Podcast
Questions and Answers
Which type of surgical suture is known to mount a strong inflammatory reaction?
Which type of surgical suture is known to mount a strong inflammatory reaction?
Synthetic sutures usually cause more tissue inflammation compared to natural sutures.
Synthetic sutures usually cause more tissue inflammation compared to natural sutures.
False
What is the primary use of Silk sutures?
What is the primary use of Silk sutures?
What is the dissolution process of natural sutures primarily based on?
What is the dissolution process of natural sutures primarily based on?
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Prolene sutures are blue and made of monofilament material.
Prolene sutures are blue and made of monofilament material.
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The key characteristic of braided sutures is that they have an increased risk of __________.
The key characteristic of braided sutures is that they have an increased risk of __________.
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What is the use of Steel sutures?
What is the use of Steel sutures?
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Nylon sutures, also known as ______, are commonly used for skin sutures.
Nylon sutures, also known as ______, are commonly used for skin sutures.
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Match the following types of sutures with their characteristics:
Match the following types of sutures with their characteristics:
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Match the following sutures with their descriptions:
Match the following sutures with their descriptions:
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What is the recommended duration for suture removal in the face area?
What is the recommended duration for suture removal in the face area?
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The submucosa is not the strongest layer in bowel anastomosis.
The submucosa is not the strongest layer in bowel anastomosis.
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Name the two layers used in the two-layer repair technique.
Name the two layers used in the two-layer repair technique.
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The __________ stapler is used for procedures like sleeve gastrectomy and end-to-end anastomosis.
The __________ stapler is used for procedures like sleeve gastrectomy and end-to-end anastomosis.
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Match the surgical techniques or tools with their corresponding uses:
Match the surgical techniques or tools with their corresponding uses:
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What is the most common cause of post-operative fever on day 1?
What is the most common cause of post-operative fever on day 1?
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Superficial thrombophlebitis can occur as early as post-operative day 2.
Superficial thrombophlebitis can occur as early as post-operative day 2.
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What is the recommended treatment for pneumonia post-operation?
What is the recommended treatment for pneumonia post-operation?
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Chest physiotherapy and __________ are key preventive strategies for post-operative complications.
Chest physiotherapy and __________ are key preventive strategies for post-operative complications.
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Match the following causes of post-operative fever with their respective post-operative days:
Match the following causes of post-operative fever with their respective post-operative days:
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What is the tensile strength duration of chromic catgut?
What is the tensile strength duration of chromic catgut?
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Monocryl is a braided synthetic absorbable suture.
Monocryl is a braided synthetic absorbable suture.
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What is the primary purpose of Vicryl plus?
What is the primary purpose of Vicryl plus?
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Catgut is derived from the submucosa of a ______ gut.
Catgut is derived from the submucosa of a ______ gut.
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Match each synthetic absorbable suture to their characteristics:
Match each synthetic absorbable suture to their characteristics:
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What is the first step in tying a square/reef knot?
What is the first step in tying a square/reef knot?
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In a granny knot, the crossings are aligned and open up.
In a granny knot, the crossings are aligned and open up.
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What angle should skin sutures enter the skin at?
What angle should skin sutures enter the skin at?
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The distance between two sutures should be _______ times the bite on each side.
The distance between two sutures should be _______ times the bite on each side.
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Match the knot type with its characteristic:
Match the knot type with its characteristic:
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Which incision type is preferred for surgeries?
Which incision type is preferred for surgeries?
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Long bites of sutures (1 cm) are less effective than short bites (0.5 cm).
Long bites of sutures (1 cm) are less effective than short bites (0.5 cm).
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What is the most common site of intra-abdominal abscess collection?
What is the most common site of intra-abdominal abscess collection?
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In children, the delayed absorbable suture used is ______.
In children, the delayed absorbable suture used is ______.
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Match the following site of abscess collection with their clinical features:
Match the following site of abscess collection with their clinical features:
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Which type of needle is best suited for delicate structures like blood vessels?
Which type of needle is best suited for delicate structures like blood vessels?
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The diameter of sutures is measured in millimeters.
The diameter of sutures is measured in millimeters.
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What suture type is represented by the color blue?
What suture type is represented by the color blue?
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Which type of suture is expected to cause eversion?
Which type of suture is expected to cause eversion?
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Sutures with a diameter labeled as No 1 are the ________ among the standard sizes.
Sutures with a diameter labeled as No 1 are the ________ among the standard sizes.
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Match the suture color to its corresponding type:
Match the suture color to its corresponding type:
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Subcuticular sutures leave visible marks on the skin.
Subcuticular sutures leave visible marks on the skin.
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What suture material is typically used for subcuticular sutures?
What suture material is typically used for subcuticular sutures?
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The _________ mattress suture has a least cut through rate.
The _________ mattress suture has a least cut through rate.
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Match the following sutures with their specific characteristics:
Match the following sutures with their specific characteristics:
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What is the primary clinical feature of Deep Vein Thrombosis (DVT)?
What is the primary clinical feature of Deep Vein Thrombosis (DVT)?
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Pharmacological prophylaxis for DVT primarily involves the use of aspirin.
Pharmacological prophylaxis for DVT primarily involves the use of aspirin.
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What is one predisposing factor for burst abdomen?
What is one predisposing factor for burst abdomen?
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Pneumatic stockings are used as part of __________ prophylaxis for DVT.
Pneumatic stockings are used as part of __________ prophylaxis for DVT.
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Match the following clinical features with their respective conditions:
Match the following clinical features with their respective conditions:
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Study Notes
Natural Non-Absorbable Sutures
- Silk is a black, braided suture derived from the silkworm.
- Silk is used for skin closure, drain fixation, and second-layer bowel anastomosis.
- Prolene is a blue monofilament suture.
- Prolene sutures are used for hernia mesh, abdominal sheath closure, vascular repair/anastomosis, and aortic, femoral, and popliteal artery repair.
- Nylon/Ethilon is a monofilament suture used for skin suture, cataract surgery, and nerve and tendon repair.
- Steel sutures are used for sternotomy incision following coronary artery bypass grafting (CABG).
- Polyester/Ethibond is used for rectus sheath closure and tendon repair.
- Polybutester is rarely used and has applications in plastic surgery.
Classification of Sutures
- Natural sutures, such as silk and catgut, are made from animal sources.
- Synthetic sutures, such as Prolene and PDS, are manufactured from synthetic materials.
- Monofilament sutures are composed of a single strand and examples include catgut, Prolene, PDS, nylon, and Monocryl.
- Braided sutures are made from multiple strands intertwined and examples include Vicryl and silk.
Suture Removal
- Non-absorbable sutures are removed based on location:
- Scalp: 5-7 days
- Face: 3-5 days
- Neck: 5-7 days
- Thorax: 10-12 days
- Abdomen: 12-14 days
- Perineum: 10-12 days
Bowel Anastomosis
- Inverted edges are preferred for bowel anastomosis.
- The submucosa is the strongest layer in bowel anastomosis.
Surgical Drains
- Different types of surgical drains are used to manage surgical site drainage, including Jackson-Pratt, Penrose, and wound vacuum systems.
Post Operative Fever
- The most common cause of post-operative fever on day 1 is atelectasis, followed by pneumonia.
- Superficial thrombophlebitis and urinary tract infections (UTI) are common causes of post-operative fever on days 2-3.
- Surgical site infections (SSI) and deep vein thrombosis (DVT) are likely causes of post-operative fever on days 4-5.
- Chest physiotherapy, including incentive spirometry, is crucial to prevent post-operative atelectasis and pneumonia.
- Pain control, treatment of congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), steam inhalation, and smoking cessation are important for post-operative recovery.
Natural Absorbable Sutures
- Catgut is derived from sheep's gut and is absorbed within 7-10 days by phagocytosis and enzymatic degradation.
- Chromic catgut has a tensile strength of 21-28 days and is completely absorbed within 90 days.
Synthetic Absorbable Sutures
- Monocryl (polyglecaprone) is a monofilament suture used subcutaneously in sizes 3-0/4-0 cutting/reverse cutting needles.
- Vicryl (polyglactin) is a braided suture that dissolves in 60-90 days and is used for common bile duct repair, bowel anastomosis, and bladder closure.
- Polydiaxone (PDS) is a monofilament suture that dissolves in 180 days and is used for the same applications as Vicryl, as well as tracheobronchial repair.
Surgeon & Surgical Factors Contributing to Wound Infection
- Midline incisions are associated with a higher risk of infection compared to transverse incisions.
- Emergency surgeries carry a higher risk of infection than elective ones.
- Continuous sutures have a higher risk of infection than interrupted sutures.
- Long suture bites (1 cm) are preferable to short bites (0.5 cm), as they reduce the number of sutures and the risk of infection.
- Shorter suture lengths are recommended, with a rule of thumb being that the suture length should be at least four times the wound length (Jenkins' theory).
- In cases of rectus sheath closure, non-absorbable sutures are preferred over absorbable sutures.
- Polydioxanone suture (PDS) is commonly used for delayed absorbable sutures in children.
Intra-abdominal Abscesses
- Intra-abdominal abscesses are most commonly found in the pelvis/pouch of Douglas.
- For supine patients, the Morrision pouch/right hepatorenal pouch is a frequent location for an abscess.
- In ambulatory patients, the pelvis/pouch of Douglas is the most likely site.
- Clinical features of an abscess include fever, chills, and rigors.
- Imaging studies, such as a contrast-enhanced computed tomography (CECT) of the abdomen, are essential for diagnosis.
- The most common initial treatment for an intra-abdominal abscess is drainage with a pigtail catheter under ultrasound guidance.
Knot Types for Suturing
- The most basic knot is the square/reef knot, consisting of one square throw followed by another square throw.
- The direction of the crossings in the square/reef knot is crucial. Crossings can be the same (black over pink) or opposite (black/pink).
- A granny/slip knot should be avoided as it does not cross correctly and can easily come undone.
- A surgeon's knot utilizes two throws followed by one single throw, providing greater initial security.
Skin Suturing
- Skin sutures should be placed with everted edges and entered at a 90° angle.
- Each suture bite should be equal, and the distance between two adjacent sutures should be twice the size of a single suture bite.
Types of Sutures
- Simple sutures do not cause eversion; they are used deep within the tissue or for internal closure.
- Mattress sutures, such as the vertical and horizontal mattress stitches, cause eversion and provide hemostasis.
- Subcuticular sutures are placed under the skin for a cosmetically better result, minimizing scarring and marks.
- Other suture types include:
- Aberdeen's knot/Cobbler's knot: Used for a continuous suture with locking, distributing tension across the wound.
- Continuous suture
- Interrupted suture
- Buried mattress suture
- Lock suture
- Purse-string suture
Needles
- Round body needles are ideal for delicate structures such as the bowel, bladder, blood vessels, and the common bile duct, as they split tissue without trauma.
- Cutting/reverse cutting needles dissect through tough structures like the sheath, skin, and fascia.
- Needles have specific parts:
- Point (needle tip)
- (2/3rd or 1/3rd) rd section (needle body)
- Swaged end (suture material attachment)
- Body (shaft)
- Needle holder
Suture Color Coding
- Identifying the suture type is essential for appropriate surgical procedures. Color coding helps:
- Brown - catgut
- Violet - Vicryl
- Blue - Prolene
- Black - silk
Suture Numbering
- Sutures have a numbering system based on diameter:
- No 1 - thickest
- 11.0 - finest
Deep Vein Thrombosis (DVT)
- DVT is a venous thromboembolism (VTE) that occurs in the deep veins of the lower extremities, more commonly than the upper limbs.
- Clinical features of DVT include unilateral lower limb swelling, pain, and tenderness.
- A duplex scan is the gold standard for diagnosing DVT.
- Mechanical prophylaxis for DVT includes early ambulation, preventing stasis, and pneumatic stockings.
- Pharmacological prophylaxis for DVT typically involves low molecular weight heparin.
Burst Abdomen/Abdominal Wound Dehiscence
- Burst abdomen occurs when the rectus sheath opens, exposing the bowel.
- Common symptoms include a cough on day 6 after surgery, a soaked dressing with reddish fluid, and the serous/salmon fluid sign.
- Emergency management involves repositioning the bowel and using a urobag/Bagota bag laparostomy.
- Definitive treatment includes resuturing of the rectus sheath in an operating room (OT) setting.
- Factors predisposing to burst abdomen include chronic cough, constipation, infection, obesity, immunocompromise, and malnutrition.
Obliteration of Large Cavities
- Sutures are commonly used to obliterate large cavities during surgical procedures.
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Description
This quiz covers various types of sutures, including natural and synthetic options, and their specific applications in medical procedures. Learn about the unique characteristics and uses of silk, Prolene, nylon, steel, and polyester sutures. Test your knowledge on the classification and function of these essential surgical materials.
