Suturing

Question 1

Diff suture characteristics?

Answer 1

• tensile strength:
  related to suture size
  related to wt required to break a suture
• knot strength: force reqd for a knot to slip
• configuration: monofilament (less risk of infection)
  braided multifilament (easire to handle and tie)
• elasticity: degree suture stretches and return to original length
• memory or suture stiffness: high memory - suture stiff, difficult handling, unties
• tissue reactivity:
  (inflammatory response to suture ) - rxn peaks in 1st 2-7 days

Question 2

Diff types of absorbable sutures?

Answer 2

• suture breaks down over time in the body
• break down depends on:
  type, size and location
• used in pts who can’t return for suture removal or in internal body tissues
• types:
  cat gut
  chromic
  vicryl
  monocryl
  PDS

catgut and chromic: natural

Question 3

Diff types of non-absorbable sutures?

Answer 3

• defined by their resistance to degradation by living tissue
• types:
  silk
  nylon
  ethibond
  prolene
  surgical steel (close up sternotomy)

Question 4

Diff b/t absorption rate and tensile strength?

Answer 4

- chromic:
absorption 70 days
tensile strength 10-14 days
- vicryl:
absorption 60-90 days
tensile strength 3-4 wks
- monocryl (subq):
absorption 91-119 days
tensil strength 21 days 
- PDS:
absorption 182-238 days
tensile strength 5-6 wks 
(close up fascia)

Question 5

Suture sizes and location used?

Answer 5

• range from #5 to #11-0
• higher the number the smaller the suture
• size O and #1 is largest suture
• size 2-O: skin - drains, deep - chest, abdomen, back
• size 3-O: skin - foot, deep - chest, abdomen, back
• size 4-O: skin - scalp, chest, abdomen, foot, extremity, deep - scalp, extremity, foot
• size 5-O: skin - scalp, brow, oral, chest, abdomen, hand, deep - brow, nose, lip, face, hand
• size 6-O: skin - ear, lid, brow, nose, lip, face
• size 7-O: skin - eyelid, lip, face

Question 6

Suture removal specific to location?

Answer 6

• scalp: 10 days
• face, ear, eyebrow, nose, lip: 5 days, follow w/ papertape or steristrips
• eyelid: 3 days
• chest and abdomen: 8-10 days
• back: 12-14 days (10-12 in kids)
• extremities: 10-14 days (8-10 in kids)
• hand: 10-14 days
• foot and sole: 12-14 days (8-10 days in kids)
• penis: 8-10 days
• condition delaying wound healing: 14-21 days ex: chronic corticosteroid use, DM

Question 7

Classificaiton of needles?

Answer 7

• taper
• cutting
• reverse cutting
• trocar pt or tapercut
• blunt pts
• side cutting or spatula pts (eye surgery)

Question 8

How do you close wounds w/ staples?

Answer 8

• be sure skin edges are everted and even
• traction on incision helps w/ placing staples
• space staples as evenly as possible
• remove any poorly placed staples

Question 9

Advantages of adhesive vs sutures?

Answer 9

• max bonding strength at 2 1/2 min
• equivalent in strength to healed tissue at 7 days post repair
• can be applied usuing only a topical anesthetic, no needles
• faster repair time
• better acceptance by pts
• water-resistant covering
• doesn’t reqr removal of sutures

Question 10

CIs to use of skin adhesives?

Answer 10

• jagged or stellate lacerations
• bites, punctures or crush wounds
• contaminated wounds
• mucosal surfaces
• axillae and perineum (high moisture areas)
• hands, feet, jts (unless kept dry and immobilized)

Question 11

Steps in use of dermabond?

Answer 11

1. apply topical anesthetic as needed
2. prepare wound w/ 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