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Surgery I - Suture

& Knots

What is the first and most important principle of wound care? Copious irrigation and adequate debridement The solution to pollution is dilution!
To minimize scars, wound closures should run parallel to which connective tissue bundles? Langer's lines
When should wound closure be delayed? If the wound is contaminated or if the time elapsed from injury exceeds 8 hours
Which wound types should never be closed? Puncture wounds, human bites, or grossly infected wounds
What type of forceps should be used: 1. On the skin 2. On delicate internal tissue 1. Adson or 3-4s (teeth) - Addison on ga has nice teeth 2. Debakey (smooth) - Debbie does dallas has a smooth ass
What is the general rule for skin closure regarding wound edges? ** Approximate, do not strangulate
How long should sutures be left in: ***** 1. on the face and neck? 2. trunk? 3. UE's? 4. LE's? 1. 3-5 days 2. 7-10 days 3. 10-12 days 4. 12-16 days
In which patient populations should sutures be kept in longer than usual? IN those who are immunosuppressed, on steroids, or who have poor nutrition, including those with diabetes and peripheral vascular disease
How should hair be removed in preparation for surgery or wound repair Using clippers Note: Never shave eyebrows
Where should epinephrine never be used and why? On tissues with poor collateral circulation such as the nose, fingers, or ears as it may cause ischemia
Name two basic kinds of suture Braided and monofilament
What is an advantage of a monofilament suture? Causes less trauma and inflammation as it passes through tissue
What is an advantage of braided suture? Has less tendency to kink or curl and requires fewer knots to be held into place
List four types of absorbable sutures Plain gut, chromic gut, Dexon and Vicryl
What is the source of plain and chromic gut? Bovine small intestine
Which has more tensile strength, plain or chromic? Chromic (14-21 days) Plain (7-14 days)
How long is tensile strength retained in Dexon and Vicryl? 14-21 days
Name the most common nonabsorbable sutures silk, nylon, polypropylene, steel
Which suture type is the most widely used and why? Silk - easy to manipulate and strong (braided)
What is an advantage to using braided synthetic over silk? Synthetics are less reactive than silk
What is an advantage of using steel suture? It retains its strength and can be twisted down to any desired degree of tension
Which body part is the only one in which steel suture is still used? Chest - closing sternotomy wounds
What size suture would you use in the following areas? 1. Chest 2. Abdomen 3. Skin 4. Blood vessels 5. Eye surgery Largest is No. 7 smallest is 11-0 1. No. 6 2. No. 1 3. 3-0 4. 5-0 thru 7-0 5. 8-0 thru 10-0
What is the name for the site of suture attachment on a surgical needle? Swage
List the four characteristics used to describe suture needles Eye, shape, point and size
Which needle point is used in the following areas? 1. skin 2. soft tissue and fascia 3. prosthetic grafts 4. liver 1. conventional cutting 2. taper 3. ground point wire 4. blunt
How far from the wound edge should an interrupted stitch be placed? 4-5 mm
Which is the dominant knot used in surgery? Square knot
What is the surgeon's knot? A square knot with a double first throw
What must be done differently when using a nylon suture as compared to a silk suture? Additional throws are necessary to secure the knot when using nylon sutures
What is the most useful and most commonly used suture closure? Simple interrupted
Which type of skin closure has the best cosmetic result? Subcuticular closure
Should wound edges be inverted or everted? Wound-edge eversion is paramount to achieving a cosmetically acceptable scar
Created by: eedavila
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