14. Sutures and Wound Repair 1

Sutures and Wound Repair

• Philip Syng Physick discovered that the body absorbs sutures made from animal tissues, leading to the development of absorbable sutures that do not require removal after healing.

• Fascia lata remains as living tissue in the body and is used as autograft suture material, integrating into surrounding tissues instead of being absorbed.

• Dead space is created by inadequately approximated wound edges, which can fill with fluid or blood, increasing infection risk and delaying healing. Proper suturing techniques aim to minimize this space.

• Mattress suture is an interrupted suture type that offers secure closure and evenly distributes tension, making it suitable for high tension areas or deep tissue closure.

• Suture material like fascia lata can become encapsulated by fibrous tissue during healing, integrating with surrounding tissues for better wound support.

• The absorption rate of surgical gut increases in the presence of infection due to heightened enzyme activity, potentially compromising wound closure.

• Polypropylene is a suitable suture material for infected wounds because it is synthetic, non-absorbable, and less likely to harbor bacteria compared to multifilament sutures.

• The subcuticular suture technique involves taking short lateral stitches beneath the skin's surface for cosmetic closure, minimizing visible scarring in sensitive areas.

• Secondary intention healing involves intentionally leaving a wound open for healing from the bottom upward, often employed for infected or large wounds.

• Surgical gut, or catgut, is derived from the submucosa of sheep intestines and is known for its strength and absorbable properties.

• Wire sutures exhibit minimal tissue reactivity, making them the most inert option among various materials and suitable for long-term applications.

• A stay suture typically does not pass through the mesentery due to its delicate nature; it is used for providing temporary support during procedures.

• Dehiscence is the partial or complete separation of wound edges post-surgery—a serious complication requiring urgent medical attention.

• Bone wax, primarily made of beeswax, controls bleeding from severed bone surfaces during surgery by sealing small blood vessels.

• Evisceration occurs when bowel protrudes through the edges of an abdominal wound, necessitating immediate surgical care.

• Silk sutures are avoided in organs like the gallbladder or kidney as they can become a base for stone formation due to their rough surface.

• Multifilament nonabsorbable sutures should not be used in active infections as they can harbor bacteria, exacerbating the infection.

• The Halsted Technique utilizes interrupted silk sutures, emphasizing careful tissue handling for optimal wound healing.

• A suture ligature, also known as stick tie or transfixion suture, is useful for securing large vessels or tissue bundles.

• Bumpers or guards on tension sutures prevent heavy sutures from cutting into skin, distributing pressure to reduce tissue damage.

• Swaged sutures, where the needle is attached to the suture, cause less tissue trauma compared to eyed needles and minimize wound size.

• Tensile strength is the maximum force that a suture can tolerate before breaking; it's crucial for selecting sutures used in varying tension scenarios.

• All previous actions, such as soaking sutures in saline, testing their strength, or straightening them, can weaken the material.

• Polypropylene suture is the least reactive nonabsorbable synthetic material and is preferred in contaminated wounds due to its low tissue reactivity.

• A purse-string suture is ideal for closing the anus following abdominal perineal resection, offering a secure closure similar to a drawstring bag.

Test your knowledge on sutures and wound repair techniques in this quiz. Learn about historical figures like Philip Syng Physick and their contributions to surgical advancements. Discover the importance of absorbable sutures in modern medicine.