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Flashcards in Suture patterns Deck (41)
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1
Q

rules for wound closure

A

Close tissue in the same number of layers as incised Appositional pattern unless good reason not to Choose the simplest pattern Avoid closure under tension Careful suturing more important than pattern choice

2
Q

Classification of patterns

A

Simple vs mattress Interrupted vs continuous Appositional vs inverting vs everting Partial vs full-thickness 1-layer vs 2-layer

3
Q

simple vs mattress

A

simple - on surface suture material runs across the wound mattres - on surface suture material is along side the wound

4
Q

Interrupted vs Continuous - Interrupted

A

• If 1 knot fails, all line won’t fail • More accurate approximation • Adjust tension at each suture

5
Q

Interrupted vs Continuous - Continuous

A

Quicker Less suture material in wound More even distribution of tension More air-tight & water-tight Cheaper - economical use

6
Q

appositional closure

A

Easy to perform Accurate alignment of wall layers Quicker regeneration of mucosa Less inflammation & fibrous scar tissue

7
Q

inverting closure

A

Greater bursting strength (24h) Similar tensile strength Reduced risk of adhesions Necrosis of tissue cuff Luminal compromise possible

8
Q

everting closure

A

Ease of placement Increased tensile strength Endothelial contact reduces thrombosis Prolonged inflammation & vascular compromise Increased incidence of adhesions Increased risk of stenosis + leakage

9
Q

Partial thickness pros

A

Not exposed to luminal contents Reduces wicking from lumen

10
Q

Full thickness pros

A

Better apposition Suture holding layer engaged

11
Q

simple interrupted - features

A

Secure anatomical closure Precise adjustment of tension possible Easily applied (Inversion if tight)

12
Q

simple interrupted - examples of when to use

A

Skin, GI tract, fascia

13
Q

Approximating sutures

A

Simple interrupted - Layer apposition good Poth & Gold crushing - buried suture, More tissue necrosis, Poorer apposition of layers (modified) Gambee (1951) - Difficult to place, Risk of not engaging submucosa

14
Q

cruciate mattress - features

A

Stronger than simple interrupted
Resists tension
Prevents eversion
Quicker than simple interrupted

15
Q

cruciate mattress - examples of use

A

skin?, tail, digit amp

16
Q

Horizontal mattress - features + examples of use

A

Features - Appositional to everting, Strangulate tissue, Edge ischaemia

Examples - Skin, muscle, tendon

17
Q

vertical mattress - features + examples of use

A

Appositional to everting
Resists tension
Skin (tension relieving)

18
Q

Vertical vs Horizontal mattress - which cuts off blood flow to the skin more

A

horizontal

19
Q

simple continous - features

A

Series of linked “interrupted” sutures
Suture line advances on one side of the wound
Good for areas under low tension

20
Q

simple continous - examples of use

A

subcutis, fascia, vessels, GI tract

21
Q

running suture - features

A

Series of linked “interrupted” sutures
Suture line advances on both sides of the wound
rapid closure at the expense of accuracy of approximation

22
Q

Ford interlocking (Blanket stitch)

A

Greater security than simple continuous
Better apposition than simple continuous
More difficult to place & finish

used in skin

23
Q

inverting patterns

A

Cushing
• Connell
• Lembert
• Halsted
• Czerny
• Parker-Kerr
• Purse-string

24
Q

everting pattern

A

Horizontal mattress

25
Q

Lembert (interrupted) - features

A

Variation of the vertical mattress, i.e. upside down
Tissue bites perpendicular to wound edge

26
Q

Lembert (interrupted) - example of use

A

Hollow viscus (second layer)

27
Q

Lembert (continuous) - Dupuytren’s - pic only

A
28
Q

Halsted

A

Modification of the Lembert
Two interrupted Lemberts as a mattress suture
Examples - Hollow viscus

29
Q

cushing - features

A

Variation of the continuous horizontal mattress (i.e. upside down)
Tissue bites parallel to wound edge
Penetrates submucosa but not lumen
Less inversion

30
Q

cushing - examples of use

A

hollow viscus

31
Q

connell

A

like cushing but penetrates the lumen

hollow viscus

32
Q

czerny

A

simple continuous partial thickeness

hollow viscus

33
Q

Parker-Kerr oversew

A

1st layer: Cushing
2nd layer: Lembert
Example - Closure of visceral stump e.g. pyometra

34
Q

purse-string

A

circular lembert

stump inversion, feeding tubes

35
Q

continous horizontal mattress

A

appositional to everting

cardiac surgery, oversewn with SC

36
Q

suture patterns that relieve tension

A
  • Vertical mattress
  • Horizontal mattress
  • Far-near-near-far
  • Far-far-near-near
  • Echelon sutures
  • Quills, bolsters, stents & pledgets
37
Q

far-near-near-far - pic only

A

tension on outside of the loop

38
Q

far-far-near-near - pic only

A
39
Q

Simple interrupted echelon suture

A

Alternating simple interrupted sutures
Narrow bite - apposition
Wide bite - tension
Can use with quills/stents

40
Q

quills + horizontal mattress

A

distribute tension - incr contact surface

everting

41
Q

Quills + Vertical mattress

A

distribute + relieve tension