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Minor surgery practical exam

What stitches are these?

The image above is a vertical mattress stitch on the left and a horizontal mattress stitch on the right.

1. Simple interrupted
2. Vertical mattress
3. a. 3 point Corner stitch
b. 4 point Corner stitch
4. Horizontal mattress
5. Subcutaneous stitch
6. Running simple.
7. Running lock stitch.
8. Running horizontal mattress stitch.

for practical exam only need to do 2-4 of each stitch drawn
30-40 minutes to complete practical
written test afterward, 50 questions, they do cut scoring
know everything that's in bold in notes
know anesthesia table
nothing yet about types of lesions, that's next quarter
a few q's about equipment
some about anaphylaxis
sterile technique
no clinical scenarios this quarter
report writing prob no q's
*read the laceration handout, irrigation, trimming etc
*read complications of healing handout, deshiscence, scarring, infx, etc
passing is 60% (this is the lowest expectation of any class I've taken here yet)

1. Simple interrupted
the most basic stitch, used 95% of the time
stitch pronates through far edge toward self
evert edges to stitch, want healing ridge
first one in center of wound
then a stitch in center of each open space, keep splitting the difference
leave 1/4 inch tails
can cause RR track scarring, is time consuming, can cause eversion of wound edges


2. Vertical mattress
this is a drawing stitch for a gaping wound
cut out ellipse, undermine 2x gap distance on each side
(undermining only for gaping wound or tissue loss)
starts with large full thickness stitch toward self
follow with small half-thickness stitch away from self in line with original stitch
tie off
add some simple interrupteds on either side to hold wound edges together
may take the vertical mattress stitches out before the simples come out

3. a. 3 point Corner stitch
point is to anchor tip of flapper
make V shaped incision, like a rip wound
tip of flapper may need to be trimmed
first stitch starts beyond point of flapper on one side
comes out of epidermis at half-depth beside tip of flapper
then thru tip of flapper at half depth
then back into skin above flapper to near start of stitch and tie off
no stitches overlap this loop
add simples around it

b. 4 point Corner stitch
for a T shaped cut or puncture with multiple flappers
or after a four-sided excision, do two of these
start first stitch above T and come out half thickness on edge beside T
go through both flapper points at half thickness
back into intact skin at half depth
emerge above T and tie off
no stitches overlap this loop
simples outside


4. Horizontal mattress
another gathering stitch
cut out ellipse, undermine
large stitch toward self
large stitch away and parallel to first stitch
tie off
simples over top to keep edge secure

5. Subcutaneous stitch
dissolving stitches
use for deep laceration, trauma
want some fat over muscle
start at base of lacerated tissue, pushing up
then down other side, tie off at bottom
it will slacken when you let go and knot falls into bottom of wound
so tie it off as tight as possible without tissue damage
ND can't suture muscle except in obstetrics
put knot at bottom to keep ends out of epidermis


6. Running simple.
fast to execute but if it comes untied the whole thing will come out
before running place one solo simple to anchor the tip of the wound
start running by tying off first stitch but not cutting thread
go about 1" then retighten, tie off
tie off to last loop to surface, pull through from top of loop
to avoid gapping
end up with 3 thread "tail" like caterpillar
if long wound maybe several sections


7. Running lock stitch.
misnomer: it doesn't lock
has to be retightened repeatedly and one last round before tying off
start with a simple to anchor end of wound
then do one more simple and don't cut threat, keep going
needle and thread passes through loop of last stitch before tightening
makes a linked look to the stitches
unravels like the wind if knot fails so tie it well


8. Running horizontal mattress stitch.
cut out ellipse, undermine
start with a simple
closer to skin edge than other mattress stitches
no simples necessary, use steri strips
or make stitches large enough to leave room for a running simple down the middle

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Comments

( 3 comments — Leave a comment )
neptunia67
Mar. 11th, 2010 01:57 am (UTC)
Wow. You're really getting into the serious stuff now, aren't you.

liveonearth
Mar. 11th, 2010 04:07 pm (UTC)
=D

So far the only surgery I've done is to pig's feet. But I feel confident enough that I could stitch up a wound, or remove a small skin lesion. The part I haven't got a good handle on is the anesthesia, which is kinda important.
neptunia67
Mar. 12th, 2010 04:34 pm (UTC)
Yeah, kinda... ;-)
( 3 comments — Leave a comment )

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