1: Suture Materials - Bennett Flashcards
use of ____ sutures decrease foreign body volume with the sacrifice of knot pull strength
smaller
elasticity
ability to return to original length after applied strain
- stainless steel, braided polyester, catgut, silk
plasticity
elongation persist with cessation of strain
- polypropylene
intermediate b/w plastic and elastic
- possesses properties of both
- nylon, polyglactin 910
flexibility
based on material and diameter of suture
- small diameter is more flexible than large
- silk and dexon are more flexible than nylon and catgut
better suited for contaminated wounds
monofilament
higher coefficient of friction, greater strength, and capillarity
braided f
capillarity
- fluid and bacteria may penetrate into interstices of braided structure
- PMNs, macrophages are too large too reach interstices
coating
- helps decrease capillarity
- improves handling
- reduces drag
characteristics of handlign
- pliability
- tissue drag
- knot tying
- knot slippage
classification of non-absorbable surgical suture (I-III)
class I - suture composed of silk or synthetic fibers, monofilament or braided class II - suture composed of natural or synthetic fibers but consisting of a coating class III - suture composed of monofilament or multifilament metal wire
name the synthetic nonabsorbable surgical sutures
- nylon: dermalon, ethilon, nurolon, surgilon
- popypropylene: surgilene, prolene
- polybutester : novafil
- polyester: mersilene, dacron, polydeck, tevdek, ethibond, ticron
nylon, silk, polyester/polypropylene - which is resorbed more?
silk most (350 d) polyester and polyrpropylene least (800 day +)
- even though structures remain in the body, they can loose tensile strength
relative tensile strength of non- absorbable sutures (greatest to least)
stainless steel wire coated braided polyester uncoated braided polyester monofilament nylon polybutester braided nylon polypropylene natural fibers (silk, cotton, linen)
relative tissue reaction of nonabsorbable sutures (least to greatest)
monofilament polypropylene monofilament polybutester monofilament nylon stainless steel wire polybutilate-coated polyester teflon/silicone-coated polyesters uncoated braided polyester natural fiber materials
when do absorbable structures lose tensile strength?
around 60 days
- natural are degraded by lysosomes, synthetic degraded by hydrolysis
natural absorbable sutures
catgut
collagen
polyglycolic acid/ dexon
- synthetic
- absorbable
- braided
- good tensile strength and knot pull
- inert
- may be coated
- skin and subcutaneous
polyglactin 910 / vicryl
- synthetic
- absorbable
- 65% tensile strength at 14 d
- completely hydrolyzed at 80 days
- may be coated with polyglactin 370 and calcium stearate
polyglyconate/maxon
- synthetic
- absorbable
- monofilament
- resists kinking and curling
- becomes softer with exposure to tissue fluid
- 70% tensile strength at 2 wk
- completely hydrolyzed at 180 d
poliglecaprone/monocryl
- synthetic
- absorbable
- monofilametn
- very pliable and inert
- hydrolyzed in 90-120 d
- 70-80% tensile strength at 14d
non-absorbable sutures gnereally maintain tensile strength longer than _____ d
60 days
silk
natural nonabsorbable
- handles well
- impregnated and coated in waxes
- low tensile strength
- highly tissue reactive
cotton/linen
- natural nonabsorbable
- similar to silk
- increased tissue rxn
- WEAKEST suture ie very low tensile strength
nylon (ethilon, surgilon)
- synthetic nonabsorbable
- possesses memory
- elastic
- high tensile strength
- low tissue reactivity
- monofilament or braided
- can be used in contaminated wounds
polyester (ethibond, dacron)
- synthetic nonabsorbable
- braided
- high tissue strength
- low tissue reactivity
- may be coated with silicone
- used when strong apposition of tissue needed
used when strong apposition of tissue needed
polyester (ethibond, dacron)
polypropylene (prolene, surgilene)
- synthetic nonabsorbable
- very inert
- monofilament
- pliabiilty and handling
- excellent tensile strength
- minimal tissue drag
- often used in contaminated wounds and plastics
used for bone fixation, tendon repair and retention sutures
stainless steel (flexon = braided)
stainless steel (flexon-braided)
- synthetic nonabsorbable
- monofilament and braided
- may corrode at stress points
- mild to moderate tissue reactivity
- may fracture, fatigue or kink
- used for bone fixation, tendon repair and retention sutures
most common suture attachment
swaged (Eyeless)
- suture attachment directly into needle
- decrease tissue damage
most common body length needle
1/2 circle
used for friable tissue
blunt point
ex: fat or granulation
used for paratenon, tendon sheath or subQ
tapered point
- useful for tissue with slight resistance
reverse vs. conventional cutting point
conventional
- cutting edge on concave
- cuts through dense tissue
- need to be careful
reverse
- cutting edge on convex
- prevents cutting through tissue
- greater strength
