AST CH 11 Test Review

 Stick tie – Length of suture for ligation that is threaded on or swaged to a needle; also referred as suture ligature. Superficial bleeders – 18in; Deep vessels – 27in; Common sizes 2-0 & 3-0.  Tie on a passer – Suture strand (tie) that has one end secured in the jaws of an instrument to facilitate placement of the tie around a deep vessel for ligating; instrument tie; Instruments used – Crile hemostat, Schnidt tonsil clamp, Adson, Sarot.  Free tie - Length of suture for ligation that is not threaded onto or attached to a needle.  Ligature reel – Absorbable or non-absorbable suture for superficial bleeders; most common – chromic, plain, or polyglactin 910 suture; most common sizes: 2-0, 3-0, 4-0.  Tensile strength – Ability to resist rupture; Amount of pull or tension that a suture strand will withstand before breaking; expressed in pounds. Plateaus at 3rd month at 70-80% or original strength; Phase 3.  Phases of wound healing o First Intention (Primary Union) – Healing occurs from side to side in sterile wound. o Phase 1 (Lag phase or inflammatory response phase) – Begins in minutes of injury and lasts 3-5 days. Physiological changes – heat, redness, swelling, pain, & loss of function. No tensile strength. o Phase 2 (Proliferation phase) – Begins approx 3rd post-op day and continues for up to 20 days. Fibroblast release collagen forming fibers giving 25-30% tensile strength. o Phase 3 (Maturation or differentiation phase) – Begins on 14th post-op day and lasts until completely healed (up to 12 months). Wound undergoes slow, sustained increased tissue tensile strength w/interweaving collagen fibers. Wound contraction complete in 21 days. Cicatrix (scar) appears in this phase. o Second Intention (Granulation) – Occurs when wound fails to heal in primary union; infection breaks down tissue; necrosis removal; could result in hernia; excessive granulation (proud flesh) may protrude defect margins and block re-epitheliation. o Third Intention (Delayed primary closure) – Two granulated surfaces are approximated; Class III or Class IV – wound is debrided & left open to heal by 2nd intention (approx 4-6 days).  Needle Codes o CPX – Cutting Point X-large o FSL – For Skin Large o TP – Taper Pericostal/Point  Drainage – Occurs pre-op, intra-op, & post-op. May need more than one type of drainage system as part of post-op.  Debridement – Removal of devitalized tissue and contaminants.  Incision closure – Closed from inner to outer; Peritoneum (fast healing, thin membrane, continuous 3-0 absorbable sure), Fascia (tough connective tissue- interrupted, heavy-gauge, non-absorbable suture), Muscle (typically retracted so no suture, if incised – then loosely interrupted absorbable suture), Subcutaneous (does not tolerate suture – may place few interrupted suture to prevent dead space in obese), Subcuticular (tough connective just under skin – short, lateral, continuous, or interrupted stitches parallel to wound - absorbable), Skin (interrupted or continuous, nonabsorbable)

or ½ curve. Davis & Geck)  Pkg – Deep blue  Suture – Clear. penetrates w/out cutting. flattened)  Signs of heat. Ethicon. Surgilene.  Class IV – Dirty/Infected. tapered. round body. neurological.3 cutting edges.round shaft. flexible. open traumatic wound (more than 4hrs old). Highest rate of infection. cardiovascular. edge. non-absorbable.  Characteristics of a needle o Eye (where suture attaches). ground point wire. kidney or liver (friable. temporary support during healing o PTFE (Polytetraflouroethylene) – soft.effective in contaminated & infected wound. tapered. knots tied using endoscopic needle holder & knot pusher. lack of adherence promotes pull-out of suture. blunt. Endoscopic Suturing – Use of suture ligature through trocar cannula. o Point (cutting. #5 largest. used in infection or 2nd intention healing o Polyester – least inert of synthetics. perforated viscus. easy passage through graft w/out vessel damage. weak tissue).  Pronova o Type. wont penetrate in deep tissue. side. identified by Brown & Sharpe wire gauge numbers. delicate tissue – GI tract.ophthalmic.polymere blend of poly (vinylidene flouride) & poly (vinylidene fluoridecohexafloura-proplylene) o Absorption rate. Never used in infection – can harbor bacteria  Monofilament nonabsorbable suture o Polypropylen (Prolene. o Packaging color. hard to apply.round. microsurgical & retention typically 3/8 circle for skin closure. Suture & swaged needle inserted through cannula. French-eyed. microbial contamination prior to procedure. blunt). 5/8 circle. blue . or eyeless (swage). most inert. used for skin to prevent tear. redness. o Tissue reaction.not subject to degrading or weakening by enzymatic action. 11-0 smallest. Not to be used in infection o Stainless steel – ridgid. 3/8 circle. & ophthalmic surgery.nonabsorbable o Tensile strength.general soft tissue approximation. causes MOST DISCOMFORT.minimal o Common usage. blunt tip. Straight (Keith) ¼ circle. o Body (shaft) length determined by ‘bite’ of tissue. conventional. used in presence of infection. o Polyglacin 910 – absorbable. closed-eyed.royal blue o Suture color. o Shape ( o Other. excellent elasticity & high tensile strength. place small cut. ½ circle. reversetriangular. swelling & loss of function are in Phase 1  Mesh o Polypropylene – inert material. 27-40%.  Suture attaches to swage  Suture diameter is refered to as gauge of suture.

between two epithelium-lined surface opened at one end. bowel. sign is abnormal drainage  Needle Matching o PS – plastic surgery o FS – for skin o OS . occurs most after bowel. occurs highest in bladder. 30”)  Suture size 6-0 to 7-0 are used for small blood vessels  Herniation. 24”. usually discovered 2-3 months post-op  Sinus tract. tensile 70% @ 2 wks.Urology o KS – keith straight o S . bladder & pelvic procedures. coban.orthopaedic o UR . occurs often in lower abdominal incision. kerlix  Reverse cutting needle is used for skin  Conventional cutting needle has 3 cutting edges and places small cut in direction of suture pull . occurs more frequent in dark-skinned o Polybutester  Pkg – Seafoam green  Suture – undyed blue  Maxon suture – Polyglyconate (absorbable. pelvic  Keloid – hypertonic scar formation. silk. adhesive) used most frequently  Elastic bandage – (wrap) ace. kling. adhesive crinkled gauze.spatula o CP – cutting point  Montgomery straps – used in situations that require frequent dressing changes  Tape – (paper.o Pronova  Pkg – Royal blue  Suture . use corticoid injection & pressure dressing to reduce  Fistula – tract between 2 epithelium-lined surface opened at both ends. 55% 3 weeks)  Dressing – most absorbable layer is the intermediate or fine mesh gauze (iodoform)  Pre-cut ties in single strands are called Ligatures (18”.result of wound dehiscence.

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