12 . A. Sutures, suture Patterns & Suturing Technique Flashcards
The ideal suture material should:
.
1.Be suitable for use in any situation;
2.Be readily available and inexpensive;
3.Be readily sterilized by steam or ethylene oxide;
4.Show high initial tensile strength, combined with small diameter material; have a good knot security;
5. Produce minimal tissue reaction;
6.Show good handling characteristics;
7.Not create an environment for bacterial growth;
8. Be absorbed after its function has been served
Absorbable sutures:
In general, they are used in closing internal tissue layers or organs w/c do not require long term support.
A.Natural absorbable
B.Synthetic absorbable
– it is absorbed by phagocytosis & enzyme degeneration.
Natural absorbable
Natural absorbable :
Surgical gut (catgut)
Collagen
- from sub-mucosa of sheep or cattle small intestine & is composed of formaldehyde treated collagen.
Surgical gut (catgut)
– a multi filament that is processed from bovine flexor tendon & is treated with formaldehyde or chromium salts or both.
Collagen
– it is absorbed by hydrolysis, not phagocytosis.
Synthetic absorbable
Synthetic absorbable :
Polyglycolic acid
Polyglactin 910
Polydioxanone
Polyglyconate
- is a braided multi filament polymer of glycolic (hydroxyacetic) acid.
Polyglycolic acid
- this material is a co-polymer of lactide & glycolide.
Polyglactin 910
- a polymer of paradioxanone, a mono filament.
Polydioxanone
- also a mono filament, co-polymer of glycolic acid and trimethylene carbonate.
Polyglyconate
:
-these materials maintain their strength for longer than 60 days. They are used where prolonged mechanical support is required e.g skin closure, and within slow healing tissues.
Non-absorbable sutures
Non-absorbable sutures:
Natural non-absorbable
Metallic sutures
Synthetic sutures
Natural non-absorbable:
Silk and cotton
– available in braided multi filament or twisted strands. Obtained from threads spun by the silk worm larvae and coated with silicon or wax to minimize capillarity w/c may promote infection.
Silk
Cotton – was introduce in _____ to replace silk.
1939
Metallic sutures:
Stainless steel
Other metallic sutures
- it is biologically inert, non-capillarity and easily sterilized by autoclaving. It has the highest tensile strength and greatest knot security of all the suture materials. But it has the tendency to cut tissues, w/ poor handling characteristics and inability to withstand repeated bending w/o breaking.
Stainless steel
– tantalum, aluminum & silver, they are not commonly used
Other metallic sutures
Synthetic sutures:
Polyamide
Polyester fibers
Polybutester
Polyamide- __________and ________ commonly used in vet. surgery.
(a) nylon and (b) polymerized caprolactam (vetafil, supramid)
- a braided multifilament available in plain and coated forms.
Polyester fibers
- almost twice as flexible as polypropylene or nylon.
Polybutester
Polyolefin plastics:
Polypropylene
Polyethylene
Polytetraflouroehtylene
a monofilament, its advantages include its strength, inertness, retention of strength after implantation, minimal tissue reactivity, and resistance to bacterial contamination. The only disadvantages are its slippery in handling and tying characteristics.
Polypropylene
a monofilament w/ excellent tensile strength but very poor knot security
Polyethylene-
- a new non-absorbable monofilament sutures that has low surface friction, chemical inertness, and enhanced flexibility. Its disadvantage is its high cost.
Polytetraflouroehtylene
Alternative to sutures:
Staples
Tissue glue
Adhesive tapes-
metal clips or staples for use in skin and other tissues have gained popularity in vet. surgery. The main advantage is speed of insertion, they are inert and well tolerated. Their major disadvantage is cost, but their ease of use and the shortened surgery time have much to recommend them.
Staples-
- there are cyanoacrylic monomers w/c polymerize on contact with moisture in the wound.
Tissue glue
designed for use in humans, limited use in animals as they do not adhere well to moist skin.
Adhesive tapes
Selection of Suture Materials
Principles in the selection:
1.Sutures should be at least as strong as the tissue through w/c they are placed.
2. The relative rates of w/c suture losses strength and the wound gains strength should be compatible.
3.If the suture biologically alters the healing process, these changes must be considered when selecting a suture.
4. The mechanical properties of the suture should closely match those of the tissue to be closed.
Skin – _____and ______ are the preferred sutures for skin. Sutures that are capillary or reactive should be avoided.
monofilament nylon and polypropylene
Subcutis- are preferred because of their low tissue reactivity.
synthetic absorbable
Fascia-
synthetic non-absorbable, surgical gut, and synthetic absorbable.
Muscle- __________ are recommended for cardiac muscle.
synthetic absorbable or non-absorbable. Nylon and polypropylene
Hollow viscus- ____________(multi-filament non-absorbable is avoided)
surgical gut, synthetic absorbable, monofilament non-absorbable
Tendon- ________ and _______ are usually recommended. PDS and polyglyconate may also be effective.
nylon, and stainless steel
Blood vessels- ___________ is the material of choice in vascular repair. Polyteraflouroethylene, nylon, coated polyester, and PDS have also been used effectively.
polypropylene
Nerve- ________________ are recommended. Low reactivity is the most important consideration in peripheral nerve repair.
nylon, polypropylene
Suture Size
Skin and subcutis :
4-O to 3-O
Muscle , Fascia and Tendon
3-O to O
Hollow Viscus
5-0 and 2-0
Vessels (ligature)
4-O to 2-O
Vessels (sutures)
6-O to 5-O
Nerve
6-O to 5-O
Suture Patterns:
A vast number of suture patterns have been described for use in animals. They have benn categorized according to the following:
Anatomical areas in w/c they are placed;
Tendency to promote apposition, inversion, or eversion of tissues;
Ability to overcome tension forces that may disrupt accurate approximation of tissues;
Whether they are placed in a continuous or an interrupted pattern.
Categorization of Suture Patterns:
According to type:
Interrupted sutures
Continuous sutures-
Interrupted sutures- each suture is individually tied and cut distal to the knot.
Advantage:
Ability to maintain strength and
tissue apposition if part of the suture
line fails.
Interrupted sutures- each suture is individually tied and cut distal to the knot.
Disadvantages:
- Increased time needed to tie multiple
knots. - Increased volume of foreign materials left in
the wound. - Poor suture recovery.
- these are neither knotted nor cut, except at each end of the suture lines.
Continuous sutures
Continuous sutures- these are neither knotted nor cut, except at each end of the suture lines.
Advantages:
- Ease of application or suture speed.
2. Use of minimal amount of suture
material. - Ease of removal.
Continuous sutures- these are neither knotted nor cut, except at each end of the suture lines.
Disadvantages:
- Less precise control of suture tension and
wound approximation. - Potentially disastrous effects of suture breakage.
Suture patterns
According to location:
1.Skin sutures
2.
Muscle & fascia sutures
3.Hollow organs sutures
4.
Nerve & tendons sutures
Common Suture Patterns:
Skin – skin suture should be placed at least 5mm from the skin edge and be placed squarely across the wound. The skin should be handled gently with fine rat-toothed forceps. Observed proper apposition of alignment of wound edges.
Common Suture Patterns:
Skin – skin suture should be placed at least 5mm from the skin edge and be placed squarely across the wound. The skin should be handled gently with fine rat-toothed forceps. Observed proper apposition of alignment of wound edges.
Common suture patterns in the skin:
Simple interrupted
Simple continuous
Ford interlocking
Interrupted vertical mattress
Interrupted horizontal mattress
Cruciate mattress
Suture patterns for muscle & fascia:
Simple interrupted
Simple continuous
Ford interlocking
Horizontal mattress
Vertical mattress
Cruciate mattress
Suture patterns for hollow organs:
Simple interrupted
Parker kerr
Purse string
Connell
Cushing
Lembert
Gambee
Halstead
Suture patterns for nerve & tendons:
Intraneural (nerve)
Locking loop or modified Kessler (tendons)
Interrupted horizontal mattress (tendons)
Sutures patterns
According to function:
Appositional sutures: simple interrupted, gambee, interrupted intradermal/subcuticular, interrupted cruciate mattress, simple contimuous, continuous intradermal/sucuticular, ford interlocking.
Inverting sutures: lembert, halstead, cushing, connell, parker kerr, purse string.
Tension sutures: simple interrupted, vertical & horizontal mattress, far-far-near-near, far-near-near-far.
Everting sutures: vertical and horizontal mattress etc.
Knot tying Technique- Square knot:
Go to ppt
