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Sutures

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fogovehe's version from 2017-08-26 23:40

Section 1

Question Answer
Fast catgut - twisted/fast absorption Tensile strength = 3-5d ; Absorbed = 30d
Common use for fast catgut suture?Facial lacerations in children
Plain catgut - twisted/rapidly absorbable Tensile strength = 7-10d; Absorbed = 70d
Common use for plain catgut suture?Vessel ligation, subcutaneous tissue
Chromic catgut - twisted/absorbable Tensile strength = 10-14d; Absorbed = 90d
Common use for chromic catgut suture?Mucosa
Polyglycolic Acid (Dexon) - braided/absorbable Tensile strength = 14-21d; Absorbed = 60-90d
Common use for polyglycolic acid (Dexon) suture?GI, subcutaneous tissues
Polyglactin 910 (Vicryl Rapide) - braided/absorbable Tensile strength = 5d; Absorbed = 42d
Common use for polyglactin 910 (Vicryl Rapid) suture?Skin repaire needing rapid absorption
Polyglactin 910 (Vicryl) - braided/absorbable Tensile strength = 21d; Absorbed = 56-70d
Poliglecaprone 25 (Monocryl) - monofilament/absorbableTensile strength = 7-14d; Absorbed = 91-119d
Common use for poliglecaprone 25 (Monocryl) suture?Skin, bowel
Polydioxanone (PDS) - monofilament/absorbableTensile strength = 28d; Absorbable = 6mos
Common use for polydioxanone (PDS) suture?Fascia, GI
Polyglyconate (Maxon) - braided/absorbableTensile strength = 28d; Absorbed = 6mos
Common use for polyglyconate (Maxon) suture?GI, mm, fascia
Panacryl - braided/absorbableTensile strength = > 6mos; Absorbable = > 24 mos
Common use for panacryl suture?Fascia, tendons
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Section 2

Question Answer
PTFE (Gore-tex) - monofilamentVascular grafts, hernia, valve repair
Nylon (Dermalon, Ethilon) - monofilamentSkin, drains
Nylon (Nurolon) - braidedTendon repair
Polyester (Ethibond, Tycron) - braidedCardiac, tendon
Polypropylene (Prolene) - monofilamentVessel, fascia, skin
Silk - braidedGI, vessel ligation, drains
Stainless steel - monofilamentFascia, sternum
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Section 3

Question Answer
Size of the suture is defined by # of Zeros
The more zeros in the #, the ______________ the sutureSmaller
5-0 = (00000) 5 zeros
2-0 = (00) 2 zeros
2-0 suture is ________________ 5-0 sutureLarger
Cutting needles are used forTough tissues, skin
Tapered needles are used for Delicate tissues, intestine
MC needle for skin closure is?3/8 circle cutting needle
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Section 4

Question Answer
Face5-0 or 6-0 nylon or polypropylene when appearance is important
Scalp3-0 nylon or polypropylene
Trunk and extremities4-0 or 5-0 nylon or polypropylene
Approximate deep tissues3-0 or 4-0 absorbable Dexon or Vicryl
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Section 5

Question Answer
Suture marks or tracks are the result of excessive tension on the tissue or leaving sutures in too long
4 Steps of Wound Healing?Inflammation, fibroblast proliferation, contraction, remodeling
1st intentionSuture, staple, glue immediately; 24-48hrs
2nd intentionWound packed open, skin contracts naturally 1mm/day
3rd intentionSignificant debridement needed, grossly contaminated, delayed closure
Irrigate wound with at least200mL of saline thru 35mL syringe and a 19 gauge needle
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Section 6

Question Answer
BupivacaineMarcaine, Sensorcaine
LidocaineXylocaine, Anestacon
Lidocaine w/epinephrine(1:200,000)
Mepivacine(Carbocaine)
ProcaineNovocaine
Onset and duration of bupivacaine?O: 7-30min; D: 5-7h
Onset and duration of lidocaine?O: 5-30min; D: 2h
Onset and duration of lidocaine w/epinephrine?O:5-30min; D: 2-3h
Onset and duration of mepivacaine?O: 5-30min; D: 2-3h
Onset and duration of procaine?O: rapid; D: 30min-1 hr
To calculate the max dose if a pt is not a 70kg adult, use the fact that a 1% sol has 10mg of drug per mL
mg/kg of bupivacaine?3 Max: 70mL of 0.25% sol
mg/kg of lidocaine?4 Max: 28mL of 1% sol
mg/kg of lidocaine w/epi?7 Max: 50mL of 1% sol
mg/kg of mepivacaine?7 Max: 50mL of 1% sol
mg/kg of procaine?10-15 Max: 70-105mL of 1% sol
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Section 7

Question Answer
Consult before suturing what?Infected, contaminated, lacerations > 6-12 hrs old, > 24 hrs on face, missle wounds, and human or animal bites
1mL of 1:10 NaHCO3 can be mixed with 9mL of liodcaine to minimized inj discomfort
Sx of toxicity from anesthetics include:Twitching, restlessness, drowsiness, light-headedness, seizures
3 basic knot techniques are?1 handed, 2 handed, and instrument tie
When to remove sutures from face and neck?3-5 days
When to remove sutures from scalp and body?5-7 days
When to remove sutures from extremities?7-12 days
Steri strips stay in place if tincture oof benzoin (spray or solution) is applied and allowed to dry before Steri-strips are applied
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Section 8

Question Answer
Simple interrupted suturesBites are taken thru the thickenss of skin, width of each stitch = distance btwn sutures
Continuous running sutureRapid closure, but depends on 2 knots and may not allow precise approximation of skin edges; locking each stitch may increase scarring
Verticle interrupted mattress suturesPrecise approximation of skin edges w/little tension, needle placed far, far, near, near sequence
Verticle interrupted mattress sutures appears __________________ to incision line?Perpendicular or vertical
Horizontal interrupted mattress sutures appears __________________ to incision line?Parallel or horizontal
Horizontal interrupted mattress sutures Everting stitch, more commonly used in fascia, used in callosed skin, palms, soles
Subcuticular closure usually requires this Continuous, horizonally applied intradermal sutures
Staples can typically be removed within3-5 days after surgery
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Section 9

Question Answer
Dermabond and Indermil are Topical skin adhesives; helpful w/topical skin incisions; only for nonmucosal area on face, torso or extremity
Adhesives are recommended w/wounds < 8 cm w/minimal tension (skin gap < 0.5cm)
Dermabond and Indermil glue sheds in5-10d
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