Susanne Lauer
Purpose
Provide strength during lag phase Promote tissue apposition primary wound healing (fast) water-tight seal to hollow organs
Classification
Continuous 1. Failure of one portion -> failure of entire suture line 2. Quicker
3. Less suture material 4. Less knots -> less irritation
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
Simple Interrupted
Gambee
Interrupted Subcuticular
Interrupted Cruciate
Simple Continuous
Continuous Intradermal
Ford Interlocking
Connell
Cushing
Interrupted
Lembert
Continuous
Halsted
Parker-Kerr
Purse String
in relation to incision
order, technique
end (tag) = end of suture Long end (tag) = end with needle
Knots
Weakest point of suture Each phase of knot = throw Need at least 2 throws for knot
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 over the top -> granny knot
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)
Surgeons Knot
Indication: moderate tension across incision First throw with two passes, followed by second throw with a single pass Subsequent knots are standard (single pass) Do NOT use, if not needed -> too much irritation bulky!
Further increase in throws -> does not increase strength If knot weak -> increase diameter of suture material
Knot placement
Knot placement
Interrupted
Buried knot
Indication:
Subcutaneous
Downloaded from: Small Animal Surgery, 3/e (on 22 February 2010 05:20 PM) 2007 Elsevier
Mattress Sutures
Interrupted Vertical mattress Interrupted horizontal mattress Quilled Near and far Stent Continuous horizontal mattress Locking Loop
Quilled
Far to near
Bred 71 d ago 1st litter HBC 2y prior (pelvic fract.) Greenish fluid from vulva 8h ago No pup yet Strong contractions
Uterine closure
1-2layer 3-0, 4-0 absorbable taper-point Simple contin +/- Cushings or Lembert
Abdominal closure
Abdominal closure
Interrupted/Continuous Advantages ?
Interrupted
Tension
precisely adjustable
Continuous
Speed More
Interrupted/Continuous Disadvantages?
Interrupted
More
Continuous
Suture
Subcutaneous
Subcuticular