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Flashcards in Suturing & I&D Deck (18)
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1
Q

Tensile Strength

Knot Strength

A

Tensile Strength: Related to suture size and the weight required to break a suture

Knot Strength: force required for a knot to slip

2
Q

Configuration

A

Monofilament - less risk of infection, more memory = harder to tie

Braided filament - less memory = easier to handle and tie

3
Q

Elasticity

Memory

Tissue Reactivity

A

Elasticity: Degree suture stretches and returns to original length

Memory: High memory = more stiff suture, difficult to handle, unties

Tissue Reactivity: Reaction peaks in the first 2-7 days

4
Q

Absorbable Suture

A

Breaks down over time in body

Breakdown depends on type of suture, suture size, and suture location

Used in patients who cannot return for removal, or in internal body tissues

5
Q

Absorbable Suture Types

A

Catgut

Chromic

Vicryl

Monocryl

PDS - often used in bowel

Catgut and chromic are only natural sutures, rest are synthetic

6
Q

Non-absorbable sutures and types

A

Defined by their resistance to degradation by living tissue

Silk - for tying off vessels

Nylon - for drains or closing

Ethibond - used for retention or tendon grafts

Prolene: for vessels, used in CV/AAA surgery

Surgical steel - to close sternotomy

7
Q

Absorption rate & Tensile strength for:

Chromic

Vicryl

Monocryl

PDS

A

Chromic: Absorption 70 days, Tensile 10-14 days

Vicryl: Absorption 60-90 days, Tensile 3-4 weeks

Monocryl: 91-119 days, 21 days tensile

PDS: 182-238 days, 5-6 weeks tensile

8
Q

Suture Size

A

The higher the number, the smaller the suture

Largest suture = 0 and #1

5-0 through 7-0 mainly used on face

9
Q

Suture Removal

Scalp

Face

Eyelid

Chest/Abdomen

Back/Foot/Sole

Extremities

Penis

Delayed wound healing

A

Scalp: 10 days

Face: 5 days

Eyelid: 3 days

Chest/Abdomen: 8-10 days

Back/Foot/Sole: 12-14 (10-12 kids)

Extremities: 10-14 (8-10 in kids)

Penis: 8-10 days

Delayed wound healing: 14-21 days

  • Chronic steroids, DM
10
Q

Adhesive Advantages over Suture

A

Max bonding strength @ 2 1/2 minutes = equal to healed tissue @ 7 days strength

No needles

Faster

Water-resistant covering

No suture removal

11
Q

Skin Adhesive Contraindications

A

Jagged/Stellate lacerations

Bites, puncture or crush wounds

Contaminated wound

Mucosal surface - Axillae and perineum (high moisture)

Hands, feet, and joints unless kept dry and immobilized

12
Q

Folliculitis

A

Superficial infection of hair follicles

Hot-tub folliculitis = pseudomonas

Usually resolves spontaneously

13
Q

Skin Abscess

Furuncle

Carbuncle

A

Skin Abscess: collection of pus within dermis and deeper skin tissues

Furuncle: infection of hair follicle - pus extends through dermis into subcutaneous tissue

Carbuncle: coalescence of several infected follicles into single mass with several draining sites

14
Q

I&D indications

A

Most patients w/ skin abscesses need I&D

Aspiration is inadequate

If draining spontaneously, may follow with warm compress to promote drainage

15
Q

Abscesses to refer to surgeon

A

Perirectal, neck, or breast near areola

Near vital nerves or major blood vessels

Hand abscess (except paronychia and felon)

Central triangle of face - possible sinus involvement

Recurrent, interconnected, or large (>5 cm)

16
Q

Antibiotic consideration

A

Not necessary for simple abscesses in healthy patients

Consider with:

Abscess >5cm

Extensive cellulitis

Systemic infection signs

Comorbidities

Immunosuppression
Prosthetic joint/valves

17
Q

Antibiotic Choice

A

Dicloxacillin, Keflex

MRSA Risk:

Clindamycin

Doxy

Bactrim

Vanco

18
Q

Closure

A

Loose, interrupted vertical mattress may speed healing

If immunocompromised, systemic infection, or significant cellulitis, may leave open and pack