Sutures and Stitch Types

Study Notes

Monofilament Sutures: Composed of a single strand; they are less likely to harbor organisms and are ideal for vascular surgery.
Multifilament Sutures: Made of multiple filaments twisted together, providing greater tensile strength.

Refers to the strength required to hold tissues in proper apposition during surgical procedures.

Simple Stitch: Basic form of suturing.
Mattress Stitch:
- Vertical mattress: Provides good tissue apposition.
- Horizontal mattress: Used for tension relief.
Lembert Suture: Involves two rows of sutures; the first row goes all the way through, while the second row inverts the tissue.
Tension Suture: Enhances tissue apposition in areas requiring extra support.

Timing of suture removal depends on the anatomical location:
- Face: 5-7 days
- Scalp: 10 days
- Trunk & Upper Extremities: 10-14 days
- Lower Extremities: 14-21 days
Prompt removal minimizes the risk of suture marks, infection, and adverse tissue reactions.

Skin Preparation: Clean and sterilize before suturing.
Suture Removal Technique: Gently elevate with forceps, cut one side, and pull toward the suture line.

Straight Needles: Suitable for superficial structures, like skin.
Curved Needles: Available in various arcs (3/8, 1/2, 5/8 of a circle) for deeper penetration.
Rounded Needles: Circular cross-section used for organs and mucosa.
Cutting Needles: Triangular cross-section for tougher tissues such as skin.
Eyeless Needles: Incorporate the thread within the needle, used in plastic and vascular surgeries.
Eyed Needles: Feature an opening for threading and limited reuse.

General Anesthesia: Commonly used for extensive procedures.
Incision Techniques: Specific techniques depending on body area (e.g., transverse for the neck, semilunar for the cheek).

Cold Abscesses: Treated with anti-TB drugs; aspiration is preferred over drainage.
Drainage Guidelines: Indicated for secondary pyogenic infections or impending rupture.

Classification:
- Open vs Closed
- Active vs Passive
Uses:
- Fluid withdrawal
- Tissue apposition to eliminate potential spaces
Drain Types:
- Corrugated Drain: Keeps track of shortening daily.
- Passive Open Drain: Simple gauze dressing for abscesses.
- Closed Passive: Similar to T-tube for controlled drainage.
- Closed Active: J-Vac system for suction.

Insertion Purpose: To evacuate pus, blood, or fluid collections.
Advantages:
- Reduces infection risk
- Prevents fluid accumulation
- Early detection of leaks or hemorrhages
Disadvantages:
- Increased infection risk
- Potential for mechanical damage or leaks
- Drains may become infective quickly.

NG Tube:
- Used for stomach decompression and long-term feeding.
- Indicated for aspiration prevention and poisoning treatment.
Orogastric Tube: Employed for massive upper GI bleeding and traumatic cases.
Foley Catheter: Used for bladder drainage, monitoring, and surgeries.
Complication Management: UTI prevention through continuous drainage and regular changes.

Cuffed/Uncuffed Options: Cuffed tubes protect against aspiration in adults; uncuffed for children.
Usage Considerations: Ideally single-use; variations include double lumen and reinforced types.