SUTURE PATTERNS.ppt

SUTURE PATTERNS

1. Suture Patterns
Interrupted
–simple
–horizontal mattress
–vertical mattress
Running (continuous)
–simple
–subcuticular

2. Suture Patterns
Look at on the effect on wound margins:
Interrupted vs Continuous or
running
1. Appositional
2. Everting
3. Inverting

3. Simple interrupted* (A)
Vertical mattress* (A)
Cruciate mattress* (A)
Horizontal mattress* (E)
Simple continuous* (takes care)
May be everting (under tension)
Appositional (approximating)
Suture Patterns

4. Simple interrupted*(A)
Vertical mattress* (A)
Cruciate mattress* (A)
Horizontal mattress* (E)
Interrupted
Suture Patterns
Lembert (I)
Halstead (I)

5. Simple Interrupted

6. Vertical
Mattress
Horizontal
Mattress

7. Cruciate Mattress

8. Simple Subcuticular

9. Cruciate Mattress
Prevents eversion of tissue edges
Forms an “X” when tied
Requires ½ number of knots vs.
simple interrupted pattern

10. Simple Subcuticular

11. Features of Interrupted
Patterns
Every suture has a knot
More precise tissue
apposition
Less efficient to place

12. Features of Continuous
Patterns
Beginning and ending knots only
More efficient
Potential for catastrophic failure
Less exact control of wound edges
Less knot security on ending knot

13. Examples of Continuous
Patterns
Simple Continuous
Continuous lock
Horizontal mattress
Lembert*
Cushing*
Connell*
Purse -string

14. Simple Continuous
Used frequently
(on SQ tissue)
Efficiently placed
“Whip stitch”
“Baseball stitch”
Features

15. Continuous Lock
stitch
“Blanket stitch”
Easier to place
as solo surgeon
Features

16. Horizontal Mattress
Used more
frequently
as an interrupted
pattern
Features

17. Everting (edges rolled out)
Horizontal mattress*
Continuous lock -tension
Simple continuous* -
tension
Everting (edges rolled out)
Suture Patterns

18. Lembert* (interrupted & contin.)
Halstead
Cushing*
Connell*
Purse -string
Parker -Kerr
Inverting (edges rolled in)
Suture Patterns

19. Lembertsuture pattern
Second visceral
layer
More commonly
used as a
continuous
pattern
Features

20. Lembertsuture pattern
Similar to vertical mattress,
except suture above tissue
Continuous used more
often
Not used on skin
Far-near-near-far pattern
Features

21. Halstead suture pattern
Eight tissue
penetration points
Far-near-near-far-
far-near near-far
Two Lemberts
side -by -side
Features

22. Cushing
First visceral layer
Parallel purchases
in tissue
Non -lumen
penetrating
pattern
Features

23. Connell
First visceral
closure
Parallel tissue
purchases
Lumen penetrating
pattern
Features

24. Cushing Connell

25. Purse String
Used to
temporarily
close a lumen
(e.g., anus)
Features

26. Parker Kerr Oversew
Used frequently
(on SQ tissue)
Efficiently placed
“Whip stitch”
“Baseball stitch”
Features

27. Guidelines for Day of Removal
Body Region Removal (days)
face 3-4
scalp 6-8
chest 8-10
abdomen 8-10
penis 8-10
ear 10-14
back 12-14
extremities 12-14
hand 10-14
foot/sole 12-14

28. Corner/flap

29. QUESTIONS?