Suturing

Question 1

What are the suture characteristics?

6

Answer 1

1. Tensile Strength
2. Knot strength
3. Configuration
4. Elasticity
5. Memory or Suture stiffness
6. Tissue reactivity (inflammatory response to Suture)

Question 2

Describe the following suture characteristics?
1. Tensile Strength: related to? 2

2. Knot strength: what is it?
3. Configuration: different types? 2
4. Elasticity: what is it?
5. Memory or Suture stiffness: what does this mean?
6. Tissue reactivity (inflammatory response to Suture): reaction peaks when?

Answer 2

1. • Related to Suture size
   • Related to weight required to break a Suture
2. Force required for a knot to slip
3. • Monofilament (less risk of infection)
   • Braided multifilament (easier to handle and tie)
4. • Degree Suture stretches and
   • return to original length
5. High memory: Suture stiff, difficult handling, unties
6. Reaction peaks in first 2 to 7 days

Question 3

Suture Types

1. What are absorable sutures?
2. Break down depends on? 3
3. Used in what patients?

Answer 3

1. Suture breaks down over time in the body
2. Break down depends on
   - Type
   - Size
   - Location
3. Used in patients who cannot return for suture removal or in internal body tissues

Question 4

Types of absorbable suture

5

Answer 4

1. Catgut
2. Chromic
3. Vicryl
4. Monocryl
5. PDS

Question 5

What are nonabsorable sutures?

What are the types? 5

Answer 5

1. Defined by their resistance to degradation by living tissue
2. Types
   - Silk
   - Nylon
   - Ethibond
   - Prolene
   - Surgical Steel

Question 6

Name the Absorption rate/Tensil strength
for the following suture types:
1. Chromic?
2. Vicryl?
3. Monocryl?
4. PDS?

Answer 6

Chromic

1. Absorption: 70 days
2. Tensil strength: 10-14 days

Vicryl

1. Absorption: 60-90 days
2. Tensil strength: 3-4 weeks

Monocryl

1. Absorption: 91-119 days
2. Tensil strength: 21 days

PDS

1. Absorption: 182-238 days
2. Tensil strength: 5-6 weeks

Question 7

What is the largest suture type?

Answer 7

Size O & #1: Largest Suture

Question 8

The higher the number the smaller the what?

Answer 8

The higher the number the smaller the suture

Question 9

What are the following suture types used for in skin and in deep situations:
1. Size 2-O?
(three for deep)

2. Size 3-O?
   (three for deep)
3. Size 4-O?
   (five for skin)
   (three for deep)
4. Size 5-O?
   (6 for skin)
   (5 for deep)
5. Size 6-O?
   (6 for skin/ none for deep)
6. Size 7-O?
   Used for? 3

Answer 9

1. Skin: Drains
   Deep: Chest, Abdomen, Back
2. Skin: Foot
   Deep: Chest, Abdomen, Back
3. Skin: Scalp, Chest, Abdomen, Foot, Extremity
   Deep: Scalp, Extremity, Foot
4. Skin: Scalp, Brow, Oral, Chest, Abdomen, Hand
   Deep: Brow, Nose, Lip, Face, Hand
5. Skin: Ear, Lid, Brow, Nose, Lip, Face
6. Smallest Suture
   Skin: Eyelid, Lip, Face

Question 10

When should you remove the following locations for sutures:

1. Scalp?
2. Face, Ear, Eyebrow, Nose, Lip? (follow with what?)
3. Eyelid?
4. Chest and abdomen?
5. Back?
6. Extremities?
7. Hand?
8. Foot and sole?
9. Penis?
10. Condition dealying wound healing?

Answer 10

1. Scalp: 10 days
2. Face, Ear, Eyebrow, Nose, Lip: 5 days
   (Follow with papertape or steristrips)
3. Eyelid: 3 days
4. Chest and Abdomen: 8-10 days
5. Back: 12-14 days (10-12 days in children)
6. Extremities: 10-14 days (8-10 days in children)
7. Hand: 10-14 days
8. Foot and sole: 12-14 days (8-10 days in children)
9. Penis: 8-10 days
10. Condition delaying Wound Healing: 14 to 21 days

Question 11

Conditions delyaing wound healing? 2

Answer 11

1. Chronic Corticosteroid use

2. Diabetes Mellitus

Question 12

What are the different classifications of needles?

6

Answer 12

1. Taper
2. Cutting
3. Reverse cutting
4. Trocar point or tapercut
5. Blunt points
6. Side cutting or spatula points

Question 13

1. Instructions for using forceps? 2
2. Needle holder? 3
3. Scissors? 2

Answer 13

1. FORCEPS
   - Hold like a pencil
   - Don’t crush skin with teeth
2. NEEDLE HOLDER
   -Use tripod grip
   -Grip needle a third from the end
   -Can press against palm
   to rotate needle
3. SCISSORS
   - Cut at tip, 45 degree angle
   - Leave half inch tail

Question 14

Placing Suture

1. Enter skin at a ____ degree angle
2. Turn needle to go through wound at ____ degrees
3. Come out ___________ to skin, even distance
4. Try to _____ skin edges with forceps

Answer 14

1. 90
2. 90
3. perpendicular
4. evert

Question 15

Staples
1. Be sure skin edges are what?

2. Traction on the incision helps with placing what?

Space staples as evenly as possible
Remove any poorly placed staples

Answer 15

1. everted and even

2. staples

Question 16

Advantages of Adhesive vs. Sutures

7

Answer 16

1. Maximum bonding strength at two and one-half minutes
2. Equivalent in strength to healed tissue at seven days post repair
3. Can be applied using only a topical anesthetic, no needles
4. Faster repair time
5. Better acceptance by patients
6. Water-resistant covering
7. Does not require removal of sutures

Question 17

Contraindications to Use of Skin Adhesives

6

Answer 17

1. Jagged or stellate lacerations
2. Bites, punctures or crush wounds
3. Contaminated wounds
4. Mucosal surfaces
5. Axillae and perineum (high-moisture areas)
6. Hands, feet and joints (unless kept dry and immobilized)

Question 18

Tissue Adhesive
Steps in Use of Dermabond
7

Answer 18

1. Apply topical anesthetic as needed.
2. Prepare wound with antiseptic.
3. Appose wound edges.
4. Crush Dermabond vial and invert.
5. Gently brush adhesive over laceration.
6. Avoid pushing adhesive into wound.
7. Apply three layers of adhesive.