- Surgical wounds.
- Traumatic wounds.
- Multiple comorbidities precluding safe intervention.
- Active infection.
- Foreign body (except surgical implants).
- Active bleeding.
- Impaired healing (corticosteroids, malnutrition, radiation, chronic disease).
- Usually implied with consent for major procedure, must obtain consent otherwise.
- Scarring (normal and abnormal).
- Bleeding (may require reoperation or transfusion).
- Infection (may require antibiotics or reoperation).
- Failure of operation or need for secondary intention healing.
- Need for revision.
- Appropriate instruments vary by wound type but include at a minimum a needle driver and tissue handling forceps.
- Consist of both a needle and suture material, each with multiple subtypes and characteristics.
- The needle and suture material may vary widely based on different types of wounds in different locations.
- Table 42–1: Point characteristics.
- Swage: the method of attaching the suture material to the needle.
- Channel swage: a channel is crimped over suture material (swage diameter > body diameter).
- Drill swage: suture material is placed in the drill hole at the rear of needle, which is then crimped (swage diameter < body diameter).
- Nonswaged: eyed needle (similar to sewing needle). Closed-eye needles require suture material to be passed through the eye each time it is threaded. French eye needles have a posterior slit allowing suture to be placed in the eye without direct threading; this causes more tissue trauma and reduced suture integrity (eye > body diameter).
- Pop-off: swage is designed to allow suture material to be gently removed from the needle with traction.
- Table 42–2: Needle body characteristics.
- Designed to transmit the penetrating force to the point.
- Varied alloy characteristics can make a needle soft or firm (ductility).
- Diameter: gauge or thickness of needle.
Table 42–1. Needle characteristics—point. |Favorite Table|Download (.pdf)
Table 42–1. Needle characteristics—point.
|Conventional cutting||Triangular point that changes to a flattened body with one cutting edge on the concave surface of the needle (surface seeking)||Skin and tendon|
|Reverse cutting||Cutting edge on convex curvature of the needle (depth-seeking) Stronger than conventional cutting||Dense tissue, including skin, oral mucosa, and tendon|
|Cutting||Side-cutting (spatula)||Flat with 2 cutting edge to reduce tissue injury and improve depth control||Ocular tissues|
|Taper-point (round needle)||Stretches tissue without direct cutting action to minimize tearing Sharpness increases with taper ratio (slope) (8–12:1) and decrease with tip angle (20–35 degrees)||Easily penetrated tissues, including abdominal viscera, dura, and peritoneum|
|Blunt||Blunt||Dissects through tissue rather than cutting it||Friable tissue, including kidney and liver|
Table 42–2. Needle Characteristics—body. |Favorite Table|Download (.pdf)
Table 42–2. Needle Characteristics—body.
|Straight||Used in easily accessible tissue|
|Tissue is manipulated to allow ...|
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