tie(tie on a pass)
free tie
handed open handed
ligature reel
used for superficial bleeders, on a reel
instrument tie (tie on a pass)
deep bleeding vessels, loaded on an instrument
stick tie or suture ligature
ligature threaded on a needle and used through a “bite” of tissue as well as on the end of the vessel, eliminates possibility of it slipping off the end of the vessel, for deep vessels
tensile strength
amount of weight or pull necessary to break the suture of ligature material, based on knot pull strength (weaker at knot)
evolution of suture
16th century, boiling oil used to stop bleeding until ligatures were used when oil ran out, discovered it worked better
6 qualifications of suture material
sterile, absorbability, adequete tensile strength, uniform in strength size and absorbability, remain tied, must not act as a foreign body
factors that influence the choice of sutures
characteristics of suture, healing, type of procedure, condition of tissue, nature of disease, and surgeons preference
absorbable suture
suture material is digested by body cells and fluids during and after healing of tissue
nonabsorbable suture
stitches become encapsulated and may remain for years without any ill effect, silk and cotton always removed, typically stronger in strength
5 factors that influence absorption time
infection, type of tissue, nutrition, diseased condition, allergy
does absorption take place quicker or slower in presence of infection?
quicker
does suture absorb fast in undernourished or nourished people?
undernourished
can chromic suture be used in the presence of infection?
yes
in which tissues/organs should silk not be used in and why?
kidney, bladder or gallbladder, may for the nucleus for a stone
disadvantages for surgical gut (2)
more tissue reaction and condition of patient affect absorption time
6 types of polyester?
mersilene, tevdek, polydek, darcon, ethiflex, ethibond
2 types of barbed suture?
stratafix and V-loc
advantages for silk
high tensile strength, knot remains firm without slipping, using halstead technique of many interrupted sutures gives firm support to the wound
disadvantages of silk
not used with infection, not used in certain tissues, causes discomfort when used for stay sutures(because tissue grows into the thread fibers)
what are 2 metals wire sutures are made out of?
stainless steel and copper (for fracture of the mandible or ostomy because it is flexible)
advantages for wire suture
inert in tissue, great strength, inexpensive can be used in presence of infection
disadvantages in wire sutures
harder to handle, kinks easily, makes bulky knots, needs wire scissors to cut
factors of ethilon & dermalon
stronger than silk, knots come untied, not recommended for infection
factors of polyester
minimal tissue retraction
mersilene used for
cardiovascular and plastic surgery, can be impregnated with teflon so it has a smooth passage through tissue
what is teflon used for
general, cardiovascular, and plastic surgery
polypropylene factors
used in cardiovascular, general, and plastic, used in the presence of infection
factors of bone wax
used in orthopedic surgery, hemostatic agent, requires warming and molding, and made from beeswax
TA 90 stapler
used to separate the omentum, jaws are slipped around omentum, pin is screwed into place, jaws are tightened, and staples fired
where are purse strings commonly used
around the appendix
where are retention stitches placed?
under all 4 layers of the abdominal
in which order is the abdominal opened?
skin, sub q, muscle/fascia, periteneum
in which order is the abdominal closed?
peritoneum, sub q, fascia, and skin
primary suture line
line of sutures that approximates the edges of the incision
secondary suture line
formed by the retention sutures, supports the primary suture line
what are 0 and 1 gauge suture used for?
ortho or abdominal closure
0-3 or 0-4 suture gauge used for
sub q
what are 4-0 and 5-0 suture gauge used for
aortic anastomosis
what are 8-0 through 11-0 gauge suture used for
micro or eye procedures (8-0)
who was pare’ ?
pioneer in surgical techniques and battlefield medicine, invented new surgical instruments and dressings, particularly with gunshot wounds
what is so special about wire scissors?
designed to cut through tough products while not harming other tissue, also has a notch in scissors to hold the wire secesrly while shearing
