Chapter 06 Sutures, Needles, and Instruments

Chapter 06  Sutures, Needles, and Instruments

Complete chapter Questions And Answers

Sample Questions

MULTIPLE CHOICE

1. The primary use for suture is essentially to:

1. strengthen, re-form, and close tissue.
2. ligate, suture, and close tissue.
3. ligate, strengthen, and stop bleeding.
4. clamp, divide, and attach tissue.

ANS: B
Suture is a generic term for all materials used to sew severed body tissues together and to hold these tissues in their normal position until healing takes place; to suture is to stitch together cut or torn edges of tissue. A ligature is a strand of suture material used to tie off (seal) blood vessels for the prevention of minor bleeding, or to isolate a mass of tissue for excision (cut out). A variety of suture materials are available for ligating, suturing, and closing the wound.

REF: Page 174

2. The ideal suture material is one that has handling characteristics such as:

1. memory.
2. slickness.
3. ease of tying.
4. removable knots.

ANS: C
Key features used to evaluate the general properties of suture material are (1) physical characteristics, (2) handling characteristics, and (3) tissue reaction characteristics. Handling characteristics of suture material are related to pliability (how easily the material bends) and the coefficient of friction (how easily the suture slips through tissue and can be tied).

REF: Page 174

3. Tissue reaction characteristics are important in a suture material because:

1. the suture should absorb and nourish the healing tissue.
2. the suture should not cause tissue inflammation or an allergic response.
3. the suture should not support infection.
4. the suture should not cause tissue inflammation or an allergic response and the suture should not support infection

ANS: D

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-2

The ideal suture material is one that causes minimal inflammation and tissue reaction while providing maximal strength during the lag phase of wound healing. Tissue reaction characteristics include inflammatory and fibrous cell reaction, absorption, potentiation of infection, and allergic reaction.

REF: Pages 174-176

4. The surgeon needs a suture material that will not degrade over time, but becomes encapsulated and supports a tissue structure that will continue to be exposed to pressure and stretching forces throughout the patient’s life. These physical properties are best described by a suture that:

1. is nonabsorbable, has good tensile and knot strength, and is the appropriate

   diameter for the tissue.

2. has a large diameter, is nonabsorbable, is highly reactive, and is a monofilament.
3. is a monofilament, is synthetically manufactured, is absorbable, and has a large

   diameter.

4. has good tensile strength, memory, and ease of tying and is absorbable.

ANS: A
Physical characteristics of sutures can be measured or visually determined and include the following properties: Diameter (size) is measured in millimeters, and expressed in USP sizes with zeroes. The finer diameter (smaller size) provides better handling qualities and small knots. Improved suturing techniques are possible with sutures of finer diameter. Tensile strength is defined as the amount of weight (breaking load) necessary to break a suture (breaking strength); it varies according to the type of suture material. Knot strength is the force necessary to cause a given type of knot to slip, either partially or completely. The most common nonabsorbable suture materials are silk, nylon, polyester fiber, polypropylene, and stainless-steel wire.

REF: Pages 176-179

5. Dr. Garrison was teaching the new residents as he closed the muscle and fascia layer following an open cholecystectomy. He stated that he liked the tensile strength of this monofilamented synthetic suture and also liked the pretty blue color, but it was hard to manage with its memory and slipperiness and normally needed six surgeon’s knots to hold. He was using:

a. Ethilon.
b. Prolene. c. Sofsilk.
d. Monocryl.

ANS: B
Prolene (polypropylene) is a clear or pigmented polymer. This monofilament suture material (Prolene, Surgilene, Surgipro, Dermalene) is used for cardiovascular, general, and plastic surgery. Because polypropylene is a monofilament and is extremely inert in tissue, it may be used in the presence of infection. It has high tensile strength and causes minimal tissue reaction. Sizes range from 10-0 to #2.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-3

REF: Page 180

6. Dr. Schumann, an older surgeon who was educated in Germany, explains his justification for his suture choice to the new perioperative nurse in the scrub role. He prefers to suture his intestinal anastomosis with a suture that has multiple filaments braided together because it ties well and holds the knot, which tightens when the thread absorbs the tissue fluids. He also needs a strand that is easy to see and only needs to retain its tensile strength for about 1 year, at which time the intestinal junction will be healed, even though this suture is considered nonabsorbable. He will ask the nurse for a 24-inch 4-0:

a. Vicryl.
b. Prolene. c. Monocryl. d. Sofsilk.

ANS: D
Silk (Sofsilk) is prepared from thread spun by the silkworm larva while making its cocoon. Top-grade raw silk is (1) processed to remove natural waxes and gum, (2) manufactured into threads, and (3) colored with a vegetable dye. The strands of silk are twisted or braided to form the suture, which gives it high tensile strength and better handling qualities. Silk handles well, is soft, and forms secure knots. Because of the capillarity of untreated silk, body fluid may transmit infection along the length of the suture strand. Silk is not a true nonabsorbable material. When buried in tissue, it loses its tensile strength after about 1 year and may disappear after several years.

REF: Page 179