CPSS E1- Suturing & Lac Repair

What sutures are non-absorbable?

Ethilon & Nurolon (Nylon)

Mersilene & Ethibond (Polyester)

Prolene (Polypropylene)

Silk

What sutures are absorbable?

Vicryl (Polyglactin), Monocryl (Poliglecaprone)

PDS II (polydioxanone)

Panacryl (duel copolymer)

Plain gut, chromic gut, fast absorbing gut

Which type of suture is less reactive: organic or synthetic?

Synthetic

Most reactive → least reactive absorbable sutures:

Fast gut

Plain gut

Chromic gut

Vicryl rapide

Vicryl

Monocryl

Panacryl

PDS II

Most reactive → least reactive non-absorbable sutures:

Silk

Pronova

Mersilene & Ethibond

Ethilon & Nurolon

Prolene

How are sutures sized?

inc 0 = dec diameter (more 0s = smaller)

When choosing suture material, what should you remember about the suture tensile strength?

Suture tensile strength should NOT exceed tissue tensile strength

What is phase 1 of wound healing (days 0-7)?

Inflammatory phase -hemostasis, chemotaxis, and inc vascular permeability

What is phase 2 of wound healing (days 7-21)?

Proliferative phase -formation of granulation tissue, re-epithelialization, and neovascularization

What is phase 3 of wound healing (day 21+)?

Maturation & Remodeling phase -further connective tissue remodeling

What is the MC absorbable suture used in surgery?

Coated vicryl (Polyglactin)

When will a coated vicryl suture reach ~50% tensile strength?

3 weeks

What is the fastest absorbing synthetic suture?

*ONLY used in superficial skin & mucosa that will heal quickly (7 days)

Coated vicryl rapide

What is the least reactive absorbable suture?

*used for SQ sutures in areas of stress (over joint surfaces- knees, elbows)

PDS II

When do PDS II sutures lose the majority of their strength?

6 weeks

Which non-absorbable synthetic suture is monofilament and widely used d/t its low tissue reactivity & high tensile strength?

Ethilon (Nylon)

What is the thickest portion of the needle where the suture material is attached?

eye or swag

What is the most common needle shape for skin?

3/8 circle

What is the exception to everting skin edges during suturing?

children

Know the different types of sutures (simple interrupted, running, etc)

:)

What is undermining?

technique of creating a plane of release beneath the skin edge of an open wound, serves to release some of tension in field of wound closure & allows skin edges to be handled with greater ease

When are skin staples particularly useful?

closing scalp wounds

What must be applied first in order for a steri-strip to stick?

Benzoin

What is primary closure?

immediate repair of the wound at any time up to 12-18 hours from the time of injury

What is secondary closure?

allowing a wound to close on its own (granulation)

What is delayed primary closure?

waiting to close the wound after ~48 hours to observe for an infection

What type of wounds is primary closure for?

deep wounds

What type of wounds is secondary closure for?

contaminated wounds, abscesses, or non-cosmetic animal bites

What type of wounds is delayed primary closure for?

animal/human bites with complex tissue damage & wounds that are >24 hrs old in older patients, DM, impaired nutrition, obese, smokers, or chronic steroid users

When can sutures on the eyelids be removed?

3-5 days

When can sutures on the face be removed?

5 days

When can sutures on the scalp be removed?

7-10 days

When can sutures on the trunk & UE be removed?

7-12 days

When can sutures on the LE be removed?

10-21 days

When can sutures on the palms, soles, or digits be removed?

10-14 days

How far apart should most sutures (except for face) be placed?

5-10mm apart & 3-4 mm from edge of wound

How far apart should sutures on the face be placed?

3-5mm apart & 2-3 mm from edge of wound

How long of a tail should you leave on simple interrupted sutures?

5-10mm

What should you align a surgical incision with?

Langer lines

What should be used for a laceration repair (3 G’s)?

goggles, gown, and sterile gloves

If patient is allergic to lidocaine, what kind of anesthetic can you use?

Ester type- Novacaine

If patient is allergic to ester-type anesthetics such as Novacaine, what kind of anesthetic can you use?

Lidocaine

Where should lidocaine with epi be AVOIDED?

face, mucous membranes, distal digits, nose, penis, ears

What type of topical anesthetic can be used in infants >5kg and must be covered with an occlusive dressing for 30-60 mins?

EMLA (Lido + Procaine)

What is the max dose of lidocaine?

4 mg/kg not to exceed 300mg

*w/ epi: 7 mg/kg

Which local anesthetic has the longest duration of action?

Bupivacaine

Which local anesthetic has a slower onset of action, but greater duration than lidocaine making it good for nerve blocks?

Mepivacaine

Which local anesthetic is an alternative agent for patients allergic to traditional anesthetics?

Diphenhydramine (benadryl)

What should you ALWAYS do when injecting?

aspirate to ensure you're not in a vessel