POUL 3000 Wound Closure and Suturing Techniques

what are the two types of wounds

open and closed

what is an open wound

exposed underlying tissue/organs open to the outside environment

what is a closed wound

occur without any exposure of the underlying tissue and organs

what are three types of ways to close surgical wounds

staples, adhesives, sutures

what are materials can staples be

stainless steel or titanium

what kinds of pros of using staples

• you can use them on external wounds that are hard to suture and require rapid closure (i.e. the skull)

• less inflammation

• easy to remove

what kind of material are used for adhesives

super glue and steri srips

what are pros of high-quality stainless steel needles

slim, strong, stable, sharp, flexible but rigid, sterile, corrosion-resistant

what are 3 parts of a surgical needle

• attachment end

• body (shaft)

• pointed end

a bigger # means a smaller needle: true or false

true

what are the two types of attachment ends

swaged and eyed

swaged

eyeless, permanently attached to set length of suture material

eyed

closed opening through which suture material is looped, reusable if sterilized

what kind of attachment end causes less tissue damage

swaged

what are three parts of a surgical needle’s body

• curvature

• diameter

• shape

• point

where do you use straight and half-curved needles

surface and exposed surfaces

where do you use curved surgical spaces

confined spaces

what are the two types of shapes of a needle

round body and triangular body

what is a round body used for

pierce and spread tissue with minimal cutting/easily penetrated tissues

what is a triangular body used for

cutting needles with 3 sharp edges/tough tissues

what does conventional mean

cutting edge on concave surface (larger hole)

what does reverse mean

cutting edge on convex surface (smaller hole)

what are the 5 characteristics of suture material

• tensile strength

• memory

• elasticity

• knot strength

• reactivity

what is tensile strength

the weight required to break suture

what is tensile strength related to

suture size

should you use a smaller or larger suture size

use the smallest size that will hold wound to minimize tissue damage

what is the relationship between suture diameter and tensile strength

the thinner the diameter the lower the tensile strength

what is memory

the ability to return to previous shape after deformed

what is memory related to

filament type

what does increased memory mean

harder to handle

what are the two filament types

monofilament and multifilament

monofilament pros

it is a single strand of suture material that minimizes tissue trauma and causes less scaring

monofilament con

it is harder to handle since it has good memory

what is multifilament

multiple fibers are braided together and often coated with silicon or wax

multifilament cons

more tissue resistance = more trauma = more scarring

bacteria can be harbored between strands and suture has wicking power to transfer bacteria into wound

multifilament pros

easier to handle because it has decreased memory

what is elasticity

ability to stretch and return to original length

what is elasticity related to

memory

what is knot strength

force required for a knot to slip

what is knot strength related to

memory

what is reactivity

amount of inflammatory response induced

what are two kinds of suture material

natural (biological material) and synthetic (polymers)

what are kind of natural sutures

catgut and chromic catgut (made from livestock intestine and collagen), silk, cotton

which suture material causes an inflammatory response

natural

what are kinds of synthetic polymers

vicryl, monocryl, nylon, etc.

what are cons of absorbable suture material

• biodegrades through inflammatory response (more scarring)

• days to weeks

when are absorbable sutures used

internal or when a patient can’t return for removal

what are non-absorbable sutures used for

skin wound closures or in cases where long-term support is needed

what are pros of non-absorbable material

non-biodegradable (less scarring) and permanent wound support

memory and elasticity have a ___ relationship

direct

know strength and memory have a ____ relationship

inverse

size and tensile strength have ____ relationship

direct

what is the needle driver grip

place a thumb and ring finger into rings

extend index finger and rest of it on the shaft of the driver, proximal to the hinge

how do you hold forceps

place thumb and index finger on either side, stabilize thumb side with middle finger

what should you never hold with your fingers

needles and tissues

what degree does the needle enter the wound at

90º

what does it mean to throw

wrap around an object

what does bite mean

distance between wound and where needle enters tissue

simple interrupted

• simple, uncomplicated

• easy to learn and perform

• maintains integrity if one breaks

• slow - lots of knots

simple continuous (running)

• slightly more difficult

• easy to learn and perform

• unravels if one breaks

• fast - fewer knots

what wounds use external wounds

simple interrupted

what wounds use simple continuous

internal wounds