Figure 10.4 Interrupted cruciate suture pattern. (With permission from Baines S, Lipscomb V and Hutchinson T (2012) Manual of Canine and Feline Surgical Principles. ResearchGate has not been able to resolve any citations for this publication. Table 10.2 suggests suitable choices of suture material for different tissues. 1. 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. Procedure: Simple interrupted suture Rationale: You have now formed the first throw. • Second intention – occurs where the edges are widely separated and / or where there is tissue loss. You can use either vertical or horizontal mattress sutures. Figure 10.15 A Chinese finger-trap suture used to secure an active suction drain. Rationale: This has now created a loop on the near side of the incision through which you place the piece of tubing. Synthetic Absorbable •Fully absorbed without foreign residues •Absorption by hydrolysis reaction •Ease of handling . Monofilament Interrupted cruciate suture – this is currently a popular type of suture formed by two linked simple sutures arranged as a figure-of-eight and tied with one knot (Fig. The incision may be enlarged if necessary and the flow of exudate can be accelerated by the use of gentle pressure over the surrounding area. Action: Using a sterile scalpel blade, make a stab incision into the skin overlying the abscess. (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.). Gloucester. 1. Rationale: The dressing should be of a type that will absorb the exudate. Rationale: The distance apart depends on the site and tissue of the wound. Size of suture material – there are two systems in use: the metric system and the United States Pharmacopoeia / European Pharmacopoeia system (USP / PhEur). Available in two types: a. 7. In amphibians, epidermal suture tension can cause dehiscence. Rationale: You can tie a full surgical knot if you want, but one throw is usually sufficient to anchor the tube. 4). Charles H. Koh. 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. There is also a lower viability of any bacteria that may stick to the material. Rationale: The suture material will be used to form the knot. The list of procedures has been arranged in alphabetical order. The most common type of abscess is that seen in cats resulting from bites and scratches. 2. (B, C) Needle body shapes and sizes. Suture needles It should be assumed that all are carried out under a general anaesthetic and that the surgical site has been prepared aseptically and draped appropriately. Action: Pass through the incision line and bring the needle up at an equal distance on the near side (Fig. 10.10A). (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) Action: Before you pull the suture material completely through, place a short length of the tubing under the suture on the near side and then pull the suture tight (Fig. If sutures are left in for too long then granulation tissue may cover the knots, making removal both difficult and painful. BSAVA Gloucester, p 289. Lembert suture – this is similar to the vertical mattress suture and is used to repair hollow organs. 5. Rationale: This creates a stitch at right angles to the incision. Continuous sutures are much quicker to do, but if one of the knots comes undone the entire line unravels. - Decrease blood supply to the wound edges. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.). Nerve • Type of tissue to be sutured A simple continuous pattern provides maximum tissue apposition and is relatively leak proof compared with a line of simple interrupted sutures. Figure 10.17 To bury a knot to start subcutaneous or intradermal sutures. If they are too far away from the edge, too great a thickness of tissue will be pulled up and may invert. Absorbable of long duration / non-absorbable. Standard surgical texts also refer to a simple continuous pattern (Smeak, 2012). Tissue adhesives have been available for some time, but the original ones had many problems so they were not widely used. Table 10.3 10.10) 3. Rationale: This will create a seal as the hole is vacated. We demonstrate in vivo three-dimensional (3-D) visualization of crystalline lens sutures in healthy eyes using swept source optical coherence tomography (SS-OCT). It is better to be proficient at a small range of suture patterns than to be bad at performing all of them. Running (continuous) sutures provide an adequate closure with even tension distribution as … Action: Place the next suture about 5 mm along the wound. A simple continuous pattern provides maximum tissue apposition and is relatively leak proof compared with a line of simple interrupted sutures. that are shortly or quickly severed and tied separately, There are only 2 knots within the tissue, they are not shortly or, internal hollow organs which their walls consist of 4 layers, (mucosa, submucosa, muscularis, serosa) such as GIT. Sutures, or stitches, are a way to close an open wound to speed healing and usually to ensure the least possible amount of scarring. material with the number 3 is much thicker than 3/0; 3/0 is thicker than 7/0). 10.14). 10.15) – This is a technique consisting of a series of knots that is used to secure a tube such as a suction drain to the skin. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) US Patent References: 3611551: N/A: 1971-10-12 ... are schematic views of a segmented suture needle pattern 110, in which the suture 13 is inserted in the hollow portion. 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. Action: Open the tips of the needle holders a little and grasp the short end of the suture material. 6. Knots They are useful to reduce patient interference and to eliminate the need for suture removal in sensitive areas (e.g. 10.10A). Suitable for all tissue types. Tissue Each individual suture is placed separately with its own knot so failure of one suture does not result in failure of the entire line. –Choose shortest instrument that will comfortably reach operative site –If cutting suture or non-tissue material, avoid using fine scissors –If possible, choose instruments in good repair . Figure 10.8 (A) Lembert suture pattern. The most commonly used and most versatile suture in cutaneous surgery is the simple interrupted suture. Chlorhexidine is an antiseptic, which will reduce the numbers of pathogens. 2. 5. • Each staple must penetrate all the layers of the tissue. This will create an unsightly suture line, which may take longer to heal or may scar. This is an everting suture. Examples of scissors, needle holders and forceps. Action: Knot the two ends together as described below. Slip knot – this is the same as a square knot except that the tension is uneven. Perhaps the biggest advantage of continuous suture patterns is 54 Hold the suture in your non-dominant hand and the needle holder in your dominant hand. If it is applied to skin there is slightly difficult to remove. 5. Common surgical procedures After Hoad 2006, p 106, Minor Veterinary Surgery with permission of Elsevier Butterworth-Heinemann. Figure 10.9 Gambee suture. The repair techniques are named the vertical lasso and horizontal lasso. This uses vertical mattress sutures and tubing from a giving set. It has drawbacks like poor knot security and poor stability in alkaline environment. • Check the staple or staple line for signs of haemorrhage, leakage or loose staples before leaving the site. Chlorhexidine is an antiseptic, which will reduce the numbers of pathogens. 10.6). 5. Procedure: Gambee suture (Fig. Rationale: The resulting suture line has sutures that are perpendicular to the incision below the tissue and advances forward above it (Fig. 1. BSAVA. Quickly memorize the terms, phrases and much more. Action: The wound should dry up and heal within a few days. 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. Rationale: This type of suture can be used in areas of tension as the pressure exerted by the horizontal sutures is spread evenly over a broad area, which reduces the likelihood of tearing through the tissue edges. 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. Action: Turn the needle around and insert it on the same side, but at a point approximately 4 mm from the incision edge (Fig. 10.12). A line of continuous sutures starts and ends with a knot, which decreases the amount of foreign material in the wound. Rationale: This will create a seal around the tube. c. Repair and treatment of corneal ulcers – requires experience as the consequences of accidental misapplication could be disastrous This type is often easier to do and may be the pattern of choice for the novice. Monofilament interrupted) or linked to the one on either side of it (i.e. Procedure: Gastrotomy continuous) 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. 8. If sutures are left in for too long then granulation tissue may cover the knots, making removal both difficult and painful. (B) Running simple continuous suture pattern. • 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. 3. Table 10.2 The more modern ones are much improved, but hand-sutured or stapled wound closure is still the method of choice. 4). Look it up now!. due to infection, movement between the edges or patient interference). Appositional suture patterns Interrupted intradermal (subcuticular) (buried knot) epidermis dermis subcutis 1 2 3 4 13. Slip knot – this is the same as a square knot except that the tension is uneven. Rationale: This will enable the purulent material to drain out more easily. (A) Lembert suture pattern. Figure 10.14 Quilled vertical mattress suture. Action: Pass through the incision line and bring the needle up through the tissue at an equal distance from the edge on the near side of the incision. They are mainly used in the skin or fascia. Healing by this method may take days, weeks or even months depending on the wound. Now form a knot, which will be buried within the incision line. Types of knot 10.13) – This technique may be used to close visceral stumps and to secure percutaneous tubes into a viscus such as may be seen in gastrostomy and cystostomy procedures. Subcutaneous sutures – these are placed in a simple continuous pattern below the skin and the bites of the suture lie vertical to the incision (Fig. Rationale: Gently allow this throw to form the knot to prevent the suture tightening excessively. - Greater stability in the event of partial failure (failure of. 10.4). To bury the knot, introduce the needle deep in the far subcutaneous or intradermal tissue passing it up into the tissue, across the incision and then down into the tissue on the near side (Fig. 5. Tissue adhesives – these are cyanoacrylate monomers that become strong insoluble polymers on contact with the water on tissue surfaces. Provide an easy and secure method of closing tissues such as the lung, liver and gastrointestinal tract, large vessels and vascular pedicles. SUTURES are used either for apposing tissues or for ligation, and a variety of different types of suture material is currently available. Rationale: This is the beginning of the second throw. Rationale: Left-handed surgeons should work in the opposite direction. 1. Rationale: The body should not be able to tip over or slip during the procedure and may be secured using tapes or other forms of support. Subcuticulis Box 10.1 outlines the factors to be considered in the use of surgical staples. Action: The patient should be sent home with antibiotics, NSAID analgesics and, if necessary, an Elizabethan collar. 5. Rationale: Use at least 500 ml of fluid to achieve total irrigation and cleaning. ii) In scaled vertebrate animals, it is imperative that the epidermis be closed in an everting suture pattern (mattress patterns) to facilitate approximation of the vascular component of the skin. 4. 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. 1. Procedure: Horizontal mattress suture Monofilament / multifilament – refers to the number of filaments that are twisted together to form a single strand. • Avoid burying any suture material from a multi-use cassette – there may be a risk of contamination from previous use. Adapted from Manual of Canine and Feline Surgical Principles. 10.6). Aberdeen knots had higher KHC and RKS than surgeon's or square knots for all suture types and number of throws (P<.001). Action: Position the anaesthetized patient in such a way as to maintain stability and provide optimal access to the site of the abscess. • Avoid using catgut in inflamed, infected or acidic wounds – absorption is more rapid in these wounds. Dew claws 10.7). Its tendency to decrease blood supply to skin edges. 4. You may add dilute chlorhexidine in a dilution of 1 : 40 if necessary. Action: Before you pull the suture material completely through, place a short length of the tubing under the suture on the near side and then pull the suture tight (Fig. Pulling the suture tight will hold the tubing in place.
1. sutures and it has good suture handling characteristics. This will create an unsightly suture line, which may take longer to heal or may scar. 4. This is a tension-relieving suture. There are various types of stapler designed for internal use and for repairing skin wounds and the staples themselves come in different sizes. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.) 10.9) Knots 4. Chapter 10 Procedure: Dew claw removal in neonatal puppies 3. There are many different types of sutures, just like there are many different kinds of procedures and injuries. Rationale: The dressing should be of a type that will absorb the exudate. Lembert suture pattern- The classical suture pattern for closing gut. Intradermal sutures – these are often used to replace skin sutures and to reduce scarring. Secure the suture with a knot, which should lie on top of the tubing. 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. 10.10A). 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. sutures in any pattern or direction. Absorbable / non-absorbable – this refers to whether the material remains in the tissue and has to be removed manually or whether it will lose its strength and subsequently be removed by phagocytosis or hydrolysis over a predestined period of time. Sylvie Korolenchuk says: 23/06/2020 at 6:46 pm Teaching a friend to crochet. Part 4 - Chinese finger knot (Roman sandal tie) Lab 3 . • inverting sutures turn the tissue edges inwards towards the lumen of an organ (e.g. Monofilament / multifilament 10.11A). Part 3 - Continuous patterns Lab 3 . (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.). Lembert suture definition at , a free online dictionary with pronunciation, synonyms and translation. • Using instruments – this is easier and more common than using hand tying and the advantage is that there is less wastage of suture material. Figure 10.6 Vertical mattress suture pattern. 1. Square knot – this is the most common type of knot and is used to anchor most suture patterns. 10.17), exiting deep in the incision line. Rationale: This is the same reason as no. Continue until you reach the end of the incision. 2. iii) The type of knot (Fig. Action: Repeat the process for the next suture, which should be about 4–5 mm away. All rights reserved. renal artery or vein) Suture Patterns Used for HollowSuture Patterns Used for Hollow OrgansOrgans 15. The number of throws required to make a secure knot also varies with each suture material and pattern (interrupted vs continuous). 2. Rationale: This is the outer layer of the area to be closed. 5. 5. If you insert the needle too close there will not be enough room to complete the manoeuvre correctly. Rationale: Each throw should be directly on top of the other if it is not to become a half-hitch (Fig. 10.16) – this is similar to the square knot except that the first throw has the strand of suture material thrown over the needle holders twice before the short strand is pulled through. Action: Open the tips of the needle holder a little and grasp the short end of the suture material and pull it through the loop. 4. Greater volume of material left in wound. 10.8). Tissue heals quickly as it is not reliant on suture for much more than 14–21 days It should be assumed that all are carried out under a general anaesthetic and that the surgical site has been prepared aseptically and draped appropriately. Removal is simple, but does require a removal device. 10.14). It may be necessary to roll the edges inwards with an instrument to achieve mucosal inversion and a tight seal. Avoid reactive materials in the creation of stoma. Action: Place a simple interrupted suture in the skin at a point close to the exit of the tube. Warming the fluid reduces cold shock. NB Even pressure must be applied to each end; if one end is pulled with greater tension than the other a half-hitch will form. 10.15). There are many types of suture material; the correct choice depends on the properties of the material, the nature of the wound, including the presence or absence of infection, the rate of healing of the tissue and the intended use of the suture. Action: Take one end between the thumb and forefinger of your left hand and the other end in your right hand and pass them over each in the front of the tube and form the first throw of a simple knot. 5. A. Purse ring suture (Fig. The tension applied to the knot is also important. 2. the skin), creating a smooth surface, • everting sutures turn the tissue edges outwards (e.g. Continuous horizontal mattress sutures – start with a simple interrupted suture and then continue with linked sutures as described above (Fig. 1. Rationale: The ends must be long enough to grasp with forceps during removal of the suture. Inverting suture patterns Lembert (interrupted or continuous) interrupted continuous 16. Welcome to Yarnandhooks, today we have brought you some of the most helpful instructions on how to make 50 and more crochet stitches in the best possible way. (Reproduced with permission from Stephen Baines, Vicky Lipscomb and Tim Hutchinson: BSAVA Canine and Feline Surgical Principles, 2012, originally illustrated by Samantha J Elmhurst.). Action: Pass across the incision and bring the needle up on the far side. • Avoid burying any suture material from a multi-use cassette – there may be a risk of contamination from previous use. Absorbable of short duration. This type of suture tends to be performed using non-absorbable suture material, with the sutures removed 10-14 days on average after wound closure (however, typically less than this for closures on the head and neck). A wide range of suture materials, patterns and sizes were used for the procedures included in the survey, clearly demonstrating the variable opinions of veterinary surgeons. • 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. Rationale: The suture will have moved along the tube. It apposes the tissue more effectively than a simple interrupted pattern and distributes the tension better. The interrupted suture is versatile. 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. Many types of instruments –Forceps, instruments for holding tissue –Needle holders –Scissors –Retractors Which instrument to use? 3. • Do not place too much tissue within the stapler. • everting sutures turn the tissue edges outwards (e.g. The knot should not be too tight unless it is used as part of a ligature for haemostasis. Absorbable vs Non-Absorbable. *After Hoad 2006, p 106, Minor Veterinary Surgery with permission of Elsevier Butterworth-Heinemann.
Monofilament / multifilament 1. Do not apply the adhesive too thickly or over a pool of blood or fluid and avoid burying the adhesive in deeper layers of tissue. Procedure: Quilled sutures • Avoid non-absorbable materials in hollow organs (e.g. Rationale: The knot should be positioned away from the incision (see simple interrupted above). Box 10.1 Basic considerations in the use of surgical staples* Secure the suture with a knot, which should lie on top of the tubing. Action: Pass across the incision and bring the needle up on the far side. 1. Rationale: One end attached to the needle will be longer than the other end, which should be about 2–3 cm long. More tension on the suture line will produce greater tissue eversion. Action: To finish the line, insert the needle back down into the tissue on the same side as it has just been brought out from and pass it across the incision to exit on the other side. Rationale: This is easiest to do using a curved needle. (See later description.). Rationale: This will prevent the introduction of new pathogens into the site. As the suture is tightened it inverts the tissues (Fig. Figure 10.11 Suture patterns: (A) subcutaneous; (B) intradermal. 1. Action: Sutures should be placed horizontally from right to left. Laparoscopic Suturing … This pattern is characteristic of the Paleozoic ammonoids. Rationale: The two lines of tubing help to spread the tension from the suture over a greater surface area. Two primary types of suture techniques exist: the continuous suture and the interrupted suture. The suture material has described a rectangle across the incision (Fig. Procedure: Castration in the rabbit Figure 10.4 Interrupted cruciate suture pattern. Action: Take the needle across the incision and bring it up through the tissue on the opposite side. Pulling the suture tight will hold the tubing in place. Rationale: The locking effect means that the line is less likely to unravel as a result of patient interference. Procedure: Ford interlocking suture (Fig. The type of suture material – multifilament suture materials tend to have better knot-holding ability than monofilament suture materials (Table 10.1). Surgical staples – these cause little or no tissue reaction and they provide excellent tissue apposition and haemostasis. Using a knot with a minimum number of throws will reduce bacterial resistance. Sutures may be placed in two main types of patterns Surgery: suture patterns - basic patterns : Interrupted. Rationale: This is the beginning of the second throw. Action: Holding the needle with needle holders, place a simple interrupted suture and knot it, but cut only the end of the suture material that is not attached to the needle. In any wound you should always consider trying to bring the edges together to promote rapid healing and this requires the use of suture material and needles and knowledge of an appropriate suturing technique. • The way in which the tissues are apposed: Ovariohysterectomy 10.16) formed tends to depend on the surgeon’s technique. The type of suture and needle used. Action: Chronic abscesses may have a thick fibrous lining that should be debrided and then reflushed. Interrupted suture patterns. 6. PDF | suture patterns as a Practical surgery of 4th stage | Find, read and cite all the research you need on ResearchGate There are many different types of sutures, with the most commonly used one called the interrupted suture.Among many others, additional types of sutures include running sutures and mattress sutures. For details of these procedures see Chapters 8 and, Medical diagnostic and treatment techniques, Restraint, handling and administration of medication, Clinical Procedures in Small Animal Veterinary Practice, Absorbable of short duration. In any wound you should always consider trying to bring the edges together to promote rapid healing and this requires the use of suture material and needles and knowledge of an appropriate suturing technique. Despite various modifications, the Wise keyhole pattern is the golden standard in planning the amount of reduction to be performed on the hypertrophic breasts [1–4]. 10.10). Rationale: This locks the previous suture in place. The disadvantages are the additional expense and the time taken to master the technique. 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. • By hand – this technique is useful in confined or hard-to-reach spaces or when sutures have been preplaced (e.g. 7. Specialized suture techniques 10.11B) and the suture line is completed with another buried knot. reduction or augmentation surgery would be required. 6. Rationale: The gap between each knot should be about 0.5–1 cm. a. Figure 10.16 Types of knot. 3. Excessive tension may strangulate the tissue and will cause the patient some discomfort, which may lead to patient interference. Action: Open the tips of the needle holders a little and grasp the short end of the suture material. 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