The sutures used to close deep, multi-layer lacerations are:

Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Medical & Surgical Nursing

Easy

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

Deep, multi-layer lacerations require the closure of deeper tissues (like fascia and dermis) to ensure proper healing and reduce complications such as hematoma or dead space.
Absorbable sutures are the standard choice for these deep layers because they provide temporary support during healing and then dissolve, eliminating the need for subsequent removal.
Vicryl (Polyglactin 910), Dexon (Polyglycolic Acid), and Monocryl (Poliglecaprone 25) are all common, well-established synthetic absorbable sutures used for this purpose.
Since all three listed sutures are valid and frequently used for deep layer closure, the most comprehensive and correct option is 'All of these'.

Option A: While Vicryl is a correct example of a suture used for deep lacerations, it is not the only one. Dexon and Monocryl are also appropriate choices.
Option B: Although Dexon is a suitable absorbable suture for deep tissue, it is not the sole option. Vicryl and Monocryl are also used.
Option C: Monocryl is an excellent choice, especially for subcuticular closure, but it is not the only suture used for deep layers. Vicryl and Dexon are also common.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Suture selection for deep wound closure as background academic context rather than a clinical decision trigger.
A key nursing role is patient education. Nurses must explain that the deep sutures will dissolve on their own, while any superficial, non-absorbable sutures will need to be removed at a follow-up appointment.
Nurses are responsible for assessing the sutured wound for signs of infection (e.g., increasing redness, warmth, swelling, purulent drainage, fever) or dehiscence (wound separation) and reporting them promptly.
What if? - What if the patient has a known allergy to the dye in colored sutures like standard Vicryl? In this case, the surgeon would select an undyed absorbable suture, such as Monocryl or undyed versions of Vicryl or Dexon, to minimize the risk of an allergic or inflammatory reaction.

How to Approach the Question

First, identify the keywords in the question: 'deep, multi-layer lacerations'. This immediately signals that the closure involves tissues beneath the skin surface.
Recall the principle of layered wound closure: deep layers (fascia, dermis) are closed to eliminate dead space and reduce tension on the skin.
Remember that sutures for these deep layers must be absorbable, as they cannot be removed later.
Evaluate each of the named sutures: Vicryl, Dexon, and Monocryl. Recognize them as common types of synthetic absorbable sutures.
When presented with a question where multiple individual options are correct and an 'All of these' option exists, it is highly likely to be the intended answer.
Conclude that since all three are appropriate for deep layer closure, 'All of these' is the most complete and accurate response.

Concept Tested & Keywords

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E6 Gynecology Williams p. 428-433