Suturing 1

What are the features of absorbable suture material?

can be broken down by the body after a period of time

commonly used for internal wounds

synthetic is broken down by hydrolysis and organic is broken down by proteolysis

What are the problems with organic suture material?

highly variable tensile strength

uncomfortable for patient when it breaks down

difficult to work with

What are the features of non-absorbable suture material?

does not break down

must be removed once the wound has healed

commonly used for closure of external wounds

What are the features of monofilament suture material?

causes less tissue drag

has high memory

more difficult to work with

What are the features of polyfilament suture material?

wicking effect - but potential to harbour bacteria

low memory

easier to work with

What size suture material should you select?

the smallest size possible as it is a foreign object to the patient

How should you select the tensile strength suture material needed?

should be at least as strong as the tissue it is intended to hold

How does the metric gauge measure the size of suture material?

the number is the diameter of the material (mm) x0.1

How does the USP gauge measure the size of suture material?

the smaller the number the larger the diameter

What are the 3 main needle shapes?

curved

straight

J-shaped

How are curved needles categorised?

the fraction of a circle that they make up

What are the advantages of using threaded needles to suture?

much cheaper

suture material can be cut to the required length

What are the disadvantages of using threaded needles to suture?

needle eye increases the diameter of the needle which causes more tissue trauma

easy to de-thread the needle so be careful

assistant will be required to cut the suture material

What are the advantages of using swaged needles to suture?

less tissue trauma caused

faster to use

What are the disadvantages of using swaged needles to suture?

more expensive

wastes more suture material

What are the 2 different needle point types?

cutting and round-bodied

What are the features of a cutting needle?

cutting edge on the inside of the curve as well as sharp point

used for tough tissue as these cut the tissue rather than dilating it

What are the features of a round-bodied needle?

sharp point but no cutting edge

used on softer tissue as they dilate the tissue as they pass through

How are suture patterns classified?

according to placement and effect on tissue edges

What are the 2 main types of suture pattern according to placement?

interrupted and continuous

What are the pros and cons of interrupted suture patterns?

if one suture breaks the other will still hold

but takes more time and more suture material is left in the body

What are the pros and cons of interrupted suture patterns?

much quicker, less suture material is left in the body, tension is evened out across the wound

if it breaks the whole suture will unravel

What are the 4 types of suture pattern according to effect on tissue edges?

appositional

tension-relieving

inverting

everting

What is an appositional suture pattern?

a pattern that apposes the tissue edges

What is a tension-relieving suture pattern?

a pattern that apposes the tissue edges with tension relief so good for skin

What is an inverting suture pattern?

inverts tissue edges to provide a more water-tight seal, commonly used for internal hollow organs

What is an everting suture pattern?

tissue edges evert (push upwards) due to placing tension-relieving sutures too tight

What are the 2 main types of surgical knot?

square and surgeon’s

What is an advantage of a square knot?

each throw will further tighten the throw below, so good for ligating blood vessels e.g.

What is an advantage of a surgeon’s knot?

double throw increases tension retention therefore less likely to loosen before locking square knot has been placed

How many knots should you tie when suturing?

3-5

How do you decide how many knots to tie when suturing?

ensure the knot is secure whilst also minimising the amount of suture material left in the patient

At which point on the needle should you attach a needle holder?

½ to 2/3 away from the point

Does this image show the correct method of removing suture from a roll?

Yes

Does this image show the correct method of removing suture from a roll?

No

What suture pattern is shown here?

simple interrupted (appositional)

What suture pattern is shown here?

cruciate mattress (tension-relieving)

What suture pattern is shown here?

simple continuous (appositional)

What are some common errors in knot-tying?

placing instruments outside of the strands instead of between

not placing instruments between the strands from the same side

What are some common errors in suturing?

placing overly tight sutures

unequal bites

sloppy suture placement

poor instrument handling

grabbing the suture material with needle holders - this weakens it

What is caused by too tight sutures?

restricted blood flow delays healing

skin will double in thickness due to inflammation which might cause the patient to rip them out

What is caused by unequal bites/ sloppy suture placement?

decreased healing

tissue can pull through if sutures are too close to the tissue edge

tension is not evened out in a continuous pattern