Sutures 2010 Web
Transcript of Sutures 2010 Web
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SUTURE PATTERNS AND CLINICAL
APPLICATIONS or the sewing course for surgeons
Susanne Lauer
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Purpose
Provide strength during lag phase
Promote tissue appositionprimary wound healing (fast)
water-tight seal to hollow organs
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Classification
How performed (placed) Interrupted (single sutures)
Continuous (sutures linked)
How tissues are affected Appositional
Inverting
Everting
How much tissue suture spans Simple
Mattress
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Advantages and Disadvantages
Interrupted Continuous
1. If one fails, remainder
unaffected
1. Failure of one portion
-> failure of entire
suture line
2. More knot tying
-> more sx time
2. Quicker
3. More suture materialimplanted
3. Less suture material
4. More knots
-> more irritation
4. Less knots
-> less irritation
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Appositional Sutures
Allows healing of like tissue layers
More physiologic
Early strength (functional fibrin adhesions) Maintains lumen
Equal seal of hollow organs compared to
inverting and everting patterns
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Appositional Suture patterns
Simple Interrupted
Gambee
Interrupted Intradermal or Subcuticular Interrupted Cruciate or Cross Mattress
Simple Continuous
Continuous intradermal or subcuticular Ford Interlocking
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Simple Interrupted Gambee
Interrupted Subcuticular
Appositional Suture Patterns
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Interrupted Cruciate Simple Continuous
Continuous Intradermal
Appositional Suture Patterns
Ford Interlocking
Appositional Suture Patterns
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Inverting and Everting Patterns
Non physiologic healing
More scar tissue,
More reaction, due to microabscesses Inverting -> less peritoneal adhesions
As single layer, not stronger than other patterns
Compromises lumen size Good water-tight seal
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Inverting Suture Patterns
Lembert
Halsted
Cushing Connell
Parker Kerr
Purse String
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Interrupted Lembert Continuous
Inverting Suture Patterns
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Inverting Suture Patterns
Halsted
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Parker-Kerr
Inverting Suture Patterns
Purse
String
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Suture Pattern Terminology
Suturing or Sewing
Suture not Stitch
Bite = span of tissue that suture encompasses
on either side of incision Bite is often referred to for: Distance
Orientation in relation to incision Spacing
Placement order, technique
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Suture Pattern Terminology
Short end (tag) = end of suture
Long end (tag) = end with needle
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Knots
Weakest point of
suture
Each phase of knot= throw
Need at least 2
throws for knot
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Square Knot
Knot must be tied as
square to be secure
Need to interchange
the strand that goes
over the top (left over
right / right over left)
If same strand overthe top -> granny
knot
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Slip Knot
Can be created during
either throw of a square
knot
If knot not tied flat
Not secure
But, can be advantageous
when tension present
(needs additional secure
throws)
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Surgeons Knot
Indication: moderatetension across incision
First throw with two
passes, followed bysecond throw with asingle pass
Subsequent knots arestandard (single pass)
Do NOT use, if notneeded -> too muchirritationbulky!
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How many knots to be safe?
Interrupted sutures: 4 throws
Continuous sutures: 5 throws
Further increase in throws -> does not increase
strength
If knot weak -> increase diameter of suturematerial
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Knot placement
Standard -> superficial
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Knot placement
Buried knot
Indication:
Subcutaneous tissue
On deep surface
Knot not exposed
Interrupted
Continuous
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Suture Placement and Knot Tying
Suture placementHand placement In flat tissue planes
Large straight needlesNeedle holder placement Difficult access areas
Smaller needles
Knot tyingBy hand or using the needle holder
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Downloaded from: Small Animal Surgery, 3/e (on 22 February 2010 05:20 PM)
2007 Elsevier
Knot Tying with Needle Holder
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Mattress Sutures
Interrupted Vertical mattress
Interrupted horizontal mattress
Quilled Near and far
Stent
Continuous horizontal mattress Locking Loop
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Tension Suture Patterns
Interrupted
vertical
mattress
Interrupted
horizontal
mattress
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Tension Suture Patterns
Quilled Far to near
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Kessy, 3y, F, Rottweiler
Bred 71 d ago
1st litter
HBC 2y prior(pelvic fract.)
Greenish fluidfrom vulva 8hago
No pup yet
Strong contractions
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Kessy, 3y, F, Rottweiler
Abd radiographs:
7 pups, one fetus
in vaginal canal;malunion of
pelvic fractures
CBC, chemistryunremarkable
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Dystocia, Cesarian Section
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Dystocia, Cesarian Section
How to close ???
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Uterine closure
1-2layer
3-0, 4-0
absorbable
taper-point
Simple contin
+/- Cushingsor Lembert
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Abdominal closure
How to close ???
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Abdominal closure
External Rectussheath!!!!!!!
Absorbablesimple interruptedor continuous
(depending onexperience)
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Interrupted/Continuous Advantages ?
Interrupted
Tension precisely adjustable
Continuous Speed
More air & watertight seal
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Interrupted/Continuous Disadvantages?
Interrupted
More foreign material
Poor suture economy
Time consuming
Continuous
Suture breakage = Disaster
Less precision
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Subcutaneous Subcuticular
Deadspace and Approximation
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Burying the knot