Suture Techniques

  • What is a taper-point needle?
    • Round body:
      • Leaves a round hole in tissue:
        • Spreads without cutting tissue
    • What is it used for?
      • Suturing of soft tissues other than skin:
        • For example:
          • GI tract, muscle, nerve, peritoneum, fascia
  • What is a conventional cutting needle?
    • Triangular body with the sharp edge toward the inner circumference:
      • Leaves a triangular hole in tissue
    • What are its uses?
      • Suturing of skin
  • What is a simple interrupted stitch?
  • What is a vertical mattress stitch?
    • Simple stitch is made;
      • The needle is reversed, and a small bite is taken from each wound edge:
        • The knot ends up on one side of the wound
  • What is the vertical mattress stitch also known as?
    • Far–far, near–near stitch:
      • Oriented perpendicular to wound
  • What is it used for?
    • Difficult-to-approximate skin edges:
      • Everts tissue well
  • What is a simple running (continuous) stitch?
    • Stitches made in succession without knotting each stitch
  • What is a subcuticular stitch?
    • Stitch (usually running) placed just underneath the epidermis:
      • Can be either absorbable or non-absorbable:
        • Pull-out stitch if non-absorbable
  • What is a purse-string suture?
    • Stitch that encircles a tube perforating a hollow viscus:
      • For example:
        • Jejunostomy tube
        • Gastrostomy tube:
          • Allowing the hole to be drawn tight and thus preventing leakage
  • What are metallic skin staples?
  • What is a staple removal device?
  • What is a gastrointestinal anastomosis (GIA) device?
    • Stapling device that lays two rows of small staples in a hemostatic row:
      • And automatically cuts in between them
  • What is a Lembert stitch?
    • It is a second layer in bowel anastomoses
    • Technique:
      • The needle is inserted perpendicular to the epidermis, approximately 8 mm distant to the wound edge.
      • With a fluid motion of the wrist, the needle is rotated superficially through the dermis, and the needle tip exits the skin 2 mm distant from the wound edge on the ipsilateral side.
      • The needle body is grasped with surgical forceps in the left hand and reloaded onto the needle driver.
      • The needle is then inserted perpendicular to the skin on the contralateral side of the wound edge, 2 mm distant from the wound edge.
      • The needle is again rotated superficially through its arc, exiting 8 mm from the incised wound edge.
      • The suture material is then tied off gently, with care being taken to minimize tension across the epidermis and avoid overly constricting the wound edges
  • What is a Connell’s stitch?
    • The first mucosa-to-mucosa layer in an anastomosis:
      • Basically, a running U stitch
    • The Cushing and Connell suture technique:
      • Is often used to close the incisions in hollow organs such as the stomach, urinary bladder, and uterus
    • In the Cushing suture technique:
      • The suture penetrates into the submucosa without penetrating the organ lumen
      • The suture runs from both sides of the incision:
        • Parallel to each other
    • The Connell suture technique is almost identical to the Cushing suture technique:
      • These two suture techniques are separated according to the tissue they penetrate during suture passage
      • While the Cushing suture technique is also passed through the submucosa, Connell suture technique is used to pass through the lumen
    • While applying these techniques, the following steps are followed:
      • A directionally opposed suture passage is made parallel to the incision.
      • Suture passage is made from the other side of the incision in the same direction as the incision, parallel to the first passage
      • The beginning of the suture line is fixed with a knot.
      • Starting from the back of the knot, a suture passage is made in the direction of the incision
      • A passage is made from the other side of the incision parallel to the first pass and in the same direction
      • When the suture is pulled, the tissue becomes inverted and the knot is buried under the skin
      • A suture passage is made in the direction of the incision
      • A passage is made from the other side of the incision parallel to the first pass and in the same direction
      • The last two steps are repeated throughout the incision
      • After the incision line is crossed, End of suture line is fixed by repeating first three steps
  • What is a suture ligature (a.k.a. “stick tie”)?
    • Suture is anchored by passing it through the vessel on a needle before wrapping it around and occluding the vessel:
      • Prevents slippage of knot-use on larger vessels

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