Deck 11: Wound Healing, Sutures, Needles, and Stapling Devices

Question 1

Which of the following wounds would be assigned a Class I?

A) compound femoral fracture
B) gunshot wound to the abdomen
C) appendectomy with no major intestinal spillage
D) inguinal hernia repair with no breaks in technique

Answer 1

D

Question 2

Which historic figure in medicine is credited with creating principles of proper tissue handling and suturing?

A) DeBakey
B) Cushing
C) Halsted
D) Kocher

Answer 2

C

Question 3

Which type of needle is preferred for suturing of skin?

A) blunt
B) cutting
C) taper
D) spatula

Answer 3

B

Question 4

Primary union wound healing occurs:

A) bottom to top
B) top to bottom
C) end to end
D) side to side

Question 5

What is the term for removal of foreign material or contaminated debris from a wound?

A) debridement
B) dehiscence
C) denuding
D) desiccation

Question 6

Which postoperative wound complication would require immediate surgical treatment?

A) fistula
B) adhesions
C) infection
D) evisceration

Question 7

A wound that is not sutured and that gradually fills in by granulation heals by which intention?

A) first
B) second
C) third
D) fourth

Question 8

All of the following are techniques for eliminating dead space in a wound EXCEPT:

A) careful approximation of tissues
B) electrical nerve stimulation
C) placement of wound drain
D) pressure dressings

Question 9

Tissue trauma is minimized by using which type of suture-needle combination?

A) threaded suture on a closed-eye taper needle
B) threaded suture on a closed-eye Keith needle
C) suture loaded on a French-eyed taper needle
D) suture permanently swaged on an eyeless needle

Question 10

Which of the following interweaves its fibers during the maturation phase of wound healing and increases its tensile strength?

A) collagen
B) enzymes
C) fibrin
D) protein

Question 11

Which type of suture needle is used on friable tissue such as liver or kidney?

A) blunt
B) cutting
C) taper
D) trocar

Question 12

Inflammation can BEST be described as:

A) a disease process accompanied by fever
B) an exaggerated immune system response
C) a normal protective response to tissue injury
D) an abnormal physiologic response to tissue injury

Question 13

If tissue is approximated too tightly, it can result in:

A) adhesions
B) granulation
C) ischemia
D) keloids

Question 14

Which type of healing occurs in an aseptic wound with good approximation and ideal surgical conditions?

A) first intention
B) second intention
C) third intention
D) fourth intention

Question 15

Evisceration of an abdominal wound is:

A) filling in of a wound from bottom up
B) excessive scar formation after surgery
C) protrusion of viscera through all tissue layers
D) single- or multi-layer separation of wound edges

Question 16

Which tissue layer of the abdominal wall provides the greatest strength and support of the wound?

A) skin
B) fascia
C) peritoneum
D) subcutaneous fat

Question 17

What kind of wound is a sacral decubitus ulcer?

A) chronic
B) clean
C) closed
D) contusion

Question 18

What is the name of a raised, hypertrophic scar due to excessive collagen formation in some darker-skinned individuals?

A) cicatrix
B) granuloma
C) keloid
D) seroma

Question 19

Which phase of healing for wounds closed by first intention begins within minutes of the incision or injury?

A) inflammatory
B) proliferation
C) maturation
D) granulation

Question 20

Another name for a suture ligature is a:

A) free tie
B) stick tie
C) tie-on-a-passer
D) ligature reel

Question 21

Ligatures are use to:

A) prevent evisceration
B) eliminate dead space
C) approximate tissue layers
D) occlude the lumen of a blood vessel

Question 22

Which needle has the cutting edge on the outside curvature of the needle body?

A) conventional
B) Keith straight
C) reverse
D) spatula

Question 23

Which nonsuture needle is used for insufflation of carbon dioxide into the abdomen for laparoscopy?

A) arterial
B) hypodermic
C) spinal
D) Veress

Question 24

What is the primary reason bolsters are used with retention sutures?

A) to facilitate easy postop suture removal
B) to prevent sutures from cutting into the skin
C) to stabilize heavy dressings without use of tape
D) to prevent dressings from touching the suture line

Question 25

What is the term for a type of suture that has the strand of suture material inserted into the hollowed-out needle end?

A) closed eye
B) crimped
C) French-eye
D) swaged

Question 26

Which type of needle is preferred for suturing skin?

A) blunt
B) cutting
C) taper
D) spatula

Question 27

Which of the following is a natural, multifilament suture classified as nonabsorbable but loses much of its tensile strength in a year and is undetectable in tissues after 2 years?

A) polyester
B) polypropylene
C) surgical silk
D) stainless steel

Question 28

Which suture gauge would be MOST appropriate for ophthalmic surgery?

A) #5
B) 0
C) 3-0
D) 8-0

Question 29

A patient undergoing chemotherapy and radiation therapy for cancer might experience prolonged wound healing due to:

A) Class I, primary union wound
B) hyperactive immune response
C) immunosuppressed status
D) vascular proliferation

Question 30

Which of the following tissues is NOT part of the abdominal wall closure when retention sutures are placed?

A) fascia lata
B) mesentery
C) peritoneum
D) subcutaneous fat

Question 31

How will the surgeon manipulate skin edges of a wound before the surgical technologist places an approximating skin staple?

A) evert the edges outward
B) invert the edges inward
C) overlap the edges tightly
D) rotate the edges slightly

Question 32

Which wound classification would be assigned to a vaginal hysterectomy with anterior and posterior colporrhaphy?

A) Class I
B) Class II
C) Class III
D) Class IV

Question 33

What is the term that describes the measure of how much a suture strand can be stretched before breaking?

A) gauge
B) capillarity
C) tensile strength
D) drag coefficient

Question 34

Some multifilament sutures are coated to:

A) provide smooth passage through tissue
B) decrease the absorption rate
C) increase the capillarity
D) prevent knot slippage

Question 35

Which suture is MOST inert in tissue?

A) chromic gut
B) plain gut
C) stainless steel
D) surgical silk

Question 36

Which of the following sutures has comparatively inconsistent tensile strength and rapid absorption rate in vivo with moderate tissue reaction?

A) plain surgical gut
B) poliglecaprone
C) polyglyconate
D) polydioxanone

Question 37

Which of the following is NOT correct about the structure/design of suture needles?

A) They may be eyed or eyeless.
B) They may be straight or curved.
C) They are classified according to the eye, point, and body.
D) They range from 1/2 circle curvature to 5/8 circle curvature.

Question 38

Ethicon sutures may be available with a designation of "plus" for some sutures, which means they:

A) are longer strands than the original versions
B) have more than one needle in the package
C) have a heavier gauge needle for thicker tissues
D) are impregnated with an antibacterial coating

Question 39

What is the chemical name of Gore-Tex suture?

A) polybutester
B) polypropylene
C) polyglactin 910
D) polytetrafluoroethylene

Question 40

Which organization specifies diameter ranges for sutures?

A) American National Standards Institute (ANSI)
B) Brown and Sharpe (B&S)
C) U.S. Pharmacopeia (USP)
D) U.S. Food and Drug Administration (FDA)

Question 41

Which suturing technique would be used to close the stump of the appendix in an open appendectomy?

A) horizontal mattress
B) vertical mattress
C) purse-string
D) retention

Question 42

Which suture technique involves making a knot in the suture outside of the body and then pushing it inside through a cannula?

A) extracorporeal method
B) figure-of-eight stick tie
C) intracorporeal method
D) secondary suture line

Question 43

The suturing technique MOST appropriate for wounds likely to become infected or suffer potential stress is:

A) blanket
B) interrupted
C) purse-string
D) simple continuous

Question 44

Which layer of the abdominal wall must be approximated securely, even if the other layers are not?

A) skin
B) fascia
C) peritoneum
D) subcutaneous fat

Question 45

What would be the type of suture placed temporarily in the tongue to hold it out of the way in a maxillofacial procedure?

A) purse-string
B) retention
C) suture ligature
D) traction

Question 46

Which internal stapling device fires a circular double row of staples to reanastomose the colon?

A) intraluminal stapler
B) linear cutter
C) linear stapler
D) ligating clip applier

Question 47

Which of the following is synthetic, monofilament, nonabsorbable, and the most inert synthetic suture used frequently in cardiovascular and ophthalmology procedures?

A) polybutester
B) polypropylene
C) polyterephthalate
D) polytetrafluoroethylene

Question 48

What is the chemical name for Dermabond™ or Indermil™?

A) cryoprecipitate
B) cyanoacrylate
C) fibrin glue
D) polymethyl methacrylate

Question 49

Which type of suture is often used to create a vascular anastomosis?

A) synthetic, absorbable, multifilament on a 3/8 circle cutting needle
B) synthetic, nonabsorbable, multifilament on a 1/2 circle taper needle
C) synthetic, absorbable, monofilament on a Keith straight needle
D) synthetic, nonabsorbable, monofilament with double-armed taper needles

Question 50

Which of the following sutures would be contraindicated in a chronic infected wound of an immunosuppressed patient?

A) plain gut
B) polydioxanone
C) polypropylene
D) stainless steel

Question 51

A way in which the surgical technologist can assist the surgeon by keeping the suture strand out of the way during a continuous running closure is by:

A) following
B) pulling
C) tagging
D) tracking

Question 52

Which of the following statements is TRUE regarding natural absorbable sutures?

A) They are packaged dry.
B) They are packaged wet.
C) They are braided multifilament strands.
D) They have less tissue reaction than synthetics.

Question 53

Which absorbable suture provides for the MOST extended wound support?

A) Vicryl
B) Monocryl
C) PDS Plus
D) Polysorb

Question 54

Which statement is CORRECT regarding monofilament sutures?

A) They have high capillarity.
B) They cause increased tissue drag.
C) They are braided, twisted, and coated.
D) They may be used in infected wounds.

Question 55

What is used to close the epidermal layer when a subcuticular wound closure has been done for good cosmesis?

A) suture bridge
B) skin closure tapes
C) split lead shots
D) suture anchors

Question 56

Which type of suture ties has an attached needle?

A) free tie
B) ligature reel
C) suture ligature
D) tie-on-a-passer

Question 57

A continuous suturing technique that places sutures in the endothelial layer of the skin in short, lateral throws is called a:

A) mattress suture
B) purse-string suture
C) traction suture
D) subcuticular suture

Question 58

Which type of synthetic mesh is absorbable?

A) polyglactin 910
B) polypropylene
C) polyester fiber
D) PTFE

Question 59

Which of the following types of vessel loops are NOT available for use?

A) blue colored for veins
B) red colored for arteries
C) yellow colored for nerves
D) green colored for bile ducts

Question 60

Which of the following surgical needles is a solid bore (not hollow) type of needle?

A) Dorsey
B) heparin
C) Keith
D) Tru-cut

Question 61

Natural absorbable sutures are broken down in the body by:

A) capillarity
B) enzymatic digestion
C) granulation
D) metabolic factors

Question 63

To achieve the goal of leaving as little foreign material in a wound, the ideal suture selected should have:

A) a large diameter gauge
B) an antibacterial coating over it
C) tightly braided fibers with capillarity
D) high-tensile strength and small diameter

Question 64

In general, a monofilament suture would require ____________ knot throws for security than a multifilament suture.

A) more
B) fewer
C) the same number of
D) more, but only if coated

Question 65

What is the term for tissue that is easily torn or shredded?

A) adhesive
B) dehisced
C) eviscerated
D) friable

Question 66

By which intention would a purulent wound treated by debridement and placement of medicated packing, then sutured after resolution of the infection heal?

A) first intention
B) second intention
C) third intention
D) primary union

Question 67

Sutures with memory, such as chromic, plain, nylon, or other monofilaments, should be stretched tightly to remove any kinks in the strand before being handed to the surgeon.

Question 68

The tensile strength of suture material should equal the tensile strength of the tissue into which suture is placed.

Question 69

Suture gauge can range from #5 (being the smallest) to 11-0 (being the heaviest) diameter.

Question 70

A surgeon's choice of suture to be used is based on the surgeon's training, the condition of the patient, the type of wound, and the conditions surrounding the surgical intervention.

Question 71

Approximation is bringing two sides of a wound together closely with sutures, wound zippers, or special adhesives so that the wound can heal from side to side.