VM 733 – Spring 2012 Lectures 4 and 5 - Suture ... - CSU PVM 2014

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Surgical Knots Buried intradermal --series of connected simple interrupted --crosses the wound on the diagonal --pay attention to spacing and tension --tie across to last raised loop --if too tight will necrose, evert, or invert Simple continuous Simple interrupted VM 733 – Spring 2012 --usually appositional, but can evert or invert if too tight --mild to moderate effect on tension --commonly utilized for skin closures --two simple interrupted passes in the Interrupted cruciate same horizontal plane, tie to form 'X' across incision Continuous Ford interlocking --less likely to fail with breakage or knot loosening --better tissue apposition --greater tissue stability Continuous intradermal (Modified horizontal mattress) BUT takes more material and time and --placed within dermis (subcuticular) may cut into tissue if under too much --begin with buried, interrupted knot tension --pass sutures in dermis parallel to incision --each passage is linked to previous --good for opposing edges passage --need absorbable suture & a cutting needle --lass pass is a backhand pass across
--unlike vertical, instead of staying in same vertical plane, move horizontally before making backhand pass VM 733 – Spring 2012 --can be more traumatic than vertical because they cover more area, but stronger as a result --may interfere with blood supply to edges of skin --forehand pass then backhand pass vs. pulley which is forehand pass, cross incision, then forehand again --no suture material on top of the incision line --apposition to slight eversion --relieves tension Interrupted horizontal mattress with and without stents Near and far mattresses --tension relieving --variation of vertical mattress aka Pulley (relative to the incision) Interrupted vertical mattress Lembert --for closure of hollow viscera --suture passed perpendicular to Cushing (above); Connell (below) incision --for closing hollow viscera --suture enters and exits tissue on the --continuous same side of the incision --suture passed parallel to incision --partial thickness From Slatter D (ed.), Textbook of Small Animal Surgery, 2003, pp215-220 --Cushing - partial thickness --often used as second layer on a --Connell - full thickness (ends up in double layer pattern lumen) --inverting --submucosa is the holding layer for viscera, so she prefers Connell because it ensures you get that layer
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Page 3: Hand Ties VM 733 - Spring 2012 Hand

VM 733 – Spring 2012 Lectures 4 and 5 - Suture ... - CSU PVM 2014

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