Chapter 16 - Suture Materials and Patterns Flashcards
What is the maximum tensile strength loss period for absorbable sutures?
A) 30 days B) 45 days C) 60 days D) 90 days
C) 60 days
What classification of sutures undergoes degradation through hydrolysis and enzymatic digestion?
A) Nonabsorbable B) Synthetic C) Natural D) Multifilament
C) Natural
How many components are there in a surgical needle?
A) 1 B) 2 C) 3 D) 4
C) 3
Figure 16-1. Anatomy of a surgical needle.
Figure 16-2. Various points and shaft designs of surgical needles. (A) Taperpoint; (B) tapercut; (C) regular cutting; (D) reverse cutting; (E) spatula point; (F) blunt point.
What is the relative knot security (RKS) formula expressed as a percentage?
A) (TS/KHC) × 100 B) (KHC/TS) × 100 C) (TS/TS) × 100 D) (RKS/TS) × 100
B) (KHC/TS) × 100
What type of needle is specifically mentioned for use in ophthalmologic surgery?
A) Cutting needle B) Taper point needle C) 1/4-circle needle D) Blunt-point needle
C) 1/4-circle needle
What is the typical percentage increase in knot security for multifilament sutures due to their frictional values?
A) 25% B) 50% C) 75% D) 100%
B) 50%
How many types of degradation mechanisms are there for absorbable sutures?
A) 1 B) 2 C) 3 D) 4
C) 3
What is the main component of a surgical needle that affects its tissue penetration?
A) Length B) Body shape C) Point shape D) Attachment end
C) Point shape
How much should a selected suture’s strength compare to normal tissue strength?
A) At least 50% B) At least 75% C) Equal to D) Less than
C) Equal to
What is the tensile strength (TS) of a suture?
A) Maximum load before knot failure B) Force a suture can withstand before breaking C) Strength of tissue surrounding the suture D) Amount of tension during tying
B) Force a suture can withstand before breaking
What is the most common configuration for surgical needles used in general procedures?
A) Straight needles B) 1/4-circle needles C) 3/8- or 1/2-circle needles D) Blunt-point needles
C) 3/8- or 1/2-circle needles
What is the effect of coating on multifilament sutures?
A) Increases capillarity B) Reduces tissue drag C) Decreases knot security D) Both B and C
D) Both B and C
How is suture size expressed in the United States Pharmacopoeia (USP) standard?
A) By millimeter B) By number C) By diameter D) By cross-sectional diameter
D) By cross-sectional diameter
What percentage of knot-holding capacity (KHC) is typically ideal for surgical sutures?
A) 50% B) 70% C) 90% D) 100%
C) 90%
How does the capillarity of multifilament sutures impact surgical outcomes?
A) Reduces infection risk B) Facilitates healing C) Increases risk of infection D) Decreases tissue drag
C) Increases risk of infection
What type of suture is designed to penetrate delicate tissues without causing trauma?
A) Cutting needle B) Blunt-point needle C) Spatula needle D) Taper point needle
D) Taper point needle
What is the torsional stiffness and diameter of a suture related to?
A) Elasticity B) Flexibility C) Knot security D) Capillarity
B) Flexibility
How are surgical needles classified based on their shape?
A) Straight, curved, and flexible B) Straight, half-curved, and curved C) Long, short, and medium D) Standard, specialty, and custom
B) Straight, half-curved, and curved
What is the ideal feature of a suture that has low tissue drag?
A) High elasticity B) Smooth surface C) High capillarity D) Monofilament structure
B) Smooth surface
Which type of needle has a cutting edge on the outer curvature?
A) Regular cutting needle B) Reverse cutting needle C) Taper point needle D) Blunt-point needle
B) Reverse cutting needle
What is the relationship between knot security and friction for multifilament sutures?
A) Inversely proportional B) Directly proportional C) No correlation D) Undefined
B) Directly proportional
How long must the suture be to penetrate both wound margins effectively?
A) As long as the wound B) At least 1.5 times the wound length C) At least 2 times the wound length D) At least 3 times the wound length
B) At least 1.5 times the wound length
What type of needle is best for closing skin or tendon?
A) Taper point needle B) Cutting needle C) Blunt-point needle D) Spatula needle
B) Cutting needle
What is the risk associated with oversized suture materials?
A) Improved knot security B) Excessive tissue reaction C) Reduced tensile strength D) Decreased flexibility
B) Excessive tissue reaction
What happens to the tensile strength of absorbable sutures over time?
A) Increases significantly B) Remains constant C) Gradually decreases D) Fluctuates
C) Gradually decreases
What should be avoided in contaminated surgical sites regarding suture materials?
A) Absorbable sutures B) Nonabsorbable sutures C) Monofilament sutures D) Multifilament sutures
D) Multifilament sutures
Use nonabsorbable
How much of a suture’s diameter is a 5-0 suture in the metric system?
A) 0.5 mm B) 0.6 mm C) 0.7 mm D) 0.8 mm
A) 0.5 mm
What is the implication of high memory in a suture material?
A) Better handling B) Increased knot security C) Difficult to manage D) Low tissue drag
C) Difficult to manage
What is the ideal usage for tapered needles?
A) Skin closure B) Dense connective tissue C) Delicate tissues D) Viscera suturing
C) Delicate tissues
What is the maximum load to failure of a knot referred to as?
A) Knot security B) Knot-holding capacity C) Knot strength D) Loop security
B) Knot-holding capacity
Which type of needle is less traumatic and should be used whenever possible?
A) Blunt-point needle B) Cutting needle C) Taper point needle D) Spatula needle
C) Taper point needle
What is the primary benefit of coated multifilament sutures?
A) Increased capillarity B) Reduced drag and friction C) Higher knot security D) Increased tissue reaction
B) Reduced drag and friction
What type of sutures are indicated where prolonged wound support is required?
A) Absorbable B) Natural C) Nonabsorbable D) Multifilament
C) Nonabsorbable
How much does the knot-holding capacity typically decrease when using coated sutures?
A) 10% B) 20% C) 30% D) 40%
B) 20%
Which sutures are better for reducing tissue reaction?
A) Multifilament B) Natural C) Coated D) Monofilament
D) Monofilament
What defines loop security in surgical sutures?
A) Ability to maintain tightness B) Resistance to slipping C) Capacity to absorb tension D) Length of the suture
A) Ability to maintain tightness
What is the risk associated with using sutures with high capillarity?
A) Enhanced healing B) Increased infection risk C) Better knot security D) Reduced tissue drag
B) Increased infection risk
Figure 16-3. Deschamps needles, showing the left- and right-handed configuration, respectively. The threaded eye near the pointed tip allows easy retrieval of the suture without the need for complete penetration by the needle. When the suture is grasped at the tip of the needle, the instrument is rotated backward out of the tissue and can be rethreaded for the next bite.
surgical knots
Polyglactin 910 composition? Trade name?
Copolymer of 90% glycolide and 10% L-lactide; coating: polyglactin and calcium stearate.
Vicryl
Polyglactin 910 structure
Braided multifilament; coated
Polyglactin 910 absorption
Resorption time: 56–70 days
Polyglactin 910 tensile strength
Tensile strength reduction by 25% at day 14, 50% at day 21, and by 100% at day 35
advantages
Good size-to-strength ratio; greater initial breaking strength and stiffness than polydioxanone; minimal tissue reaction; excellent handling properties
disadvantages
May cut through friable tissue (especially if not coated)
Polyglycolic acid composition?
Polymer of glycolic acid; Dexon II is coated with polycaprolate
Safil Dexon
Polyglycolic acid structure? Trade name?
Braided multifilament; can be coated
Polyglycolic acid absorption time
Resorption time: 60–90 days
Polyglycolic acid tensile strength
Tensile strength reduction by 35% at day 14 and by 65% at day 21
Polyglycolic acid advantages
Good handling characteristics
Polyglycolic acid disadvantages
Very rapid absorption in the oral cavity; tends to drag through tissues; less knot-breaking strength than polyglactin 910
Braided lactomer composition? Trade name?
Copolymer of glycolide and lactide; coating: mixture of a caprolactone/glycolide copolymer and calcium stearoyl lactylate
Polysorb
Braided lactomer structure
Braided multifilament; coated
Braided lactomer absorption
Resorption time: 56–70 days
Braided lactomer advantages
Tensile strength is 140% of minimum knot strength requirements of the European/United States Pharmacopoeia initially, 80% at day 14 and 30% at day 21; biomechanically superior to polyglactin 910
Braided lactomer disadvantages
High initial tensile strength; good knot security; excellent handling properties
Braided lactomer
Rapid loss of strength when exposed to serum or inflamed peritoneal fluid
Glycomer 631 composition? Trade name?
Combined polymer of glycolide, dioxanone and trimethylene carbonate.
Biosyn
Glycomer 631 structure
monofilament
Glycomer 631 resorption time
90-110 days
Glycomer 631 tensile strength
Tensile strength is 75% of minimum knot strength requirements of the European/United States Pharmacopoeia at day 14 and 40% at day 21
Glycomer 631 advantages
Monofilament suture with only minimal memory and excellent handling properties; minimal tissue reaction
Glycomer 631 disadvantages
None known
Polyglytone 6211 structure
Monofilament
Polyglytone 6211 composition? trade name
Copolymer of glycolide, caprolactone, trimethylene carbonate, and lactide.
Caprosyn
Polyglytone 6211 absorption
Resorption complete within 56 days
Polyglytone 6211 tensile strenght
Loses almost all tensile strength within 21 days
Polyglytone 6211 advantages
Provides short-term tensile strength combined with very rapid absorption
Polyglytone 6211 disadvantages
Rapid absorption
Polydioxanone structure
monofilament
Polydioxanone composition? Trade name?
Polymer of poly-p-dioxanone
PDS II
Polydioxanone Absorption?
Resorption time: 180 days
Polydioxanone tensile strenght?
Tensile strength reduction by 25% at day 14, 30% at day 28, 50% at day 42
Polydioxanone advantages
Absorbable suture material that maintains tensile strength over a prolonged period of time; less memory effect than polyglyconate
Polydioxanone disadvantages
Moderate knot security, moderate handling characteristics
Polyglyconate structure
Monofilament
Polyglyconate composition and trade name
Copolymer of glycolide and trimethylene carbonate
Maxon
Polyglyconate resorption
Resorption time: 180 days
Polyglyconate tensile strength
Tensile strength reduction by 25% at day 14, 50% at day 28, 75% at day 42
Polyglyconate advantages
Slow resorption and loss of tensile strength; three-times stronger than polyglactin 910 at day 21 of wound healing; good knot security
Polyglyconate disadvantages
High memory effect, limited pliability, and moderate handling properties
What other polyglyconate exists?
Monosyn copolymer of glycolide trimethylene carbonate, caprolactone
What is polyglyconate Monosyn resorption?
Resorption time: 60–90 days
What is polyglyconate Monosyn tensile strenght?
Tensile strength reduction by 30% at day 7, 50% at day 14 and 80% at 21 days
What is polyglyconate Monosyn advantages?
Very good handling properties and good knot security; quick resorption after loss of tensile strength
What is polyglyconate Monosyn disadvantages?
-
Poliglecaprone composition? Trade name?
Copolymer of glycolide and caprolactone
Monocryl
Poliglecaprone structure?
Monofilament
Poliglecaprone absorption?
Resorption time: 90–120 days
Poliglecaprone tensile strength?
Tensile strength reduction by 50% at day 7 and 80% at day 14; complete loss of tensile strength within 21 days
Poliglecaprone advantages
Very low tissue drag owing to smooth surface; good handling characteristics; high initial tensile strength; minimal tissue reaction
Poliglecaprone disadvantages
Rapid loss of tensile strength but moderate resorption time
Silk composition and trade name
Raw silk spun by silkworm; Sofsilk, Silkam
Silk structure
braided multifilament coated or uncoated
Silk tensile strength
doesn’t have
Silk advantages
Excellent handling characteristics; useful for ligatures
Silk disadvantages
Does not maintain tensile strength more than 6 months; may potentiate infection – should be avoided in contaminated sites; has significant capillarity; incites some inflammatory reaction
Surgical steel composition and trade name
Alloy or iron
Steelex
Surgical steel structure
Monofilament or as multifilament twisted wire
Surgical steel tensile strength
Greatest tensile strength of all sutures
Surgical steel advantages
Greatest knot security of all sutures; no inflammatory reaction
Surgical steel disadvantages
Tissue movements against the inflexible ends may cause inflammation and necrosis; poor handling properties; cannot withstand repeated bending without breaking; multifilament wire can fragment and migrate, leading to sinus tract formation
Nylon composition and trade name
Polymer of polyamide
Dafilon
Monosof
Nylon structure
Monofilament or multifilament
Nylon tensile strength
Intermediate tensile strength; monofilament nylon loses about 30% of its original tensile strength by 2 years because of chemical degradation; multifilament nylon retains no tensile strength after 6 months
Nylon advantages
Suitable for use in contaminated wounds; degradation products act as antibacterial agents
Nylon disadvantages
Poor handling characteristics and poor knot security; not recommended for use within serous or synovial cavities because buried sharp ends may cause frictional irritation
Polycaprolactam composition and trade name
Polymerized caprolactam (=polyamide 6)
Supramid
Braunamid
Polycaprolactam structure
Multifilament with a polyamide coating
Polycaprolactam tensile strength
Better tensile strength than nylon
Polycaprolactam advantages
Excellent handling properties, high knot security
Polycaprolactam disadvantages
Intermediate tissue reactivity; has a tendency to form sinuses on implantation in tissues and is therefore best suited for use in the skin
Polyester composition and trade name
Polyethylene terephthalate
Mersilene
Synthofil
Dragofil
Ethibond
Ticron
Polyester structure
Monofilament or multifilament; uncoated or coated with polybutilate or silicone or polyethylene/vinyl acetate
Polyester tensile strength
Very high and sustained tensile strength
Polyester advantages
High tensile strength
Polyester disadvantages
Noncoated polyester fibers have a high coefficient of friction; knot security is poor and is further reduced by coating; causes marked tissue reaction and fibrous encapsulation; should not be used in contaminated wounds
Ultra high–molecular weight polyethylene tensile strength
Superior strength; greater tensile strength and less elongation under load than polyester sutures
Ultra high–molecular weight polyethylene advantages
High abrasion resistance; good knot security; less tissue drag than polyester sutures
Polypropylene structure
Monofilament
Polypropylene tensile strenght
Moderate tensile strength
Polypropylene advantages
Greatest knot security of all synthetic monofilament sutures; least thrombogenic suture material; minimal tissue reactivity and least likely to potentiate infection; high elasticity
Polypropylene disadvantages
Slippery handling and tying characteristics
Polybutester composition and trade name
Copolymer of butylene terephthalate and polytetramethylene ether glycol
Novafil
Polybutester structure
Monofilament
Polybutester tensile strength
Moderate
Polybutester advantages
Good handling characteristics and knot security; more flexible than polypropylene or nylon; elongates elastically under load or tension when wound edema occurs and returns to its original form when edema subsides; minimal tissue reaction
Polybutester disadvantages
Elasticity and moderate tensile strength limit suitability for repair of large traumatic wounds
Figure 16-5. Technique for tying an Aberdeen knot. (A) The single strand of the suture end and the last suture loop are used; (B) the fingers of one hand are slipped through this loop; the thumb and index finger hold the loop open while the middle and ring fingers grasp the single strand; (C) the loop is slipped off the thumb and the hitch is tightened by exerting traction in the direction of the arrow; (D to H), then steps (B to C) are repeated at least two times to add additional throws; (I) finally, the single strand of suture is passed through the last loop and tightened to lock the knot.
Figure 16-7. The 4S-modified Roeder knot is tied by (A) starting the knot with a single throw; (B) wrapping the tail of the suture three times around both strands of the loop entering the abdomen; (C) completing the knot with a half hitch knot around the standing part of the suture; and (D) completed knot is tightened by alternately pulling on the standing part and strand of the abdominal loop that exits from the cannula and is then slid into the abdominal cavity using a knot pusher.
Figure 16-8. A barbed suture equipped with a loop at one end for fixation of the first suture loop and unidirectional barbs throughout the length of the suture strand can be used for tissue apposition. These barbed suture materials allow knotless suturing.
Figure 16-6. Technique for tying a Forwarder knot. (A) The standing and the working end of the suture are positioned adjacent to each other and the needle holders and the working end of the suture is turned around the standing end of the suture and the needle holder; (B) the needle holder is used to grasp the working end of the suture through the preplaced loops; (C) the working end of the suture is pulled through the loops and locks the knot.
What is the minimum number of throws required for a secure square knot using No. 2-0 USP suture materials for polyglycolic acid?
A) 2 B) 3 C) 4 D) 5
B) 3
How much does the breaking strength of monofilament sutures decrease when clamped with a mosquito forceps instead of a needle holder?
A) 5% B) 10% C) 15% D) 20%
B) 10%
What additional throws are required for a sliding half-hitch knot to achieve knot security compared to a square knot?
A) 1 B) 2 C) 3 D) 4
B) 2
For larger diameter suture materials, how many throws are needed to achieve sufficient knot security?
A) 3 B) 4 C) 5 D) 6
C) 5
What percentage of increase in throws is needed for fat-coated No. 2-0 USP polydioxanone compared to plasma-coated for secure square knots?
A) 10% B) 20% C) 30% D) 40%
B) 20%
What is the ideal suture end length recommended to optimize knot integrity?
A) 2 mm B) 3 mm C) 4 mm D) 5 mm
B) 3 mm
How many throws are necessary for secure square knots using nylon and polydioxanone?
A) 2 B) 3 C) 4 D) 5
C) 4
What percentage decrease in knot security is associated with exposure to inflamed peritoneal fluid for polyglactin 910 after 14 days?
A) 20% B) 30% C) 40% D) 50%
D) 50%
What is the main failure mode for USP No. 2 braided lactomer loop sutures based on testing?
A) Suture failure B) Knot failure C) Fascial failure D) Tissue necrosis
C) Fascial failure
How long should the suture material for extracorporeal knotting in equine laparoscopy typically be?
A) Standard length B) 1.5 times standard length C) 2 times standard length D) Longer than standard length
D) Longer than standard length
What knot represents a special configuration to end a continuous suture line?
A) Square knot B) Surgeon’s knot C) Forwarder knot D) Aberdeen knot
D) Aberdeen knot
For the Forwarder knot, how does it compare in KHC and RKS to conventional knots for large-gauge suture material?
A) Inferior B) Equal to C) Superior D) No difference
C) Superior
What is the tensile force distribution directly related to in suture patterns?
A) Length of suture B) Number of segments parallel to the tension line C) Diameter of suture D) Type of knot
B) Number of segments parallel to the tension line
What is the knot-holding capacity (KHC) related to in suture security?
A) Suture length B) Number of throws C) Type of knot D) All of the above
D) All of the above
What type of knot should be avoided when unnecessary due to placing more suture material into the wound?
A) Square knot B) Surgeon’s knot C) Granny knot D) Half-hitch knot
B) Surgeon’s knot
How does knot security change with increasing suture diameter?
A) Increases B) Decreases C) Remains the same D) Fluctuates
B) Decreases
What is the average reduction in breaking strength for monofilament sutures when clamped incorrectly?
A) 5% B) 10% C) 15% D) 20%
B) 10%
In what environment is the knot security of USP No. 2 polyglactin 910 significantly decreased?
A) Dry environment B) Phosphate-buffered saline C) Sterile saline D) Natural tissue
B) Phosphate-buffered saline
What is the potential decrease in knot security associated with knotless suture materials?
A) 10% B) 20% C) 30% D) 40%
B) 20%
What is the total number of throws required for asymmetric knots like sliding half-hitch to achieve knot security?
A) 1 additional throw B) 2 additional throws C) 3 additional throws D) 4 additional throws
B) 2 additional throws
What is the primary advantage of using interrupted suture patterns over continuous patterns?
A) Increased failure risk B) Increased security C) Longer surgery time D) More suture material used
B) Increased security
What is the difference in the number of throws needed for knots constructed from two single suture strands versus those at the end of a continuous suture line?
A) 1 fewer throw B) 1 more throw C) 2 more throws D) 3 more throws
C) 2 more throws
For a sliding half-hitch knot, how is the tension applied to create it?
A) Towards the incision B) Perpendicular to the incision C) Away from the incision D) Randomly
C) Away from the incision
What percentage of knot-holding capacity is typically considered adequate for secure knots?
A) 50% B) 70% C) 80% D) 90%
D) 90%
What are the two main factors that influence knot security according to the text?
A) Type of knot and suture length B) Type of suture material and knot configuration C) Suture diameter and tension D) Number of throws and environment
B) Type of suture material and knot configuration
What is a critical factor when performing knot tying to avoid pulling apart the tissues?
A) Pulling both ends together B) Pulling opposing ends perpendicular to the incision C) Pulling one end only D) Using a surgeon's knot
B) Pulling opposing ends perpendicular to the incision
How does the use of barbed suture materials impact the amount of suture material implanted?
A) Increases it B) Decreases it C) No effect D) Doubles it
B) Decreases it
What is the typical result of using a sliding half-hitch in deep tissue areas?
A) Increased knot security B) Easier to adjust tension C) Ability to slide the knot into position D) Reduced tissue irritation
C) Ability to slide the knot into position
What is the primary use of appositional sutures?
A) To evert tissue edges B) To invert tissue edges C) To bring tissue surfaces into direct contact D) To provide tension across the wound
C) To bring tissue surfaces into direct contact
In minimally invasive surgery, which type of knot is preferred for knot tying?
A) Standard square knot B) 4S-modified Roeder knot C) Granny knot D) Half-hitch knot
B) 4S-modified Roeder knot
What effect does intrinsic suture tension have on surrounding tissues?
A) Promotes healing B) Can cause ischemic necrosis C) Enhances knot security D) Reduces tissue drag
B) Can cause ischemic necrosis
Which suture materials are considered biomechanically superior for laparoscopic knots?
A) Polyglactin 910 and polyglycolic acid B) Polydioxanone and polyglyconate C) Braided lactomer and nylon D) Polypropylene and silk
B) Polydioxanone and polyglyconate
What is the effect of a more extensive suture volume on tissue during surgery?
A) Decreased healing B) Increased complication rates C) Improved knot security D) No effect
B) Increased complication rates
What is the recommended outcome of the Forwarder knot and Aberdeen knot combination for continuous suturing?
A) Inferior KHC B) Equal KHC C) Superior KHC D) No impact on KHC
C) Superior KHC
What percentage of knot-related complications can potentially be decreased with knotless suture materials?
A) 10% B) 20% C) 30% D) 40%
B) 20%
How does the location of a wound affect extrinsic suture tension?
A) No effect B) Significantly increases tension C) Can decrease tension D) Varies based on the type of tissue
B) Significantly increases tension
What is a disadvantage of using barbed sutures in surgical procedures?
A) Increased time for suturing B) Higher costs C) Increased complication rates D) More bulky knots
B) Higher costs
Which suture material is preferred for skin closure to reduce bacterial transport?
A) Polypropylene B) Silk C) Catgut D) Nylon
A) Polypropylene
What is the recommended distance for needle entry from the incision line when closing skin?
A) 1 to 2 mm B) 3 to 5 mm C) 5 to 10 mm D) 10 to 15 mm
B) 3 to 5 mm
What suture pattern is commonly used for skin closure?
A) Continuous B) Simple interrupted C) Cruciate D) Mattress
B) Simple interrupted
What is the recommended spacing between interrupted sutures for skin?
A) 2 mm B) 3 mm C) 5 mm D) 10 mm
C) 5 mm
For subcutaneous sutures, which pattern is generally preferred if drainage is necessary?
A) Simple interrupted B) Continuous C) Horizontal mattress D) Vertical mattress
A) Simple interrupted
What type of suture material is typically used for fascia closure?
A) Absorbable B) Nonabsorbable C) Braided D) All of the above
D) All of the above
What size suture is generally recommended for closing the equine linea alba?
A) USP No. 0 B) USP No. 2 C) USP No. 4 D) USP No. 7
B) USP No. 2
What suture pattern is often used for gastrointestinal tract closure?
A) Lembert B) Simple continuous C) Gambee D) All of the above
D) All of the above
What is the typical tension that sutured cystotomy wounds need to withstand?
A) 50 cm H2O B) 70 cm H2O C) 90 cm H2O D) 110 cm H2O
C) 90 cm H2O
Which suture material is least likely to cause infection in contaminated tissues?
A) Braided lactomer B) Multifilament nylon C) Monofilament polypropylene D) Polyglactin 910
C) Monofilament polypropylene
For tendon repair, which suture pattern is most resistant to gap formation?
A) Simple interrupted B) Three-loop pulley C) Horizontal mattress D) Simple continuous
B) Three-loop pulley
What is the primary reason to avoid multifilament sutures in infected tissues?
A) Increased strength B) Allow biofilm formation C) Easier to handle D) Lower cost
B) Allow biofilm formation
What type of suture material is recommended for ligating blood vessels?
A) Nonabsorbable B) Absorbable C) Multifilament D) Braided
B) Absorbable
Which suture is commonly recommended for epineural suturing in nerve repair?
A) Monofilament nylon B) Polyglactin 910 C) Braided polyester D) Absorbable sutures
A) Monofilament nylon
What is a key characteristic of the preferred suture material for the gastrointestinal tract?
A) Prolonged retention of strength B) High tissue reactivity C) Absorbable with low capillarity D) Nonabsorbable
C) Absorbable with low capillarity
What is the recommended suture interval for the linea alba closure?
A) 5 mm B) 10 mm C) 15 mm D) 20 mm
C) 15 mm
Which suture material is recommended for urinary tract procedures?
A) Nonabsorbable sutures B) Absorbable synthetic sutures C) Multifilament sutures D) Catgut
B) Absorbable synthetic sutures
What is the effect of alkaline urine on absorbable sutures?
A) Strengthens them B) No effect C) Accelerates hydrolysis D) Makes them more secure
C) Accelerates hydrolysis
For which type of tissue is it crucial to incorporate the fascial layer during suturing?
A) Muscle B) Skin C) Tendon D) Blood vessels
A) Muscle
Which suture material is least thrombogenic?
A) Polyglactin 910 B) Polypropylene C) Braided lactomer D) Nylon
B) Polypropylene
What is the consequence of placing sutures too close together in skin closure?
A) Improved cosmetic outcome B) Excessive tissue reaction C) Reduced tension D) Increased healing time
B) Excessive tissue reaction
Which suture pattern is commonly used in urinary bladder closure?
A) Continuous B) Simple interrupted C) Vertical mattress D) Horizontal mattress
A) Continuous
What is the optimal ratio of suture length to wound length for linea alba closure?
A) 1:1 B) 2:1 C) 3:1 D) 4:1 or more
D) 4:1 or more
Which suture material is known for its good handling characteristics and elasticity for skin sutures?
A) Nylon B) Polybutester C) Polypropylene D) Silk
B) Polybutester
For suturing muscle, why is it important to place sutures perpendicular to muscle fibers?
A) To reduce bleeding B) To prevent pull-out C) To enhance healing D) To minimize scarring
B) To prevent pull-out
What is the best suture material for tendon repairs?
A) Monofilament B) Braided C) Nonabsorbable D) Absorbable
C) Nonabsorbable
Which suture material is recommended for nerve repair due to low tissue reactivity?
A) Polyglactin 910 B) Nylon C) Polybutester D) Silk
B) Nylon
What type of closure is preferred for contaminated wounds?
A) Nonabsorbable sutures B) Absorbable monofilament sutures C) Braided sutures D) Metallic staples
B) Absorbable monofilament sutures
What should be done to eliminate dead space before placing skin sutures?
A) Place more sutures B) Use continuous sutures C) Place subcutaneous sutures D) Avoid suturing
C) Place subcutaneous sutures
What is the typical healing rate of the urinary bladder compared to the gastrointestinal tract?
A) Slower B) Faster C) About the same D) Variable
B) Faster
What pattern is more commonly used for gastrointestinal sutures?
A) Lembert pattern B) Simple interrupted C) Continuous D) All of the above
D) All of the above
What is a recommended suture pattern to ensure a tight seal in urinary tract procedures?
A) Simple interrupted B) Continuous inverting C) Vertical mattress D) Horizontal mattress
B) Continuous inverting
Which suture material is associated with higher tissue drag and capillarity?
A) Monofilament B) Multifilament C) Polybutester D) Nylon
B) Multifilament
What is the recommended suture size for equine tendon repairs?
A) USP No. 0 B) USP No. 2 C) USP No. 4 D) USP No. 6
B) USP No. 2
What happens if nonabsorbable sutures are used in the urinary tract?
A) Promotes healing B) May lead to lithogenesis C) Enhances closure D) Decreases infection risk
B) May lead to lithogenesis
Which suture type is often used in vascular repair?
A) Absorbable synthetic B) Nonabsorbable monofilament C) Multifilament D) Braided
B) Nonabsorbable monofilament
What is a potential disadvantage of using barbed sutures?
A) Reduced tissue irritation B) Increased cost C) Enhanced handling D) Improved healing
B) Increased cost
Which pattern provides higher load-to-failure for fascia closure?
A) Interrupted B) Continuous C) Simple interrupted D) Horizontal mattress
B) Continuous
What effect does muscle orientation have on suturing?
A) Increases healing B) Affects holding power C) No effect D) Reduces blood supply
B) Affects holding power
Which suture pattern is more resistant to tensile loading for tendon repair?
A) Simple interrupted B) Three-loop pulley C) Continuous D) Horizontal mattress
B) Three-loop pulley
What is the main suture type that is appositional and may cause inversion with excessive tension?
A) Cruciate B) Simple Interrupted C) Gambee D) Ford Interlocking
B) Simple Interrupted
Which suture pattern is described as providing precise anatomical closure?
A) Interrupted Horizontal Mattress B) Continuous Intradermal C) Simple Interrupted D) Allgöwer Corium Vertical Mattress
C) Simple Interrupted
What percentage of strength does the Cruciate suture pattern provide compared to the Simple Interrupted pattern?
A) 50% B) 75% C) Greater than Simple Interrupted D) 25%
C) Greater than Simple Interrupted
Which suture pattern is specifically mentioned as reducing mucosal eversion?
A) Simple Continuous B) Gambee C) Interrupted Horizontal Mattress D) Interrupted Intradermal
B) Gambee
How does the Allgöwer Corium Vertical Mattress compare in holding strength to the Interrupted Vertical Mattress?
A) It has greater holding strength. B) It has less holding strength. C) It has the same holding strength. D) It is not comparable.
B) It has less holding strength.
Which suture pattern is noted for placing more suture material into the wound than Simple Interrupted?
A) Ford Interlocking B) Interrupted Vertical Mattress C) Simple Continuous D) Continuous Intradermal
B) Interrupted Vertical Mattress
What is a key characteristic of the Interrupted Horizontal Mattress suture pattern?
A) It is always appositional. B) It causes inversion. C) It is everting and depends on suture tension. D) It is less precise than SI.
C) It is everting and depends on suture tension.
What advantage does the Continuous Intradermal pattern have over Simple Interrupted sutures?
A) Requires more suture removal. B) Provides a superior cosmetic outcome. C) Causes more tissue reaction. D) Has greater tensile strength.
B) Provides a superior cosmetic outcome.
In terms of apposition, which pattern is described as providing maximal tissue apposition?
A) Simple Interrupted B) Simple Continuous C) Ford Interlocking D) Interrupted Vertical Mattress
B) Simple Continuous
What is the degree of eversion of the Interrupted Horizontal Mattress pattern compared to IVM?
A) Less everting B) More everting C) The same as IVM D) Cannot be determined
B) More everting
Which suture pattern allows for concurrent closure of skin and subcutis?
A) Ford Interlocking B) Simple Interrupted C) Interrupted Vertical Mattress D) Continuous Intradermal
C) Interrupted Vertical Mattress
How does the tension affect the knot placement in the Simple Interrupted pattern?
A) It should be centered. B) It should be offset to one side. C) It should be buried. D) It should be tight against the incision.
B) It should be offset to one side.
Which pattern is synonymous with the Ford Interlocking suture?
A) Simple Interrupted B) Gambee C) Reverdin D) Continuous Intradermal
C) Reverdin
What type of apposition does the Continuous Intradermal pattern provide?
A) Everting B) Appositional C) Inverting D) None of the above
B) Appositional
Which suture pattern is characterized as providing a relatively airtight and fluid-tight closure?
A) Simple Continuous B) Interrupted Horizontal Mattress C) Allgöwer Corium Vertical Mattress D) Interrupted Intradermal
A) Simple Continuous
What is the potential consequence of excessive tension in the Simple Continuous suture?
A) Improved apposition B) Strangulation of the skin C) Increased healing time D) Greater tensile strength
B) Strangulation of the skin
Which pattern may cause pressure necrosis if placed under tension?
A) Interrupted Vertical Mattress B) Continuous Intradermal C) Ford Interlocking D) Simple Interrupted
C) Ford Interlocking
What is the main characteristic of the Cruciate suture pattern?
A) It is weak under tension. B) It is stronger than Simple Interrupted. C) It cannot be used for tension adjustment. D) It is only suitable for intradermal use.
B) It is stronger than Simple Interrupted.
How much suture material does the Inverting Vertical Mattress place compared to Simple Interrupted?
A) More B) Less C) Equal D) Not comparable
A) More
Which suture pattern is noted for its ability to adapt tissue precisely?
A) Gambee B) Allgöwer Corium Vertical Mattress C) Simple Interrupted D) Ford Interlocking
D) Ford Interlocking
What is the relationship between the Interrupted Vertical Mattress and the Allgöwer pattern in terms of cosmetic outcome?
A) IVM has a better cosmetic outcome. B) Allgöwer has a better cosmetic outcome. C) Both are equal. D) Neither is cosmetic.
B) Allgöwer has a better cosmetic outcome
In what condition is the Gambee pattern particularly effective?
A) When precise adaptation is needed. B) When mucosal eversion must be reduced. C) When quick closure is required. D) When tension needs to be adjusted.
B) When mucosal eversion must be reduced
Which pattern is less precise than the Simple Interrupted due to excessive tension?
A) Continuous Intradermal B) Interrupted Horizontal Mattress C) Simple Continuous D) Ford Interlocking
D) Ford Interlocking
Which suture pattern allows for the least interference with vascular supply?
A) Allgöwer Corium Vertical Mattress B) Continuous Intradermal C) Gambee D) Interrupted Vertical Mattress
D) Interrupted Vertical Mattress
How does the strength of the Continuous Intradermal compare to percutaneous skin closure?
A) Stronger B) Weaker C) Equal D) Not comparable
B) Weaker
What type of suture pattern provides better security in case of partial failure?
A) Simple Interrupted B) Cruciate C) Ford Interlocking D) Gambee
C) Ford Interlocking
In terms of apposition, which pattern is identified as slightly everting?
A) Interrupted Vertical Mattress B) Continuous Intradermal C) Interrupted Horizontal Mattress D) Gambee
A) Interrupted Vertical Mattress
Which pattern is most suitable for creating a quick, effective closure?
A) Simple Interrupted B) Ford Interlocking C) Continuous Intradermal D) Gambee
A) Simple Interrupted
Which pattern should be used if maximal tissue apposition is required?
A) Interrupted Horizontal Mattress B) Simple Continuous C) Gambee D) Allgöwer Corium Vertical Mattress
B) Simple Continuous
How is the Continuous Intradermal pattern characterized in terms of cosmetic outcome?
A) Inferior B) Moderate C) Superior D) Not defined
C) Superior
Appositional and everting suture patterns. (A) Simple interrupted
C) cruciate
(B) interrupted intradermal/subcuticular;
D) Gambee; this pattern can be used as an appositional suture pattern for skin (a) or intestine
D) Gambee; this pattern can be used as an appositional suture pattern for skin (a) or intestine this is intestine!
(E) interrupted vertical mattress;
(F) Allgöwer corium vertical mattress;
G) interrupted horizontal mattress; (H) simple continuous;
(H) simple continuous
(I) continuous intradermal;
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(J) Ford interlocking (a); to terminate this pattern, the needle is introduced in the opposite direction from that used previously, and the end is held on that side; the loop of the suture formed on the opposite side is tied to the single end (b).
(J) Ford interlocking (a); to terminate this pattern, the needle is introduced in the opposite direction from that used previously, and the end is held on that side; the loop of the suture formed on the opposite side is tied to the single end (b).
Inverting suture patterns. (A) Cushing
Inverting suture patterns B) Connell;
Inverting suture patterns C) Lembert interrupted
Inverting suture patterns B) Lembert continuous
Inverting suture pattern (D) Parker-Kerr;
Inverting suture pattern (E) purse-string.
Tension suture patterns. (A) Interrupted vertical mattress pattern used as a tension suture;
Tension suture patterns. (B) interrupted horizontal mattress pattern placed as a tension suture with stents to reduce focal pressure on the skin, followed by a simple interrupted suture pattern to achieve wound closure;
Tension suture patterns. C) quilled/stented; (D) far-near-near-far;
Tension suture patterns.(E) walking suture;
Tension suture patterns. (F) locking loop (a) and double-locking loop (b); for the locking loop patterns, bites perpendicular to the tendon fibers are superficial relative to bites that are aligned parallel to the fibers;
Tension suture patterns. (G) 3-loop pulley pattern (a) with a cross-sectional view (b) of this pattern demonstrating that each loop is oriented 120 degrees relative to the others.
What percentage reduction in the risk of surgical site infections (SSIs) is associated with the use of triclosan-coated suture material?
A) 10% B) 15% C) 20% D) 26%
D) 26%
In horses, what was the primary finding regarding triclosan-coated suture material used for subcutaneous closure after exploratory celiotomy?
A) It reduced SSIs significantly. B) No beneficial effect was found. C) It improved healing times. D) It increased infection rates.
B) No beneficial effect was found.
How many types of staple cartridges are available for reusable thoracoabdominal (TA) staplers?
A) 2 B) 3 C) 4 D) 5
B) 3
What is the leg length of the staples in the green cartridge for TA staplers?
A) 3.5 mm B) 4.0 mm C) 4.8 mm D) 5.0 mm
C) 4.8 mm
What is the closed height of staples in the blue cartridge for TA staplers?
A) 1.5 mm B) 2.0 mm C) 2.5 mm D) 3.0 mm
A) 1.5 mm
Which staple size is most commonly used in equine surgery due to its longer staple leg?
A) 3.5 mm B) 4.0 mm C) 4.8 mm D) 5.0 mm
C) 4.8 mm
What is the range of cartridge sizes for disposable reloadable GIA staplers?
A) 30 mm to 90 mm B) 60 mm to 100 mm C) 50 mm to 100 mm D) 30 mm to 100 mm
D) 30 mm to 100 mm
In GIA staplers, how much shorter is the incision cut by the knife blade compared to the last staple at the distal end?
A) 6 mm B) 8 mm C) 10 mm D) 12 mm
B) 8 mm
What is the diameter ratio for vessels that ligating clips should accommodate for safe hemostasis?
A) One quarter to one half B) One third to two thirds C) One half to two thirds D) One quarter to one third
B) One third to two thirds
What is the width of the regular U-shaped staples in the ligating dividing stapler (LDS)?
A) 5.0 mm B) 5.8 mm C) 6.5 mm D) 7.0 mm
B) 5.8 mm
The width of the wide U-shaped staples in the LDS measures how many millimeters?
A) 6.0 mm B) 7.0 mm C) 8.0 mm D) 9.0 mm
C) 8.0 mm
How much distance is there between the staples placed by the LDS?
A) 4.0 mm B) 5.0 mm C) 6.35 mm D) 9.53 mm
C) 6.35 mm
What type of tissue should not be compressed for the LDS application?
A) 0.50 mm B) 0.75 mm C) 1.0 mm D) 1.5 mm
B) 0.75 mm
What was the mean arterial bursting pressure achieved with the LDS compared to LigaSure application?
A) Significantly higher B) Significantly lower C) The same D) Not reported
B) Significantly lower
What is the primary advantage of using ligating clips?
A) Cost-effectiveness B) Ease of application C) Reduces surgery time D) All of the above
D) All of the above
What is the advantage of using surgical skin staples compared to sutures?
A) Increased tensile strength B) Better wound edge eversion C) Easier application in deep wounds D) None of the above
B) Better wound edge eversion
What was found in a recent meta-analysis regarding the difference in SSI rates between sutures and staples?
A) Staples had a lower SSI rate. B) Sutures had a lower SSI rate. C) No significant difference was found. D) Staples had a significantly higher SSI rate.
C) No significant difference was found.
In an ex vivo study, which staple size showed better tissue apposition for jejunocecostomy?
A) 3.5 mm B) 3.8 mm C) 4.0 mm D) 4.8 mm
B) 3.8 mm
What is the purpose of 2-octylcyanoacrylate in surgical procedures?
A) Hemostasis B) Suture replacement C) Tissue grafting D) Bone fixation
B) Suture replacement
What is the main composition of fibrin glues used in surgery?
A) Fibrinogen and thrombin B) Collagen and elastin C) Gelatin and fibrinogen D) Thrombin and calcium chloride
A) Fibrinogen and thrombin
What is one of the main advantages of fibrin glues when applied to wet surfaces?
A) Increased cost B) Improved adhesion C) Reduced application time D) Decreased tissue compatibility
B) Improved adhesion
How are modern cutaneous tapes beneficial compared to traditional sutures?
A) They provide less resistance to infection. B) They maintain the integrity of the epidermis. C) They are suitable for high-tension areas. D) They are easier to remove.
B) They maintain the integrity of the epidermis.
What is the final closure width of the regular U-shaped staples in the LDS?
A) 5.0 mm B) 5.3 mm C) 5.8 mm D) 6.0 mm
B) 5.3 mm
How long should the precompression time be for the GIA stapler before inserting staples?
A) 5 seconds B) 10 seconds C) 15 seconds D) 20 seconds
C) 15 seconds
What should be avoided when applying ligating clips to ensure hemostasis?
A) Adequate vessel dissection B) Proper clip size C) Insufficient vessel length beyond the clip D) Stable application
C) Insufficient vessel length beyond the clip
hat type of closure do absorbable lactomer subcuticular staples provide compared to metal staples?
A) Weaker B) Stronger C) Equivalent D) None of the above
B) Stronger
What should be avoided when using tissue adhesives like 2-octylcyanoacrylate?
A) Application on intact skin B) Use on large or deep wounds C) Use for superficial wounds D) None of the above
B) Use on large or deep wounds
n the use of GIA staplers, how many staggered rows of staples are typically applied?
A) Two B) Three C) Four D) Five
C) Four
What potential risk is associated with the use of skin staples in horses undergoing exploratory celiotomy?
A) Improved cosmetic outcomes B) Decreased SSI rates C) Increased SSI risk D) Reduced tissue reaction
C) Increased SSI risk
What is the advantage of using modern cutaneous tapes for wound closure?
A) More resistance to infection B) Higher tension on wounds C) More precise edge approximation D) None of the above
A) More resistance to infection
How much compression does the tissue experience during staple closure using GIA staplers?
A) Minimal B) Moderate C) High D) Variable
A) Minimal
What is the effect of using absorbable subcuticular staples compared to metal skin staples?
A) Higher inflammation B) Lower inflammation and superior cosmetic outcomes C) Equal outcomes D) Lower cosmetic outcomes
B) Lower inflammation and superior cosmetic outcomes
