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What are the 3 components to ideal wound closure technique?
- tensile strength maintained throughout the healing process
- technically simple and quick for the surgeon to perform
- allow for precise wound edge apposition
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___________ is inversely proportional to the wound closure tension, which affects ___________.
Blood supply to the wound edge; healing
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Why shouldn't you dissect subQ in small animals?
the vascular supply is superficial, middle, and deep plexuses; there is only one blood supply to the SQ--> dissecting below the SQ can severely compromise blood supply to the wound edges
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Wound healing occurs by ____________, and the wound may have a(n) _________ by ________ post-sx if... (3)
epithelialization; epithelial seal; 24 hours; there is ideal apposition of SQ, dermis, and epidermis.
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What appositional patterns do we use in vet med? (4)
simple interrupted and continuous, cruciate, ford interlocking, interrupted and continuous intradermal
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What patterns will we use to close each body wall layer in vet school?
- linea alba- simple interrupted
- SQ- simple continuous
- epidermis- cruciate (intradermal in shelter)
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Why is cruciate often chose for skin closure?
stronger than simple interrupted, prevents eversion
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How do you bury the knot at the beginning of a suture line? At the end?
- Beginning: deep to superficial on near side; then superficial to deep on far side; tie parallel to incision
- End: Loop 1 is superficial to deep on far side; loop 2 is superficial to deep on far side, tightened; free end should point toward opposite end of incision and be deep
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What is the name of the suture pattern use with intradermal closure?
buried knots with horizontal mattress
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What inverting suture patterns do we use? (3)
cushing, lembert, purse-string
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When do we use inverting suture patterns?
hollow organs with a large lumen (bladder, uterus, stomach)
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Describe the cushing suture pattern.
partial thickness bites taken parallel to incision line; creates tissue inversion with a watertight seal
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Describe the lembert suture pattern.
partial-thickness bites perpendicular to incision line; far-near--> near-far
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What is the purse string suture pattern, and when is it used?
circular variation of continuous lembert; used to temporarily close orifices, tubes, drains, biopsy sites
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What are the everting suture patterns? (2)
horizontal and vertical mattress
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Describe the horizontal mattress suture pattern.
suture parallel to incision line--> cross incision--> parallel to incision line--> cross incision--> so on
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When do we use horizontal mattress? (3)
areas of high tension (such as joints), step defects (after mastectomy, suturing thick lateral skin to thin ventral skin), underlay mesh
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What are disadvantages to horizontal mattress? (2)
can compromise blood supply, can cause eversion
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Describe the vertical mattress suture pattern.
far--> far-near--> near perpendicular to incision
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When is vertical mattress used? (3)
resist tension, stretch skin, mesh application
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What is an advantage of vertical mattress over horizontal mattress?
vertical allows better blood flow
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