Chapter 11
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| 1st century | Celsus and Glaenus ligated vessels
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| 19th century | Sterile technique. Pasteur: Organisms outside the body caused disease. insturments should be boiled and passed through flame. Lister:Infection was a result of "Disease dust". Soaked suture in carbolized oil
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| 20th Century | Suture made of catgut, silk, kangaroo. Fist synthetic suture polyglycolic acid
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| Tensile strength | Maximum amount of weight it can endure before breaking
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| Absorbable suture | Capable of being absorbed by the tissue. Should absorb by the time the tissue has healed. Avoid tissue reaction
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| Nonabsorbable suture | resists enzymatic digestion or absorption by tissue
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| Monofilament suture | single thread structure, do not harbor bacteria, more difficult to hold knot, ideal suture type if infection present
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| Multifilament suture | Multiple threads braided or twisted. capillarity, able to harbor bacteria. avoid use when there is infection. great tensile strength. easy passage through tissue. easy handling. secure knots
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| Capillarity | Capability to harbor bacteria and tissue fluids
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| Tie on pass | Adson tonsil with suture at tip
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| Name a chemical, electrical and mechanical way to obtain hemostasis | Chemical: Avitene Electrical:Bovie Mechanical:Suture
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| Natural suture | cellulose, animal product, animal tissue.Natural absorbable:digested by body enzymes that attack the suture strand
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| Synthetic suture | polymers from petroleum based products. Synthetic absorbable is hydrolyzed by the body. Water in tissue breaks down synthetic fibers. Minimal tissue reaction
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| The united states pharmacopeia USP and Brown and Sharp B and S | USP specifies diameter (gauge) for suture. B and S specifies commercial wire gauge numbers largest is 7
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| Where is absorbable suture used | Areas that do not need continuous support. Subcutaneous tissue and mucosal layer of the intestine
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| Where is nonabsorbable suture used | where there is need for continuous support. Closed abnormal openings in the heart, dura of the brain, dura over spinal cord, fascia and skin
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| What are common monofilament absorbable sutures | Plain gut, chromic gut, PDS and monocryl
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| What are common monofilament nonabsorbable suture | Prolene, surgilene (used on heart with cooleys), Nylon, stainless steel
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| What are common Multifilament absorbable suture | Vicryl and dexon
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| What are common multifilament nonabsorbable suture | silk, surgical cotton, braided nylon, mersilene, ethibond (strong used for ortho)
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| Ligatures | Ties to occlude vessels. Precut lengths (18, 24, 30in). or comes in suture reels. Cut suture shorter than 1/4in if multifilament and cut at 1/4 in for monofilament
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| Free tie | No needle or needle holder. Place suture in surgeons hand. Monofilament leave 1/4 in tail and multifilament leave 1/8in tail
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| Suture ligature | Stick tie:Sutures with a swaged atraumatic needle loaded onto a needle holder. Large vessel occlusion to prevent suture slippage.
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| Reel tie | Occlude superficial bleeders. Radiopaque and include in count
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| Instrument tie | Tie on a pass: suture is loaded onto an instruement crile, schnidt, adson
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| List the from first to last the layers of closure | 1. Peritoneum 2. Fascia 3. Muscle 4. Subcutaneous 5. Subcuticular 6. skin
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| Primary suture line | Sutures that approximate wound edges for first intention healing. Ex pursestring, subcuticular
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| Second suture line | ease tension on the primary. Retention sutures placed lateral to primary sutures
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| Linear staples | Two parallel rows of staples
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| Ligating cutters | Two ligating clips side by side then divides the tissue between the clips
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| Cutting needle | 3 cutting edges
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| Taper points | round shaft without a cutting edge
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| blunt needle | round shaft that ends in a blunt tip
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| Shaft | Between the suture stand and the point. Length is determined by the depth of the bite or the tissue to be sutured
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| Point | Determines the shape of the body. body shapes are round, triangular or flattened. Tapered and blunt needles have round bodies. Cutting needles have triangular bodies
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| Body | stright or most common is 1/2 circle body. Microsurgical needles are retention suture needles usually 3/8 circle
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| CDC classifies wounds in what three categories | Clean. Clean contaminated. Contaminated. dirty infected
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| Inflammation | Injured tissues release histamine. bodies protective response to injury
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| First intention wound healing | Primary closure. Phase 1 lag phase- inflammatory response. Phase 2 proliferation. Phase 3 maturation-cicatrix forms
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| Second intention wound healing | granulation-proud fesh-excessive granulation of tissue may form
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| Third intention of wound healing | delayed primary closure-contaminated or dirty wounds
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| What are the three main factors that influence wound healing | 1 Physical condition 2. Intraoperative tissue handling 3. application of principles of asepsis and sterile technique
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| Dehiscence | Partial or total separation of tissue after closure
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| Friable | Easily torn
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| Evisceration | Protrusion of the viscera through the edges of a separated wound. Emergency
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| Fistula | Abnormal tract between two epithelium lined surfaces that is open at both ends
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| Sinus tract | abnormal tract between two epithelium lined surfaces that is open at one end only
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| Keloid scar | Hypertrophic scar formation
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| Why does the surgeon try to use the smallest suture for wound closure | 1. Minimal tissue trauma 2. minimal foreign material in body
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| What is 1 and 0 suture most used on | Ortho wounds and abdominal fascia
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| what is 4-0 and 5-0 suture used on | aortic anastamosis
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| What is 6-0 and 7-0 suture used on | smaller anastamosis or coronary or carotid arteries
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| 8-0 throught 11-0 suture used on | microvascular and eye procedures
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| 4-0 suture is used on | dural closure
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| 3-0 and 4-0 suture is used on | subcuticular skin
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| What are factors for choosing suture | 1. type of procedure 2. condition of tissue 3. disease processes 4. surgeon preference 5. suture cost 6. availablility of suture
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| What are disease processes that affect suture closure | DM. immune system diseases, pituitary gland dysfunction, localized infection, systemic infections
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| Pliability | How easily suture passes through tissue. How easily suture ties knots and knot security
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| What is the most important information on a suture box | suture size, material, size of needle
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| What are surgical needles made of and what is the needle eye? | Made of steel. Needle eye is where the suture is attached
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| Closed eye needle | Round or square holes have to lead suture through. Causes more tissue damage
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| French eye needle | Pull the taut strand into a V shape. Load quicker than closed eye. More tissue damages than eyeless
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| Eyeless or swaged needle | Suture inserted into one end of the needle. Single arm attachment or double arm. Permanently attached suture or control release
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| Conventional cutting needle and reverse cutting needle | Conventional: 3 cutting edges that extend the length of the shaft Reverse: Opposing cutting edges along the shaft
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| Side cutting needle and tapered point needle | side: opthalamic procedures aka spatula tapered: Round shaft without cutting edges, doesn't cut tissue, used on delicate tissue
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| Blunt point and ground point wire needles | Blunt: round shaft with blunt tip ground: point with sharp edges and round body
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| What size circle are microsurgical needles | 3/8 circle
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| Hypodermic needle | Inject medications, withdraw medications into a syringe, draw fluids from tissue. Gauge 12-30. smaller the needle the larger the number
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| Arterial or venous/cannula needle | employ a needle to introduce a plastic indwelling catheter into a vessel, used to obtain arterial blood gas
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| Arterial needles | Ex Potts-Cournand, introduc diagnostic or angioplasty guiding catheters into arterial system
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| Irrigation needles | small ccannulated tube, straight or angled, disposable and non disposable, different lengths
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| Biopsy needles | Obtain tissue samples from inside the body. Ex dorsey needle, chiba biopsy needle, franklin silverman and trucut biopsy needle
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| Continuous or running suture | evenly distributed tension. Simple continuous:Long straight edges that easily evert. Continuous running/locking, blanket stitch: suture is locked prior to next throw, reduce skin tension and increase wound edge eversion
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| Interrupted suture | for Tissue under tension (Halsted method). Interrupted horizontal mattress: 2 bite placed parallel. Interrupted vertical mattress: 2 bite 1st place close to wound edge 2nd placed slightly behind first
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| Endoscopic suturing: Extracorpeal and Intracorporeal | Extracorporeal: Creating the knot outside the body. Intracorporeal: Internal suturing and tying knot inside the body ex endoloop
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| Wound Zipper | Noninvasie, atraumatic device for skin closure. Eliminates needle holes and sharps injury, faster than suturing
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| Cyanoacrylate | Synthetic adhesive for skin closure. ex Dermabond and indermil. Chemical liquid glue, dries in 2 minutes. Flexible, wears off in 7-10days. Can't use if infection is present
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| Fibrin Glue | Biologic adhesive and hemostat agent. Mix calcium chloride and thrombin. Drawn in two separate syringes and applied at the same time
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| Bridges | Plastic device that bridge and close the incision. tension can be adjusted
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| Bolsters | Plastic or rubber tubing on retention suture to prevent retention suture from cutting the skin
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| Button holes | Tendon suture
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| Split lead shots | Clipped on ends of subcuticular sutures after skin closure
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| Umbilical tape | retraction and isolation during surgery
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| Vessel loops | Isolation and retraction, elasticity. White/yellow=Nerves or ducts. Red=Arteries. Blue=veins
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| Suture Anchors | Used in ortho for fixing tendons and ligaments to bone
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| What are the benefits and disadvantages of stapling | Advantage: Less tissue reaction, accelerated wound healing, less operating time, efficiency. Disadvantages: Increased cost, must be preciseley placed
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| Fascia and skin stapler | Approximate skin edges, single staple per action, close abdominal fascia
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| Linear staples and linear cutter | 2 straight, staggered, evenly spaces, parallel rows of staples used for transection ex TA. Cutter: Staples and cuts tissue ex GIA
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| Ligating clips and linear dissecting stapler | occlude small structures. Dissecting stapler: 2 ligating clips side by side and then divides the tissue between the clips
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| Intraluminal stapler | Circular, anastomosis of tubular structures Ex EEA
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| Synthetic meshes | Pliable, easy to cut, easy to suture, porus
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| Biological materials | Fascia Lata, Muscle of cattle or muscle from patients thigh. Ingrowth mesh: Sugisis, porcine small intestine
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