Suture materials Flashcards
What are the functions of suture material?
Wound closure
Ligation
Attachment of tubes
Stay sutures
What are features of the ideal suture material?
INTERACTION WITH TISSUES - maintains strength until wound strength develops, rapid resorption when no longer required, encapsulated without post-op complications, easily removed, minimal tissue reaction, doesn’t favour bacterial growth, minimal drag through tissues, suitable for all wounds
INTERACTION WITH SURGEON - easy to handle (pliable, low memory), good knot security
MATERIAL PROPERTIES - easy to sterilise, non-capillary, non-electrolytic, non-corrosive, non-allergenic, non-carcinogenic
PRACTICAL CONSIDERATIONS- cheap, readily available, range of sizes
How is suture material classified?
ORIGIN: Natural vs synthetic
PERSISTENCE: absorbable/non-absorbable
STRUCTURE: multifilament/monofilament
Describe the tissue reaction and absorption of natural and synthetic fibres.
NATURAL: tissue inflammatory reaction, variable absorption
SYNTHETIC: less reaction, predictable absorption
Describe the persistence of absorbable and non-absorbable fibres.
ABSORBABLE: temporary wound support, loss of strength (21d)
NON-ABSORBABLE: elicits tissue reaction –> encapsulation, strength persists >60d
Contrast multifilaments and monofilaments
MULTIFILAMENT: easier to handle, better knot security, capillarity
MONOFILAMENT: less tissue drag, can weaken when crushed, prone to kinking
How can ‘other items’ affect suture classification? 3
COATING - coated vs uncoated. Coating improves handling and reduces tissue drag.
COLOUR (dyed/undyed) - improves visibility
PACKAGING - cassette, individual packet
What does FACTS stand for in the context of suture material?
Interaction with tissue:
Absorption Completion
Tensile Strength and loss.
List some examples of SYNTHETIC ABSORBABLE MULTIFILAMENT 4
Important to know!!!!
Vicryl - Polyglactin 910
Dexon - Polyglycolic acid
Polysorb - Lactomer 9-1
Panacryl - Poly(L-lactide,glycolide)
Describe for SYNTHETIC ABSORBABLE MUTLIFILAMENT, the:
tissue interaction
tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: absorption complete at 60-90d.
Speed: Polysorb>Vicryl>Dexon
TENSILE STRENGTH AND LOSS: loss 33% (7d), 80% (14d), 100% (21d). Strength: Polysorb>Vicryl>Dexon
HANDLING AND KNOTTING: good handling/knotting, tissue drag - improved by coating
USE: vessel ligation, general soft tissue closure (skin, mouth)
List examples of SYNTHETIC ABSORBABLE MONOFILAMENT - SHORT DURATION - 2
Monocryl - Polyglecaprone
Caprosyn - Polyglytone
Describe for SYNTHETIC ABSORBABLE MONOFILAMENT - SHORT DURATION, the:
Tissue interaction
Tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: absorption complete @90-120d, speed Caprosyn>Monocryl
TENSILE STRENGTH AND LOSS: high tensile strength, loss 50% (7d), 60% (14d), 100% (21d)
HANDLING AND KNOTTING: monocry - soft and pliable, low memory. Caprosyn - more sticky
USE: general soft tissue closure, visceral closure - monocryl
List examples of SYNTHETIC ABSORBABLE MONOFILAMENT - LONG DURATION - 3
PDS 2- Polydioxanone
Maxon - Polyglyconate
Biosyn - Glycomer 631
Describe for SYNTHETIC ABSORBABLE MONOFILAMENT - LONG DURATION, the:
Tissue interaction
Tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: absorption complete @110-210d
TENSILE STRENGTH AND LOSS: strong materials (>nylon, prolene), loss 26% (14d), 40% (28d), 75% (42d), Strength: PDS 2> Maxon>Biosyn
HANDLING AND KNOTTING: PDS - memory, tendency to coil, 7 knots
USE: soft tissues needing long support, muscle, fascia, linea alba, viscera.
List 3 Synthetic non-absorbable monofilament
Prolen/SurgiPro - Polypropylene
Ethilon/Monosof - Polyamide
Flexon - Steel
Describe for SYNTHETIC NON-ABSORBABLE MONOFILAMENT, the:
Tissue interaction
Tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: minimal - inert
TENSILE STRENGTH: strong, 25% loss at 2 years -nylon
HANDLING AND KNOTTING: Memory Propylene>Nylon, knot security - prolene>nylon
USE: Inert - skin, stoma, vessels, prolonged support - hernia, tendon
List 3 Synthetic non-absorbable MULTIfilament
Mersilene, Ethibond - polyester
Novafil - Polybutester
Supramid - Caprolactam
Describe for SYNTHETIC NON-ABSORBABLE MONDOFILAMENT, the:
Tissue interaction
Tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: moderate inflammation
TENSILE STRENGTH: stronger than nylon, very little loss of strength
HANDLING AND KNOTTING: fair handling, slight elasticity, sheath cracks on knotting
USE: ligament prosthesis, skin closure
List 2 NATURAL ABSORBABLE MULTIFILAMENTS
Catgut - plain or chromic
Collagen - ophthalmic surgery
Describe for SYNTHETIC NON-ABSORBABLE MULTIFILAMENT - LONG DURATION, the:
Tissue interaction
Tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: absorption complete @60-70d, tissue reaction marked, faster in infected/vascular/acidic wounds, unpredictable - absorption via phagocytosis cf hydrolysis
TENSILE STRENGTH AND LOSS: 33% loss (7d), 67% loss (14d)
HANDLING AND KNOTTING: knots weaker when wet, poor knot security so leave ends long, good handling
USE: vessel ligation, ophthalmic surgery
Give an example of a suture material that is Natural, non-absorbable multifilament
Mersilk, PermaHand - Silk
Describe for NATURAL NON-ABSORBABLE MULTIFILAMENT, the:
Tissue interaction
Tensile strength and loss
Handling and knotting
Use
TISSUE INTERACTION: moderate-marked inflammation, encapsulation in fibrous tissue
TENSILE STRENGTH: weak - will break, very slow absorption - 2yr
HANDLING AND KNOTTING: handling good (silk)
USE: large vessel ligation, NOT in viscera - ulcers and calculi
What are general points to consider when doing a rational selection of suture material? 3
Tensile strength should match that of tissue which depends on collagen content (fascia/skin> viscera> muscle/fat)
Rate of loss of strength = gain in wound strength (rate of healing: viscera>skin>fascia)
Will suture alter healing biologically? (tissue reaction, potentiation of infection, sinus formation, potentiation of calculi, thrombi and ulcers
What are some general rules to avoid complications?
avoid multifilament in contaminated wounds
avoid non-absorbable sutures in hollow organs
use inert material in the skin
avoid reactive material for stoma creation
use slowly/non - absorbable material in fascia/tendons
avoid burying any suture from a multi-use cassette
avoid catgut in inflamed, infected or acidic wounds
What materials might you use for skin?
non-abs, mono - nylon, prolene
abs, multi - vicryl
What material might you use for the subcutis?
abs, mono/multi - monocryl, vircryl, caprosyn
What material might you use for fascia?
abs/non-abs, mono - PDS, biosyn, prolene
What material might you use for muscle?
abs, mon - PDS, biosyn, maxon
What material might you use for viscera?
abs, mono - Monocryl, PDS
What material for tendon?
non-abs, mono - prolene, nylon
What material for nerve?
non-abs, mono - prolen, nylon
What material for vessel ligation?
abs , multi - vicryl, polysorb
OR
non-abs, mono - prolene, silk
What material for vessel repair?
non-abs, mono - prolene, surgiPro
How is suture material size categorised?
in 1/10smm ascending scale linear no missing value same for all sutures Metric - UK, USP = USA Metric guage 4/5/6 last longer. 0.2/0.3/0.4 less reaction, less discomfort
How should you choose a suture?
less tissue trauma - tissue tract less suture material volume smaller knots - reduced bulk greater knot security encourages gentle handling
Rounghy what size suture should you use for: dogs cats delicate tissue tough tissue
DOG = 3 metric
CAT = 2 metric
Delicate tissue - reduce by 1-2 metric
Tough tissue - increase by 0.5-1 metric
What suture size should you use for skin?
1.5-3 metric
What suture size should you use for s/c?
1.2-2 metric
What suture size should you use for fascia?
2-3.5 metric
What suture size should you use for muscle?
2-3 metric
What suture size should you use for viscera?
1-2 metric
What suture size should you use for tendon?
2-3.5 metric
What suture size should you use for vessel ligation - small?
1.5-2 metric
What suture size should you use for vessel ligation - large?
3-4 metric
What is a swaged needle?
a needle with no eye, having suture attached to a hollow end
What are the advantages of a swaged needle?
available for use immediately unlikely to detach suture material less handling of suture material less fraying of suture material less tissue trauma likely to be sharper guaranteed sterile greater range of needles available.
How are surgical needles classified?
SIZE (length, diameter)
SHAPE (straight, curved, curved on straight, compound curve, j-shape)
CURVE SHAPE (3/8 circle, 1/2 circle, 5/8 circle)
POINT - NON-CUTTING (round bodied, taper point), CUTTING (taper cut, standard cutting, reverse cutting, side-cutting (spatula))
What are the features of a reverese cutting needle?
as sharp as cutting needle
the third cutting edge is located on the outer convex curvature of the needle.
What are the advantages of a cutting needle?
reverse cutting needles are stronger than cutting needle
danger of tissue cutout is greatly reduced
hole left by the needle leaves a wide wall of tissue against which the suture is to be tied
What are the considerations for a rational choice of surgical needle?
sharp enough to pass through tissue
no change to tissue architecture
needle resists bending/breakageTrue
needle hole just big enough for suture
Tissue characteristics - strength and friability
Wound characteristics - depth and accessibility
Surgeon’s preference - hand versus instruments
What is least important when deciding most appropriate material? (initial tensile strength, tissue characteristics, handling ease, rate of tissue healing)
Ease of handling
True/False: knot security is better for monofilament material
False
True/False: use non-absorbable material in the creation of a permanent stoma
True
Why is multi-filament better than monofilament for ligating blood vessels?
Less physically irritant to tissues
Out of these options, when would you use (Polyglytone = synthetic absorbable, multifilament)?
[closure of bladder/GIT/fascia/SC tissue}
closure of SC tissue
What is polyglecaprone (monocryl)?
synthetic absorbable monofilament (has high tensile strength)
What is the surgical advantage of having a suture material with a high tensile strength?
compared with weaker material, a smaller guage may be used.
Is polyglecaprone (monocryl) or polyamide (ethilon) easier to handle?
polyglecaprone (monocryl)
How long does it take visceral wounds to heal?
2-3 weeks
