Sutures and Stapling Devices — MCQs
Which type of collagen is most abundant in hyaline cartilage?
Which of the following structures in the spermatic cord is typically preserved (not divided) during vasectomy surgery?
For a midline incision in the abdomen, length of suture required is:
What type of graft or dressing is used to cover the post-burn wound shown in the image?
Which of the following statements is true about the suture material shown in the image?
A patient has a lacerated, untidy wound of the leg and attended the casualty department after 2 hours. His wound should be:
Vacuum assisted closure is contraindicated in which of the following conditions -
Which of the following layers are cut during fasciotomy ?
Which one of the following regarding absorbable meshes is NOT true?
What is the typical absorption duration of Polydioxanone sutures?
Sutures and Stapling Devices Indian Medical PG Practice Questions and MCQs
Question 1: Which type of collagen is most abundant in hyaline cartilage?
- A. Type I
- B. Type II (Correct Answer)
- C. Type III
- D. Type IV
Explanation: ***Type II*** - **Type II collagen** is the predominant type found in **hyaline cartilage**, providing tensile strength and elasticity [1]. - It is crucial for the **structural integrity** and functionality of cartilage in articular surfaces [1]. *Type I* - Predominantly found in **bone**, tendons, and skin, contributing to tensile strength but not a major component of hyaline cartilage [2]. - It forms the structure of **fibrocartilage**, such as in the **intervertebral discs**. *Type IV* - Mainly located in **basement membranes** and plays a role in filtration and structural support of epithelial cells, not in hyaline cartilage. - It is critical in the formation of structures like **glomeruli** in kidneys, differing from cartilage's needs. *Type III* - Found in **reticular fibers** and supporting tissues throughout the body, important for organ structure but not prominent in hyaline cartilage. - Often associated with **vascular structures** and is not involved in the composition of cartilage.
Question 2: Which of the following structures in the spermatic cord is typically preserved (not divided) during vasectomy surgery?
- A. Autonomic nerves
- B. Testicular vein
- C. Vas deferens
- D. Testicular artery (Correct Answer)
Explanation: ***Testicular artery*** - The goal of a vasectomy is to interrupt sperm transport, not the blood supply to the testis. The **testicular artery** is the most critical structure to preserve as it provides the primary blood supply to the testis. - Preserving the **testicular artery** ensures continued blood flow to the testis, preventing ischemia and maintaining both spermatogenesis (though sperm won't exit) and endocrine function (testosterone production). - Surgeons carefully isolate and preserve the testicular artery while dividing only the vas deferens. *Vas deferens* - The **vas deferens** is the target structure that is deliberately divided and ligated during vasectomy. - Cutting the **vas deferens** interrupts the pathway for sperm transport from the epididymis to the ejaculatory duct, achieving permanent contraception. - This is the only structure within the spermatic cord that is intentionally divided during the procedure. *Autonomic nerves* - While **autonomic nerves** (sympathetic postganglionic fibers) are present in the spermatic cord and innervate the vas deferens, they may be inadvertently damaged during the vasectomy procedure. - The primary function of these **autonomic nerves** related to the vas deferens is smooth muscle contraction for sperm transport, which becomes irrelevant once the vas deferens is divided. - These nerves are not actively preserved as their division doesn't significantly impact testicular function. *Testicular vein* - The **testicular vein** (pampiniform plexus) drains blood from the testis and is also typically preserved during vasectomy, along with the testicular artery. - However, the **testicular artery** is considered more critical as arterial blood supply is essential for tissue viability, whereas venous drainage has collateral pathways through cremasteric and deferential veins. - Both vessels are preserved, but the arterial supply takes priority in surgical technique.
Question 3: For a midline incision in the abdomen, length of suture required is:
- A. 3 times the length of incision
- B. 4 times the length of incision (Correct Answer)
- C. 2 times the length of incision
- D. 5 times the length of incision
Explanation: ***4 times the length of incision*** - The standard recommendation for interrupted abdominal fascial closure is to use a **suture-to-wound length ratio** of approximately **4:1**. - This ratio ensures sufficient material for adequate fascial apposition, overlapping bites, and knots, which are crucial for preventing wound dehiscence. *3 times the length of incision* - A 3:1 suture-to-wound ratio might be insufficient for secure fascial closure, potentially leading to increased tension on the suture lines and a **higher risk of dehiscence**. - This ratio could be considered for very specific continuous closure techniques, but it's generally not recommended for standard interrupted closures. *2 times the length of incision* - A 2:1 ratio is generally considered **inadequate** for most fascial closures, especially in the abdomen. - This ratio would likely result in insufficient suture material, leading to very large bites and an insecure closure, significantly increasing the risk of **wound dehiscence** and **herniation**. *5 times the length of incision* - While it ensures enough material, a 5:1 ratio suggests using **excessive suture material** which might extend operating time. - Using significantly more suture than necessary offers no proven benefit in terms of wound security and can sometimes introduce more foreign material into the wound.
Question 4: What type of graft or dressing is used to cover the post-burn wound shown in the image?
- A. Split thickness skin graft (Correct Answer)
- B. Full thickness skin graft
- C. VAC dressing
- D. Normal saline dressing
Explanation: ***Split thickness skin graft*** - The image shows a **meshed pattern** on the skin graft, which is characteristic of a **split-thickness skin graft** that has been expanded to cover a larger area. - This type of graft consists of the epidermis and a portion of the dermis, making it more flexible and able to **"take" more reliably** on various wound beds, commonly used for burn wounds. *Full thickness skin graft* - A **full-thickness skin graft** includes the entire epidermis and dermis and typically does not have a meshed appearance. - They are used for smaller defects where cosmesis is a priority, but have a **lower take rate** than split-thickness grafts, making them less suitable for large burn wounds. *VAC dressing* - A **VAC (Vacuum-Assisted Closure) dressing** is a system that applies negative pressure to a wound to promote healing and is not a skin graft itself. - It involves a foam or gauze dressing sealed with an adhesive film, connected to a vacuum pump, which is not what is depicted in the image. *Normal saline dressing* - A **normal saline dressing** is a simple wet-to-dry or wet-to-wet dressing for wound care, involving gauze soaked in normal saline. - This is a basic wound management technique and does not involve grafting or have the characteristic meshed appearance seen in the image.
Question 5: Which of the following statements is true about the suture material shown in the image?
- A. Made of cat submucosa
- B. Not degraded
- C. Made of rabbit submucosa
- D. Degraded by enzymatic degradation (Correct Answer)
Explanation: ***Degraded by enzymatic degradation*** - Catgut sutures are **natural absorbable sutures** made primarily from purified collagen. - Their absorption in the body occurs through **enzymatic degradation** and phagocytosis, which is a key characteristic distinguishing them from synthetic absorbable sutures that undergo hydrolysis. *Made of cat submucosa* - While historically referred to as "catgut," these sutures are not actually made from cat intestines. - They are typically derived from the **submucosa of sheep or goat intestines**. *Not degraded* - Catgut sutures are explicitly classified as **absorbable surgical sutures**, as stated on the packaging. - Absorbable sutures by definition are designed to be broken down and **resorbed by the body** over time. *Made of rabbit submucosa* - Catgut sutures are not typically made from rabbit submucosa. - The primary sources for natural absorbable sutures like catgut are the **intestines of sheep or goats**.
Question 6: A patient has a lacerated, untidy wound of the leg and attended the casualty department after 2 hours. His wound should be:
- A. Debrided and sutured immediately
- B. Sutured immediately
- C. Cleaned and dressed
- D. Debrided and sutured secondarily (Correct Answer)
Explanation: ***Debrided and sutured secondarily*** - An **untidy wound** indicates contamination, irregular edges, and devitalized tissue, which significantly increases the **risk of wound infection**. - The standard management involves **thorough debridement** to remove all contaminated and non-viable tissue, followed by **delayed primary closure** (suturing after 3-5 days once the wound shows healthy granulation) or **healing by secondary intention**. - This approach is especially important for **lower extremity wounds**, which have a higher infection risk due to relatively poorer blood supply compared to facial wounds. - Even though the patient presented within 2 hours (well within the "golden period"), the **untidy nature** of the wound makes **immediate primary closure risky** and secondary closure the safer, preferred option. *Debrided and sutured immediately* - While **debridement is essential** for untidy wounds, **immediate primary closure** after debridement is generally reserved for **tidy wounds** with minimal contamination. - For untidy wounds, immediate closure increases the risk of **trapping bacteria and devitalized tissue**, leading to **wound infection**, abscess formation, or dehiscence despite being within the golden period. - Primary closure may be considered in select cases with minimal contamination and excellent debridement, but this is not the standard teaching for untidy wounds. *Sutured immediately* - **Immediate suturing without debridement** of an untidy wound would be dangerous, as it would trap contaminants, foreign material, and devitalized tissue. - This approach would significantly increase the risk of **serious wound infection**, including **gas gangrene** or necrotizing fasciitis in contaminated wounds. - Proper wound preparation is mandatory before any closure is considered. *Cleaned and dressed* - Simple **cleaning and dressing** is insufficient for an untidy wound as it does not address the devitalized tissue that requires **surgical debridement**. - While this avoids the risk of premature closure, it fails to provide adequate treatment for a wound that needs formal surgical debridement to remove non-viable tissue and reduce bacterial load. - This approach might be acceptable only as a temporary measure if surgical debridement cannot be performed immediately.
Question 7: Vacuum assisted closure is contraindicated in which of the following conditions -
- A. Chronic osteomyelitis
- B. Large amount of necrotic tissue with eschar (Correct Answer)
- C. Abdominal wound
- D. Surgical wound dehiscence
Explanation: ***Large amount of necrotic tissue with eschar*** - The presence of a large amount of **necrotic tissue** and **eschar** is a contraindication for VAC therapy because it prevents effective contact between the foam and viable tissue, impairing wound healing. - Eschar acts as a physical barrier, trapping bacteria and hindering the proper function of negative pressure by preventing uniform pressure distribution and fluid removal from the wound bed. *Chronic osteomyelitis* - While chronic osteomyelitis can be challenging, VAC therapy can sometimes be used as an **adjunctive treatment** after surgical debridement to manage the wound and promote granulation tissue formation. - It helps in controlling infection and closing the wound by removing exudates, reducing edema, and improving blood flow. *Abdominal wound* - VAC therapy is commonly used for **abdominal wounds**, especially after damage control surgery or in cases of open abdomen management. - It facilitates closure by promoting granulation, reducing edema, and protecting the abdominal contents. *Surgical wound dehiscence* - **Surgical wound dehiscence** is a common indication for VAC therapy, as it helps to manage the open wound, promote granulation tissue, and prepare the wound for eventual secondary closure or grafting. - VAC therapy reduces surgical site infections, removes exudates, and enhances tissue perfusion, leading to better wound healing outcomes.
Question 8: Which of the following layers are cut during fasciotomy ?
- A. Skin
- B. Skin+subcutaneous tissue+Superficial fascia
- C. Skin+subcutaneous tissue+Superficial fascia+deep fascia (Correct Answer)
- D. Skin+subcutaneous tissue
Explanation: ***Skin+subcutaneous tissue+Superficial fascia+deep fascia*** - A **fasciotomy** is a surgical procedure to relieve **compartment syndrome** by releasing the **deep fascia** that constricts muscle compartments. - To access and incise the deep fascia, all overlying layers must be cut: **skin**, **subcutaneous tissue** (also called superficial fascia or hypodermis), and finally the **deep fascia** itself. - Note: "Superficial fascia" and "subcutaneous tissue" refer to the same anatomical layer, but both terms are listed here to reflect common clinical terminology. *Skin* - Cutting only the skin does not provide access to the deep fascia and cannot relieve compartment syndrome. - The skin is merely the outermost protective layer. *Skin+subcutaneous tissue* - While both these layers must be incised, stopping here leaves the **deep fascia** intact. - The deep fascia is the primary constricting structure in compartment syndrome and must be released. *Skin+subcutaneous tissue+Superficial fascia* - This option is anatomically redundant since superficial fascia and subcutaneous tissue are the same layer. - More importantly, this still does not include division of the **deep fascia**, which is essential for decompression in a true fasciotomy.
Question 9: Which one of the following regarding absorbable meshes is NOT true?
- A. They show very good results as collagen deposition is maximum (Correct Answer)
- B. They are made of polyglycolic acid fibre
- C. They are used to buttress sutured repair
- D. They are used in temporary abdominal wall closure
Explanation: ***They show very good results as collagen deposition is maximum*** - Absorbable meshes are **resorbed by the body** over time, leading to less collagen deposition compared to non-absorbable meshes, which provide a permanent scaffold for tissue integration. - While they can be useful in certain situations, the statement implies **superior results due to maximum collagen deposition**, which is contradictory to their nature and purpose in situations where permanent reinforcement is needed. *They are made of polyglycolic acid fibre* - Many absorbable meshes, such as **Dexon** and **Vicryl**, are indeed made from synthetic polymers like **polyglycolic acid (PGA)** or polylactic acid (PLA). - These materials are designed to be **hydrolyzed and absorbed** by the body. *They are used to buttress sutured repair* - Absorbable meshes can be used to **reinforce a primary suture line** in contaminated fields or when there is concern for tissue breakdown. - They provide **temporary support** while the native tissue heals. *They are used in temporary abdominal wall closure* - In cases of **abdominal compartment syndrome** or severe contamination, absorbable meshes may be used for **temporary closure** of the abdominal wall. - This allows for staged repair and reduces the risk of infection often associated with permanent meshes in these scenarios.
Question 10: What is the typical absorption duration of Polydioxanone sutures?
- A. 4 weeks
- B. 6 weeks
- C. 2 weeks
- D. 6 months (Correct Answer)
Explanation: ***Correct: 6 months*** - **Polydioxanone (PDS) sutures** are known for their **prolonged absorption time**, typically ranging from 180 to 210 days, or approximately 6 months. - This characteristic makes PDS sutures suitable for tissues requiring **extended support** during the healing process. - PDS retains approximately **50% tensile strength at 4 weeks** and **25% at 6 weeks**, with complete absorption occurring over 6-7 months. *Incorrect: 2 weeks* - An absorption duration of 2 weeks is characteristic of **rapidly absorbing sutures**, such as **chromic gut** or **fast-absorbing synthetic sutures**, which are used for tissues that heal quickly or require minimal support. - PDS sutures offer much longer tensile strength retention and absorption than this brief period. *Incorrect: 4 weeks* - A 4-week absorption time is considerably shorter than that of PDS sutures. This duration might be seen with some **intermediate-absorbing sutures**, but not with the long-lasting PDS. - Sutures absorbed in this timeframe would not provide sufficient support for tissues where PDS is typically indicated. *Incorrect: 6 weeks* - While longer than 2 or 4 weeks, 6 weeks (approximately 42 days) is still much shorter than the typical absorption profile of PDS sutures. - Sutures like **Vicryl Rapide** might fall into this absorption range, but PDS is designed for applications needing several months of support.
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