5. • The way in which the tissues are apposed: • simple interrupted sutures restore and align the anatomical surface of the tissue (e.g. All rights reserved. There is an enormous range of suture patterns; if a wound is to heal satisfactorily it is important to choose a pattern that will both close an incision and provide maximum mechanical support with minimal tissue reaction. One strand is held with more upwards pressure, resulting in a knot that can slide easily to tighten or to loosen. a stick). Suture materials are required for a variety of purposes during surgery including: Rationale: This interlocking suture is a form of ‘blanket stitch’ and can be placed quite quickly. Jun 30, 2020 - Explore Jose Reynosa's board "Suture types" on Pinterest. Suture patterns are typically categorised as: 1. continuous or interrupted 2. inverting, appositional, or everting 3. the effect the suture pattern has on wound tension.The choice of using interrupted versus continuous suture patterns still remainscontroversial. 1. • Check that the tissue is correctly aligned within the stapler and that no other tissues are caught up before firing the stapler. Procedure: Castration in the young cat 6. Box 10.1 Basic considerations in the use of surgical staples*. 3. Interrupted suture patterns. 2. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) Sutures are used to close wounds SUTURE COMPONENTS A) THREAD B) NEEDLE TYPES OF THREAD Surgical suture material can be classified on the basis of the characteristics absorbability, origin of material and thread structure. 10.13). Each individual suture is placed separately with its own knot so failure of one suture does not result in failure of the entire line. Setting time varies between 2 and 60 seconds depending on the thickness of the glue layer, the amount of moisture and the chemical makeup of the adhesive. There should be very little evidence of scarring. The advantages are that there are fewer knots, making it quicker to place, and the tension is spread better over a larger area than it is with a simple suture. 10.10A). 10.11A). rodents) where the wound is very small. Rationale: Use at least 500 ml of fluid to achieve total irrigation and cleaning. Figure 10.9 Gambee suture. Monofilament / multifilament 10.12) The tension applied to the knot is also important. Rationale: This will allow you to pull the suture tight and will be used to tie the knot. Fascia This will create an unsightly suture line, which may take longer to heal or may scar. It is better to be proficient at a small range of suture patterns than to be bad at performing all of them. Each staple must penetrate all the layers of the tissue. Rationale: The suture material has made a horizontal line parallel to the edge of the wound (Fig. 2. Joseph L. Hudgens, RP Pasic. Action: Holding the needle with needle holders, insert the needle approximately 8–10 mm away from the edge of the incision on the far side (Fig. Rationale: The path described by the suture material is a line at right angles to the incision. Basic components of suture needles recent developments in cranial cruciate repair, bowel surgery or orthopaedic surgery), knowledge of which may be gained by attendance on training courses, tuition by more experienced members of the veterinary profession both within your practice and in other practices, reading up-to-date journals and research via the internet. All needles, with the exception of straight ones, should be held in needle holders, which will provide control as the needle is pushed through the tissue and, when using cutting needles, will protect your gloves or fingers. If the tissue is delicate you hold the needle closer to the suture material end, and closer to the point for tougher tissues. • Whether each suture is individually placed (i.e. 2. Action: The patient should be sent home with antibiotics, NSAID analgesics and, if necessary, an Elizabethan collar. sutures and it has good suture handling characteristics. Rationale: The suture will have moved along the tube. 2. 10.14) – A quill is material such as a piece of rolled gauze or a piece of tubing from an old giving set that is used to distribute the tension of a suture over a greater surface area. Specialized suture techniques a. Cutaneous wounds and incisions Reduction in tissue handling and trauma rodents) where the wound is very small. A non-absorbable multifilament (e.g. Over time this wastage becomes very expensive! 12. Interrupted - each stitch is cut and tied as a separate entity : Advantages: Allow precise adjustment of tension along the length of wound. 5. Suitable for all tissue types. Ceratitic - lobes have subdivided tips, giving them a saw-toothed appearance, and rounded undivided saddles. Procedure: Castration in the dog using the open method 2. BSAVA. It is modified of simple continuous suture technique. Action: Leave both ends of the suture material long. Action: Clean and dry the surrounding area and leave the wound open to drain. 1. Rationale: This will allow sufficient space to place the mattress suture at right angles to the line of the incision (Fig. Rationale: This interlocking suture is a form of ‘blanket stitch’ and can be placed quite quickly. Avoid using catgut in inflamed, infected or acidic wounds – absorption is more rapid in these wounds. Procedure: Castration in the mature cat Action: The site should be clipped and prepared aseptically and sterile drapes should be placed over the patient and around the abscess. 4. Muscle 1. Action: Tie a knot with the two ends of the suture material. Suture removal – sutures should be removed once there is sufficient healing to prevent the wound reopening. As a general rule when selecting suture material, consider the following: • Avoid multifilament material in contaminated wounds – there is a risk of ‘wicking’ and the spaces between the strands may harbour blood, which will become a medium for bacterial growth. 11. 4. For example, as a rough guide, a mass closure of a midline laparotomy may warrant use of PDS, a vascular anastomosis will probably require prolene, a hand-sewn bowel anastomosis may need vicryl, and securing a drain may need a silk suture. 8. Rationale: Monofilament suture material will not ‘wick’ up the infection. 4. Rationale: This is the beginning of the second throw. Now form a knot, which will be buried within the incision line. Lumpectomy A Chinese finger-trap suture used to secure an active suction drain. Both systems are usually displayed on the packaging. • The way in which the tissues are apposed: Because of the variations in the clinical presentation of asymmetric breasts, differ-ent combinations of either, Join ResearchGate to discover and stay up-to-date with the latest research from leading experts in, Access scientific knowledge from anywhere. There are various types of stapler designed for internal use and for repairing skin wounds and the staples themselves come in different sizes. 10.5). Cause more inflammation owing to 4 penetrations by, Consist of series of simple interrupted sutures that are tied at the, Minimal amounts of knots within tissue (only 2 knots). Choice of suture material for different tissues* Rationale: This is easiest to do using a curved needle. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) 5. Setting time varies between 2 and 60 seconds depending on the thickness of the glue layer, the amount of moisture and the chemical makeup of the adhesive. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) Chapter 10 The suture bites are parallel to the line of the incision. Action: To end the line of sutures, tie a knot using the suture material attached to the needle and the last loop of suture that is exterior to the tissue. Action: Pull up the ends of the suture around the tube and tie the ends together (Fig. Rationale: This creates a stitch at right angles to the incision. Rationale: This will reduce the risk of introducing pathogens into the wound and the risk of acquiring infection from the patient. Gloves and safety glasses are recommended. Action: Holding the needle with needle holders, place a simple interrupted suture and knot it, but only cut the end of the suture material that is not attached to the needle. • Carefully remove the stapler after firing to prevent disruption of the staple or the staple line. Procedure: Treatment of an aural haematoma The knot must be left offset from the wound and not resting in the incision (Fig. Figure 10.2 Examples of scissors, needle holders and forceps. Action: Pull up the ends of the suture around the tube and tie the ends together (Fig. The suture is started by burying the knot in the dermis (see later description) and the suture line lies intradermally. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) Usually subjected to removed by biting, licking or. Action: The patient should be sent home with antibiotics, NSAID analgesics and, if necessary, an Elizabethan collar. Interrupted sutures take longer to do, but they are the most common type. Action: Chronic abscesses may have a thick fibrous lining that should be debrided and then reflushed. Neutering A modified Gambee is placed in the same way, but does not penetrate the lumen of the intestine. 12. 3. Running simple continuous sutures (Fig. Loop the suture away from you around the needle holder twice, then grasp the suture end with your needle holder. This suture will be the anchor for the rest of the suture line. Absorbable of long duration / non-absorbable (Fig 10.12). Sutures are used to close wounds … Knots Rationale: Each throw should be directly on top of the other if it is not to become a half-hitch (Fig. A surgeon’s knot is asymmetrical so must be followed by a square knot on top to ensure security. The technique may be one handed, which is useful in small spaces, or two handed, which allows better control. Action: Cut the suture material on either side, leaving the ends about 2–3 mm long. Specialized suture techniques post castration or in fractious patients). (B) Running simple continuous suture pattern. The needle should be grasped by the tips of the needle holder at a point on the needle that is one-third to half of the way along the needle from the suture material end. Table 10.3 and Figure 10.1 describe the basic components of suture needles. Procedure: Simple interrupted suture Common Surgical Procedures Synthetic / non-synthetic or natural – natural materials tend to cause a considerable tissue reaction and catgut in particular cannot be depended upon to produce reliable knots so these materials are no longer recommended. Reduction in surgical time, which is of benefit to critically ill patients, Reduction or elimination of contamination by intestinal contents. Action: Move about 6–8 mm along the incision and reinsert the needle into the tissue on the near side. Action: Repeat as you go along the incision (Fig. 5. • Each staple must penetrate all the layers of the tissue. Plain Gut resorption rate from 3 to 5 days. Many types of instruments –Forceps, instruments for holding tissue –Needle holders –Scissors –Retractors Which instrument to use? The tension applied to the knot is also important. 10.17), exiting deep in the incision line. sutures is not advocated (e.g., facial flaps), the skin sutures may need to remain in place for a longer time.Table 1gives general guidelines for suture removal times. 10.6). Action: Pass through the incision line and bring the needle up at an equal distance on the near side (Fig. Rationale: This will enable the purulent material to drain out more easily. f. Useful in small species (e.g. sutures veterinary surgeons should always consider which is the appropriate suture material, surgical needle and suture size for a given tissue and be familiar with suture characteristics and tissue requirements. There are many knots within the tissue (more than 2 knots), means these techniques which are used for suturing of, Include these techniques which are used for suturing of, Include these sutures that are used restrictedly for, Its ability to maintain strength and tissue position if part of, -Decreased tissue edema following closing compared with. Action: Continue to place a line of interrupted vertical mattress sutures along the incision line so that each one helps to hold the piece of tubing in place (Fig. Action: Abscesses with a large dead space may be partially closed with a Penrose drain in place (see below). 2. Action: Pass through the incision line and bring the needle up at an equal distance on the near side (Fig. 1. Non-absorbable Only gold members can continue reading. 10.5). The use of surgical staples does not compensate for poor surgical technique and may bring its own problems. • Use 3 metric for dogs and 2 metric for cats. 10.3A). (B) The position of the knot in relation to the incision. As the holding layer of an organ is the submucosa, the needle should penetrate only to this depth and never into the lumen. The drapes will help to absorb fluid, thus preventing the patient becoming excessively wet during the flushing of the abscess. 7. Abscesses Procedure: Simple continuous suture (Fig 10.12). Sutures, or stitches, are a way to close an open wound to speed healing and usually to ensure the least possible amount of scarring. • Select the correct size of staple – the staple must be able to close the tissue securely. Rationale: The ends must be long enough to grasp with forceps during removal of the suture. Another excellent way to learn and become practically proficient is the use of cadavers, although you should consider the moral and ethical issues associated with this. Action: Bring the needle up on the opposite side 2–5 mm away from the tissue edge (Fig. material with the number 3 is much thicker than 3/0; 3/0 is thicker than 7/0). • Use slowly absorbable materials in fascia or tendons – the rate of healing is slow and the tissue requires the support of the sutures for some time. The bites of the suture lie parallel to the line of the incision (Fig. Figure 10.9 Gambee suture. This technique is chosen when there is significant gapping of wound edges or dead space deep in the laceration. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.). (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) renal artery or vein). Remember that there are two throws in a square knot. Pulling the suture tight will hold the tubing in place. In this technique, your absorbable suture would be used to bury the knot at the lowest point of the wound. The types of material (Table 10.1) can be broadly divided into: Suture materials commonly used in practice*. Figure 10.13 Purse ring suture. Tension on the tube increases as the tube is pulled, thus preventing its removal. • Avoid burying any suture material from a multi-use cassette – there may be a risk of contamination from previous use. A. Purse ring suture (Fig. Continuous horizontal mattress sutures – start with a simple interrupted suture and then continue with linked sutures as described above (Fig. The drapes will help to absorb fluid, thus preventing the patient becoming excessively wet during the flushing of the abscess. Reduction in surgical time, which is of benefit to critically ill patients In general, a minimum of three throws is required to form a secure knot when using an interrupted pattern (more throws are required for many suture materials). Simple Interrupted Suture. Multifilament / monofilament 5. Action: Insert the needle on the opposite side perpendicular to and 5 mm along the incision. It can be time consuming to remove as each loop must be cut individually to avoid pulling suture material that has been exposed to the external environment through the inner tissues of the wound. There are many different types of sutures, just like there are many different kinds of procedures and injuries. The most commonly used suture patterns and knots are described and illustrated, along with Information on suture materials and surgical needles used for sutures and knots It is our hope that this handbook will be useful to medical students and residents as a quick guide to basic suture patterns and methods of knot tying. 2. 5. 5. Study Flashcards On Surgery lecture 6 Sutures & suture patterns at Cram.com. (A) Basic components of a needle. Action: Holding the needle with needle holders as described above, introduce the needle through the tissue on the far side (or right side) of the wound 2–5 mm away from the tissue edge (Fig. Lembert sutures). One strand is held with more upwards pressure, resulting in a knot that can slide easily to tighten or to loosen. Action: Knot the two ends together as described below. Rationale: The short end is the end without the needle. This type is often easier to do and may be the pattern of choice for the novice. Look it up now!. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.). The use of tissue glue has proved to be effective in: This is a specialized suture used in the repair of the intestine. 3. Rationale: The dressing should be of a type that will absorb the exudate. The final knot is made by taking a “bite” of the second to last pass though the tissue and tied in the usual fashion. The list of procedures has been arranged in alphabetical order. • Avoid reactive materials in the creation of stoma. the skin), creating a smooth surface • Type of tissue to be sutured Jul 24, 2016 | Posted by admin in SMALL ANIMAL | Comments Off on Suturing techniques and common surgical procedures, Suturing techniques and common surgical procedures, Procedure: To tie a Chinese finger-trap suture, Procedure: Tying a square knot using instruments, Procedure: Surgical treatment of abscesses in dogs and cats, Procedure: Surgical treatment of abscesses in rabbits, Procedure: Placing a Penrose drain in an abscess, Procedure: Treatment of an aural haematoma, Procedure: Cystotomy for the removal of cystic calculi, Procedure: Dew claw removal in neonatal puppies, Procedure: Dew claw removal in adult dogs, Procedure: Ovariohysterectomy in the bitch, Procedure: Ovariohysterectomy in the queen, Procedure: Castration in the dog using the open method, Procedure: Castration in the dog using the closed method. Each individual suture is placed separately with its own knot so failure of one suture does not result in failure of the entire line. Part 5 - Suture … 10.10) • Using instruments – this is easier and more common than using hand tying and the advantage is that there is less wastage of suture material. The authors have devised a technique for individualized keyhole pattern in the treatment of asymmetric breasts, when the surgical solution is simply the reduction and reshaping of the larger breast to fit to the smaller one. The needle must not penetrate into the lumen and the suture bites are placed perpendicular to the incision as in the vertical mattress suture pattern. • Apposing tissues to facilitate rapid healing Action: Place a simple interrupted suture and leave the two ends of suture material free. SUTURES are used either for apposing tissues or for ligation, and a variety of different types of suture material is currently available. Action: Tie a knot with the two ends after applying the appropriate tension. Gloves and safety glasses are recommended. The type of suture material – multifilament suture materials tend to have better knot-holding ability than monofilament suture materials (Table 10.1). 4. 10.16). Be careful not to pull the suture right through the wound as you will then have to repeat it. Knot security depends on: • In the USP / PhEur system, larger numbers represent suture material of a larger diameter while numbers followed by zero represent smaller sizes (i.e. This suture will be the anchor for the rest of the suture line. Synthetic materials produce little tissue reaction. Cystotomy 10.16). Patterns of Axillary Surgery in DCIS Patients Within the US National Cancer Database. Figure 10.10 (A) Standard simple continuous suture pattern. Square knot – this is the most common type of knot and is used to anchor most suture patterns. 4. Action: Knot the two ends together as described below. Monofilament material with the number 3 is much thicker than 3/0; 3/0 is thicker than 7/0). The suture material has described a rectangle across the incision (Fig. Rationale: The dressing should be of a type that will absorb the exudate. A separate composite score is provided for the vault sutures (mid-coronal, bregma, anterior sagittal, obelion, lambda, and mid-lambdoid) and lateral-anterior sutures (sphenofrontal, pterion, mid-coronal, inferior sphenotemporal, and superior sphenotemporal). • Never use staples in tissues that are inflamed, oedematous or necrotic. Appositional sutures are … 10. The images were also changed in Adobe Photoshop® 4 to grayscale (not RGB color). The knot should have a minimum number of throws. This is a specialized suture used in the repair of the intestine. Lab 3 . The type of knot (Fig. Action: In most cases the wound is left open to drain and to heal by second intention, but in some cases it may be necessary to place a suitable dressing (see Ch. 5. 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