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Surgery > Chapter 17 suture material, tissue staplers, and ligation devices > Flashcards

Chapter 17 suture material, tissue staplers, and ligation devices Flashcards

1
Q

skin staples and measurements

A

results in tissue evertion closed: width regular: 4.8-5.0mm wide: 6.4-7.0 mm depth regular: 3.4 - 3.9mm wide: 6.4-7.1mm

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2
Q

TA stapler/staples: sizes and dimension

A

Thoracic-abdominal stapler Blue - two lines of staples. length 4mm height, 3.5mm compresses to 1.5mm TA 30-3.5 TA 55 -3.5 TA 90 - 3.5 Green - two lines of staples. length 4mm, height 4.8 mm compresses to 2mm TA 30 - 4.8 TA 55 - 4.8 TA 90 - 4.8 TA 30-3V - three lines of staples

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3
Q

GIA stapler measurements

A

two lines of staples on each side. length 3mm height 3.85mm, compresses to 3.5mm 50 = creates 5 cm length transection 90 = creates 9 cm length transection

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4
Q

straight needles

A

used at the surface of the body (skin) and are used for placement of tension-relieving sutures in the skin where a moderate distance between the incision and the exit point of the suture is desirable

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5
Q

curved needle

A

essential in small or deep surgical fields, where the size of the surgical field and working area is limited. Fraction of a circle 5/8, ½, 3/8, ¼

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6
Q

combination needles

A

curved and straight section are called J- Ski- or F-needles

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7
Q

swaged needles (eyeless)

A

less trauma due to eyeless base and better choice for delicate tissues (ocular, intestinal, urinary). i. Channel-swaged needles have the suture crimped in a depression in the body of the needled ii. Laser-drilled swage have the suture crimped in a hole drilled in the body of the needle. Can be gripped farther back on the needle and have less tissue drag.¬

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8
Q

Non-swaged suture needle

A

Can be useful for passing large suture in orthopedic surgery or other specialized applications. They are reusable and have either a closed eye or a ridged slit (French or split needles) to hold suture i. Suture should be loaded from the concave surface because the suture will be less prone to pulling out of the needle. ii. Due to the increased width (doubling back on itself through the eye or slit) results in increased tissue trauma iii. Continued reuse will dull the needle

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9
Q

Needle points

A

blunt, taper, cutting

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10
Q

blunt

A

used in friable tissue

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11
Q

taper

A

fine point that pierces and spreads tissue during needle passage. (GI, fat urinary, muscle)

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12
Q

cutting

A

for increased ease of tissue penetration (skin, periosteum, fascia) 1. Standard cutting: the cutting surface is on the concave surface 2. Reverse cutting: the cutting surface is on the convex surface resulting in less risk of inadvertent needle hole elongation and pull through. A cutting needle with cutting surface on the concave surface and the tendency for surgeons to pull towards the concave surface increases needle hole size and consequentially increases the risk of suture pull through.

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13
Q

tapercut

A

combination needle with a reverse cutting point and an oval body to allow needle penetration with less risk of inadvertent tissue cutting or fraying

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14
Q

spatulated

A

lateral cutting for ocular surgery

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15
Q

diamond point

A

4 cutting edges for plastic surgery and decreased skin resistance and minimal scaring.

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16
Q

Suture

A

a. To hold tissues in apposition and carry all physiologic forces until wound healing progresses to the point that the tissue can sustain those forces. b. Essential characteristics – sterility, uniform diameter and size, pliability for ease of handling, uniform tensile strength, nonirritating composition, and freedom from impurities are essential qualities of suture material. c. USP – United States Pharmacopeia standard suture sizes

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17
Q

breaking strength

A

the stress value on the stress-strain curve at which suture acutely fails.

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18
Q

capillarity

A

the degree to which absorbed fluid is transferred along a suture.

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19
Q

creep

A

the tendency of a suture to slowly and permanently deform under constant stress.

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20
Q

elasticity

A

the degree to which a suture will deform under stress or load and return to its original form when the load is removed

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21
Q

fluid absorption

A

the degree to which a suture will absorb fluid following immersion.

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22
Q

knot pull out strenght

A

the load required to break a suture deformed by a knot. Deformation caused by knot placement generally results in a 10% to 40% loss of strength.

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23
Q

knot strength

A

the force necessary to cause a knot to slip

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24
Q

memory

A

the tendency for a suture to return to its original shape after deformation.

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25
Q

plasticity

A

the degree to which a suture will deform without breaking and will maintain its shape after removal of the deforming force.

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26
Q

pliability

A

the ease of handling and the ability to change the shape of suture

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27
Q

stress relaxation

A

the ability of suture to reduce stress under constant strain

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28
Q

suture pull out value

A

the weight required to pull a suture loop from tissue. (fat – 0.2kg, muscle 1.27kg, skin 1.82kg, fascia 3.77kg)

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29
Q

tensile strength

A

similar to ultimate strength, breaking strength, or yield strength. This is a measure of a suture’s ability to resist deformation and breakage and the stress at which deformation (yield strength) or rupture (breaking or ultimate strength) occurs.

30
Q

monofilament

A

single stranded with less tissue drag, less pliable and more susceptible to catastrophic damage from crushing or nicking. Less tissue drag

31
Q

multifilament

A

multi stranded (braided or twist) 1. Braided configuration is greater strength and pliability compared to monofilamentous material 2. Increased tissue drag (increased risk for tissue bunching and tissue trauma) and capillarity with increased tendency for bacterial colonization. Use should be avoided in contaminated wounds or in applications where wicking of bacteria is undesirable

32
Q

polyblend

A

made of multiple polymers (orthopedic application)

33
Q

self-anchoring

A

barbed sutures made from a monofilament suture base have been introduced in an attempt to eliminate bulky knots and intermittent, high-tension regions associated with loop sutures. Resulted in equivalent cosmesis, wound healing, and numbers of adverse events when compared with standard knotted suture.

34
Q

water insoluble

A

Vicryl suture is coated with a 50:50 mixture of polyglactin 370 and calcium stearate; increases pliability, reduces tissue drag, and improves tying characterisitics. However, water insoluble coating will reduce knot security compared with uncoated suture.

35
Q

water soluble

A

: Dexon II polyglycolic acid, copolymers of glycolide and ¬caprolactone to facilitate knot formation

36
Q

antibiotic coating

A

(PDS plus – triclosan coated suture) was shown in humans to decrease postoperative wound infection from 11% to 5%.

37
Q

absorbable suture

A

a. Loses most of its tensile strength within 60-90 days in living mammalinan tissue.

38
Q

enzymatic degradation

A

catgut and collagen-based materials are degraded with proteases and collagenases.

39
Q

Hydrolytic degradation

A

synthetic absorbable sutures. Random main-chain scission of ester linkages.

40
Q

environmental factors that influence absorption rates i. Urine 1. When immersed in sterile urine, PDS lost all strength in ____days; Polyglycolic acid (Dexon) lost _____% of its initial breaking strength in ____days. 2. ______infected urine a. PDS and polyglycolic acid lost all strength after ___ day b. PDS, poliglecaprone 25 (monocryl), polyglyconate (maxon) and glycomer 631 (biosyn) disintegreated after ____ days 3. Ecoli infected urine resulted in a reduction of tensile strength, but was less dramatic than other studies ii. pH 1. glycolide (poliglecaprone 25, polyglyconate, glycomer 631) degrade more rapidly in ________environments. 2. Dioxanone component (polydioxanone) and nylon degrade more rapidly in _______environments iii. Bodily fluids (pancreatitc secretions, bile, gastric secretion or blood) iv. Temperature v. Bacteria

A

i. Urine 1. When immersed in sterile urine, PDS lost all strength in 3 days; Polyglycolic acid (Dexon) lost 65% of its initial breaking strength in 10 days. 2. Proteus infected urine a. PDS and polyglycolic acid lost all strength after 1 day b. PDS, poliglecaprone 25 (monocryl), polyglyconate (maxon) and glycomer 631 (biosyn) disintegreated after 7 days 3. Ecoli infected urine resulted in a reduction of tensile strength, but was less dramatic than other studies ii. pH 1. glycolide (poliglecaprone 25, polyglyconate, glycomer 631) degrade more rapidly in alkaline environments. 2. Dioxanone component (polydioxanone) and nylon degrade more rapidly in acidic environments iii. Bodily fluids (pancreatitc secretions, bile, gastric secretion or blood) iv. Temperature v. Bacteria

41
Q

Catgut

A

i. Twisted material from small intestineal submucosa of sheep or the intestinal serosa of cattle ii. Relatively weak iii. Is not uniform in diameter and has random thinner and weaker zones throughout its length iv. Tissue reaction is high and absorption is extremely variable depending on local conditions. v. Enzymatic degredation, complete resorption in 2- 3 weeks

42
Q

polyglycolic acid: Dexon - braided homopolymer

A

i. Hydrolysis Absorbed in 60 days – 90 days ii. 50% tensile strength in 2-3 weeks iii. Greatest breaking stress iv. Greater knot security compared with polyglactin 910

43
Q

polyglactin 910: Vicryl

A

braided multifilament copolymer 90% glycolide and 10% L-lactide) i. Vicryl Plus: antibacterial tricolsan coating ii. Vicryl rapide: irradiated form with rapid absorption iii. 50% tensile strength in 2-3 weeks

44
Q

poliglecaprone 25: Monocryl - monofilament copolymer

A

i. Comparable knot performance (loop holding capacity and distance of knot sliding) to polyglactin 910, Polydioxanone, and lesser performance compared with polyglyconate (Maxon) ii. HIGHEST initial breaking strength (superior to vicryl,gut, and PDS) iii. Monocryl plus tricolsan coating iv. 50% strength in 1 week v. 70-80% in 2 weeks vi. 100% absorbed in 90-120 days

45
Q

polyglytone 6211: Caprosyn - monofilament polymer

A

i. No measurable strength is seen after 3 weeks

46
Q

slowly absorbed synthetic sutures

A

PDS, polyglyconate, biosyn,

47
Q

polydioxanon: PDS II - monofilament

A

i. With or without triclosan coating ii. 50% tensile strength in 5-6 weeks iii. Better handling and less memory than polyglyconate iv. Intermediate knot security

48
Q

polyglyconate

A

co-polymer of glycolic acid and trimethylene carbonate, monofilimant i. 50% strength in 4-5 weeks ii. Has better knot performance (loop-holding method testing) compared with polydioxanone, polyglactin 910, coated polyglycolic acid, and poliglecaprone 25, polyglyconate.

49
Q

glycomer 631: biosyn

A

monofilament i. 50% tensile strength at 2-3 weeks ii. 100% absorbed in 90-110 days

50
Q

nonabsorbable sutures

A

silk, polypropylene, nylon, vetafil, polyester, stainless steel

51
Q

silk

A

natural braided multifilament (vasculature ligation) i. Degraded by hydration and is deteriorated in 2 years ii. 56% tensile strength lost in 12 weeks. iii. Used for ligation of large vessels because it has excellent handling characterisitics and good knot security iv. Avoid where inflammation is undesirable and in infected or contaminated wounds v. Foreign protein that incites a considerable tissue reaction and the associated inflammation is thought to be responsible for progressive occlusion of partially ligated vessels over time. (portosystemic shunts)

52
Q

polypropylene

A

monofilament polyolefin (tendon, ligament, joint capsule, fascia) i. Prolongued suture strength, lack of hydrolysable bonds make it resistant to degradation. Highest energy to break point

53
Q

Nylon

A

monofilament polyamide i. Second in energy to break point to polypropylene ii. Nonabsorbable, but susceptible to degradation as a result of hydration iii. 50% tensile strength in 12 weeks iv. Monofilimant leader line used in orthopedic repair will elongate under constant load and its physical properties are significantly influenced by sterilization techniques (least impact on elongation and strength) is ethylene oxide sterilizations.

54
Q

vetafil polymerized caprolactam

A

– nylon based multifilament twisted suture (skin only because of sinus formation)

55
Q

polyester: polyethylene, polybutester, and composites

A

i. Strongest = polyblend ii. FiberWire – multifilament ultra-high-molecular-weight polyethylene core surrounded by a braided polyester and polyethylene exterior. 1. Greater knot security and abrasion resistnace compared with abraided polyester suture. 2. When compared with stainless steel, FiberWire had significantly greater strength in three-point bending and unlike steel, maintained stiffness until ultimate failure. 3. Has the greatest maximal failure load of the polyblend sutures

56
Q

stainless steel

A

304, 316, or 316 L (L = low concentration of carbon which increases corrosion resistance) i. Resistant to corrosion because of high chromium and nickel content ii. Second strongest and poor handling iii. Avoid creating surface defects, as these may promote crevices or fretting corrosion and may serve as mechanical stress risers

57
Q

surgical mesh a. Used for large defects created or treated during surgery that cannot be completely closed with ________tissue. b. To augment repair of slow-healing tissues (tendons or ligaments or prosthetic replacments) c. Constructed of metal, synthetic polymers, or biologically derived materials.

A

a. Used for large defects created or treated during surgery that cannot be completely closed with autogenous tissue. b. To augment repair of slow-healing tissues (tendons or ligaments or prosthetic replacments) c. Constructed of metal, synthetic polymers, or biologically derived materials.

58
Q

woven mesh tend to be more elastic in the bias direction (45 degrees from the warp and weft). 1. ________– set of lengthwise filaments aligned in one direction 2. _______– woven over and under the warp filaments at a perpendicular angle 3. _______–grain direction (bias) 45 degrees from the warp and weft. All woven fabric have two bias directions at 90 degrees to each other 4. Woven fabrics are _____, _______, and less _____compared with knitted meshes.

A

tend to be more elastic in the bias direction (45 degrees from the warp and weft). 1. Warp – set of lengthwise filaments aligned in one direction 2. Weft – woven over and under the warp filaments at a perpendicular angle 3. Cross –grain direction (bias) 45 degrees from the warp and weft. All woven fabric have two bias directions at 90 degrees to each other 4. Woven fabrics are stronger, stiffer, and less porous compared with knitted meshes.

59
Q

knitted mesh more porous and flexible and weaker than woven. Are intermeshing loops of one continuous filament. 1. ______– the row of distensible loops across a fabric 2. ______– the column of loops along the length of the fabric. _____account for the strength of knitted mesh 3. Knitted materials have different mechanical properties, depending on the direction force is applied (________) 4. A very small pore size will prevent ingrowth of capillaries and fibroblasts, causing encapsulation, rather than incorporation. 5. Larger pore mesh, will be stronger repairs in 90 days after implantation

A

more porous and flexible and weaker than woven. Are intermeshing loops of one continuous filament. 1. Course – the row of distensible loops across a fabric 2. Wale – the column of loops along the length of the fabric. Wales account for the strength of knitted mesh 3. Knitted materials have different mechanical properties, depending on the direction force is applied (anisotropic) 4. A very small pore size will prevent ingrowth of capillaries and fibroblasts, causing encapsulation, rather than incorporation. 5. Larger pore mesh, will be stronger repairs in 90 days after implantation

60
Q

SIS porcine small intestinal submucosa

A

multilaminate material that allows for ingrowth of native tissues. Bioscaffold. 1. A strong initial inflammatory response is present, and in spite of the fact that porcine small intestinal submucosa is a foreign animal protein, no prolonged inflammatory reaction or classical tissue rejection reaction occurs.

61
Q

surgical application of a mesh… i. Mesh should be trimmed and customized to fit a surgical wound. 1. Trimming with _______may seal the edges and prevent fraying. 2. The edge of the mesh should be doubled over to create a hem and prevne tmesh fraying and pull-out on the margins. 3. With tension, a ____cm overlap is recommended versus ____cm without tension

A

i. Mesh should be trimmed and customized to fit a surgical wound. 1. Trimming with electrocautery may seal the edges and prevent fraying. 2. The edge of the mesh should be doubled over to create a hem and prevne tmesh fraying and pull-out on the margins. 3. With tension, a 1cm overlap is recommended versus 0.6cm without tension

62
Q

mesh complications

A
  1. Mechanical failure, commonly occurs at the tissue-mesh interface 2. Visceral adhesions 3. Fistula formation 4. Mesh migration or extrusion 5. Infection
63
Q

Skin Staples – stainless steel and tend to evert the wound edge

A

i. Diameter 0.5mm ii. Closed width – 4.8-5.0mm (regular) and 6.4-7.0mm (wide) iii. Depth – 3.4-3.9 (regular) and 6.4-7.1 (wide)

64
Q

skin staple advantages…

A

i. Reduced surgical time ii. Less pain iii. Greater wound oxygenation iv. Potential for greater resistance to infection v. One study cited less histologic inflammation with staple use compared with sutures. However, other studies document no difference in complications for ventral abdominal midline incisions closed with skin staples

65
Q

skin staple disadvantages…

A

i. Potential increased risk for infection-inflammation in dogs undergoing stifle surgery with use of staples (increased postoperative infection-inflammation) ii. Pig study demonstrated an substantial inflammation not seen in dogs and cats iii. Removal difficulty and associated tissue trauma and discomfort

66
Q

hemostatic clips

A

iii. Principles of vascular clip appliceation 1. Skeletonize the vessel to remove as much of the surrounding tissue as possible. 2. Maximal diameter of a vessel a. The diameter of the vessel should be no more than 2/3 and no less than 1/3 the clip length 3. Applied several millimeters from the cut edge of the vessel 4. Arteries and veins should be clipped separately.

67
Q

LDS

A

(ligate-divide staple) device- will significantly reduce surgical time i. Regular (5.79mmx5.23mmx closure width 5.33mm) ii. Wide (8mmx7.2mmxclosure width 7.3mm)

68
Q

Linear stapling devices

A

a. 30-90mm and 2-3 staggered rows of staples b. Liver and lung lobectomies are most common applications also used for closure of stomach or bowel c. GIA – linear stapling device with a cutting device

69
Q

circular stapling devices

A

a. End-to-end, end-to-side, side-to-side anastomosis in the gastrointestinal tract b. Double staggered, circular row of staples is placed, and a stoma is created within the staples. The resulting anastomosis is inverted. c. Contraindicated if tissue thickness is less than 1mm or greater than 2.5mm d. Pre-placement of a purse-string suture is required. A doughnut of tissue remains in the stapling device. This doughnut consists of the excised purse-string sutures and the associated bowel. Evaluate this tissue for luminal patency e. Size is a limitation especially in the small bowel of small dogs and cats.

70
Q

cyanoacrylate

A

glue that if placed within the wound will cause a foreign body reaction and local inflammation secondary to toxic byproducts. Byproducts of polymerization are cyanoacetate and formaldehyde. i. Polymerization and tissue bonding occur when the glue encounters anions associated with moisture on the surface of the skin or wound edge ii. Advantages include increased speed of wound closure, abrogation of the need for suture removal, and reduced patient cost compared with sutures. iii. Form an occlusive seal over a wound, establish a barrier to microbial penetration, and have antibacterial effects. iv. Disadvantages include the relatively low strength.

71
Q

Staple Sizes

A
72
Q

GIA measurments

A

3.5mm or 4.8mm

50, 80, 90, 100mm lengths

Surgery (53 decks)

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