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2025 - Intro to Surgery 737A > EXAM 1: Lecture 6 - Suture materials and patterns > Flashcards

EXAM 1: Lecture 6 - Suture materials and patterns Flashcards

1
Q

why is suture an important role in wound repair

A

provides hemostasis and supports healing tissues by apposing and supporting tissue layers

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2
Q

what are the 2 main factors when deciding what suture you should use

A

type of tissue and anticipated duration of healing

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3
Q

T/F: ligature placed on a vessel may only need to function for hours/until a clot is formed

A

true!

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4
Q

what are some types of tissue only need suture support for a few dyas

A

muscle, subq, skin

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5
Q

what type of tissue requires suture support for weeks

A

fascia

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6
Q

what type of tissue requires suture support for months

A

tendons

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7
Q

what are some things that are patient based that can delay healing

A

infection, obesity, malnutrition, neoplasia, drugs, collagen disorders, hypoproteinemia, radiation therapy

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8
Q

T/F: You do not need to maintain apposition of tissue until wounds tissue strength returns

A

false!! you sure do need to maintain apposition of the tissue

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9
Q

describe some characteristics of the ideal suture

A

easy to handle, reacts minimally in tissue, inhibits bacterial growth, holds securely when knotted, absorbs with minimal reaction, nonallergenic, noncarcinogenic

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10
Q

T/F: The idea suture material does exist

A

false, it does not! Surgeons must choose a suture that most closely approximates the ideal

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11
Q

what is united states pharmacopeia (USP)

A

the most commonly used standard for suture size

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12
Q

what does USP tell us

A

denotes dimensions from fine to coarse

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13
Q

what is the smallest and what is the largest suture sizes

A

12-0 is the smallest and 7 is the largest

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14
Q

how do you pronounce “3-0” suture

A

three ought

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15
Q

how do you pronounce “3” for suture size

A

it is just #3 suture

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16
Q

how do you pick suture size

A

the smallest diameter suture that will adequately secure wounded tissue should be used

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17
Q

why should you pick the smallest diameter suture…isnt bigger always better??

A

you want to minimize trauma to the tissue AND reduce the amount of foreign material

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18
Q

when is flexible suture indicated

A

for ligating vessels or performing continuous suture patterns

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19
Q

T/F: Nylon and surgical gut are stiff compared to silk suture

A

true

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20
Q

how is flexibility of suture determined

A

by torsional stiffness and diameter which influence its handling and use

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21
Q

what does the surface characteristics of suture influence

A

the ease in which it is pulled through the tissue AKA amount of friction or drag

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22
Q

T/F: Rough sutures cause more injury than smooth

A

true, smooth surfaces are very important in delicate tissues

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23
Q

what do sutures with smooth surfaces require

A

greater tension to ensure good apposition of tissues and have LESS knot security

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24
Q

do braided materials or monofilament materials have more drag

A

braided materials

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25
Q

why are braided materials often coated

A

to reduce capillarity to provide a smooth surface

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26
Q

what is capillarity

A

the process by which fluid and bacteria are carried into the interstices of multifilament fibers

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27
Q

T/F: Neutrophils and macrophages are too large to enter interstices of the fiber so infection may persist in non-absorbable suture

A

True!

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28
Q

T/F: Braided materials have degrees of capillarity

A

true!!!

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29
Q

are monofilament or multifilament considered noncapillary

A

monofilament1

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30
Q

T/F: Coating does not reduce the capillarity of some sutures

A

false, it totally does

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31
Q

should capillary suture material be used in contaminated/infected sites?

A

no! Remember macrophages and nutrophils are too large to get into the braided material

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32
Q

how is knot tensile strength measured

A

by the force in lbs that the suture strand can withstand before it breaks when knotted

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33
Q

T/F: tensile strength of the suture should not greatly exceed the tensile strength of the tissue

A

TRUE!!!

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34
Q

what is relative knot security

A

holding capacity of a suture expressed as a percentage of its tensile strength

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35
Q

what is knot-holding capacity

A

strength required to untie or break a defined knot by loading the part of the suture that forms the loop

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36
Q

what is tensile strength

A

the strength required to break an untied fiber with a force applied in the direction of its length

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37
Q

what are the 3 main categories suture material is classified by

A

structure, behavior in tissue, and origin

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38
Q

what are 2 characteristics of suture structure

A

monofilament and multifilament

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39
Q

what are the 2 characteristics of suture behavior in tissue

A

absorbable and nonabsorbable

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40
Q

what are the 3 characteristics of the origin of suture

A

synthetic, organic, and metallic

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41
Q

what are the characteristics of monofilament

A

less tissue drag, do not have interstices that can harbor bacteria/fluid BUT care should be used in handling because nicking/damaging the material with forceps/needle holders may weaken or break it

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42
Q

what are the characteristics of multifilament

A

generally more pliable and flexible

may also be coated to reduce tissue drag and enhance handling characteristics

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43
Q

describe monofilament vs multifilament

A

mono - nonwicking, more memory, does not handle well

multi - wicking, less memory, good handling

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44
Q

T/F: Sutures of organic origin are gradually digested by tissue enzymes and phagocytized

A

true

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45
Q

T/F: Sutures manufactured from synthetic polymers are also digested by tissue enzymes

A

FALSE!! They are principally broken down by hydrolysis

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46
Q

T/F: Nonabsorbable sutures are ultimately encapsulated or walled off by fibrous tissue

A

True

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47
Q

what is the generic name of chromic gut and is it monofilament or multifilament

A

surgical gut and multifilament

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48
Q

what is the generic name of Dexon and is it monofilament or multifilament

A

Polyglycolic acid and multifilament

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49
Q

what is the generic name of Vicryl and is it monofilament or multifilament

A

polyglactin 910 and multifilament

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50
Q

what is the generic name of PDSII and is it monofilament or multifilament

A

Polydioxanone and monofilament

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51
Q

what is the generic name of maxon and is it monofilament or multifilament

A

polyglyconate and monofilament

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52
Q

what is the generic name of Monocryl and is it monofilament or multifilament

A

Poliglecaprone 25 and monofilament

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53
Q

what is the generic name of Biosyn and is it monofilament or multifilament

A

Glycomer 631 and monofilament

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54
Q

what are some characteristics of absorbable suture material

A

most lose tensile strength within 60 days, eventually disappear from site because it was phagocytized/hydrolyzed

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55
Q

what is catgut

A

surgical gut

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56
Q

what are some of the characteristics of catgut

A

most common non-synthetic absorbable suture material, made from submucosa of sheep intestine or serosa of bovine intestine

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57
Q

how is catgut broken down

A

via phagocytosis

58
Q

what is really important to remember about catgut

A

elicits a notable inflammatory reaction

59
Q

what type if suture is catgut/surgical gut

A

organic absorbable suture

60
Q

what is a major downfall of catgut/surgical gut

A

it is rapidly removed from infected sites or areas where it is exposed to digestive enzymes and is quickly degraded in catabolic patients. Knots may also loosen when wet

61
Q

how is synthetic absorbable suture broken down

A

via hydrolysis

62
Q

what are 2 majors benefits of synthetic absorbable suture

A

it causes minimal tissue reaction and infection/exposure to digestive enzymes does not significantly influence the rate of absorption

63
Q

T/F: polyglycolic acid, polyglactin 910, and poliglecaprone 24 are not rapidly degraded in infected urine

A

FALSE, they may be rapidly degraded

64
Q

what are the 3 types of nonabsorbable suture material

A

organic nonabsorbable, synthetic nonabsorbable, and metallic sutures

65
Q

what is the most common organic nonabsorbable suture

A

silk!

66
Q

why is silk used in cardiovascular procedures

A

due to its excellent handling characteristics

67
Q

when/why should silk not be used

A

It should be avoided in contaminated sites due to being a braided suture. It also loses tensile strength after 6 months

68
Q

what are 2 types of synthetic nonabsorbable suture

A

braided multifilament and monofilament

69
Q

what is good about synthetic nonabsorbable suture

A

they are typically strong and induce minimal tissue reaction

70
Q

what should NEVER be used/implanted in the body

A

cable ties because they release toxic substances during degradation

71
Q

what is the most common metal used in metallic sutures

A

stainless steel

72
Q

what are the benefits of metallic suture

A

it is strong and has minimal tissue reaction

73
Q

what are some disadvantages of metallic sutures

A

knot ends can create an inflammatory reaction, tendency to cut tissues, and may fragment or migrate

74
Q

what are 4 things we consider when choosing suture

A
  1. length of time the suture is needed
  2. risk of infection
  3. effect of suture material on wound healing
  4. dimension/strength of suture required
75
Q

why should monofilament be used in skin

A

to prevent wicking/capillary transport of bacteria to deeper tissue

76
Q

why is synthetic monofilament nonabsorbable good for skin

A

they have good knot security and are relatively non-capillary

77
Q

T/F: Absorbable sutures can be used in skin and do not need to be removed

A

FALSE!! You may use it in skin BUT they should be removed because absorption requires contact with body fluids

78
Q

what is important to remember about suture for SQ sutures

A

they are used to obliterate dead space and reduce tension on skin edges

79
Q

what suture material is preferred for SQ

A

multifilament or monofilament absorbable suture

80
Q

what type of suture pattern can you use to close the rectus fascia

A

interrupted or continuous suture pattern

81
Q

what us important to remember about continuous suture patterns

A

you should use a strong nonabsorbable or standard absorbable monofilament with good knot security

82
Q

how many square knots or throws should you place for abdominal closure

A

3-4 square knots or 6-8 throws

83
Q

T/F: muscle has good holding power and is not very difficult to suture

A

FALSE!! It has poor holding power and is difficult to suture

84
Q

T/F: You can use absorbable or nonabsorbable suture for muscle

A

true

85
Q

Sutures placed _____ to the muscle fibers are likely to ____

A

parallel, pull out

86
Q

what type of suture should you pick for tendons

A

strong, nonabsorbable, and minimally reactive

87
Q

what type of suture needle should you pick for suturing tendons

A

taper or taper-cut needle

88
Q

what size suture is best for tendons

A

the largest suture that will pass without trauma

89
Q

what are parenchymal organs

A

liver, spleen, kidneys

90
Q

what type of suture should you pick for parenchymal organs

A

absorbable monofilament suture

91
Q

what are hollow viscus organs

A

trachea, GI tract, bladder

92
Q

what type of suture should you use for hollow viscus organs

A

absorbable monofilament

93
Q

why should we not use non absorbable suture in hollow viscus organs

A

may be calculogenic when placed in bladder or gallbladder AND may be extruded into the lumen when implanted in intestine

94
Q

what is important to remember about polyglycolic acid suture and the bladder

A

it rapidly dissolves when incubated in sterile urine (6 days) or infected urine (3 days)

95
Q

what should you keep in mind for suture selection with infected or contaminated wounds

A

they should be avoided in highly contaminated/infected wounds, multifilament should not be used and surgical gut should be avoided

96
Q

what suture is good for contaminated or infected wounds

A

absorbable suture

97
Q

what suture should be used for vessels and vascular anastomoses

A

absorbable suture

98
Q

why are most surgical needles made from stainless steel wire

A

because its strong, corrosion free, and does not harbor bacteria

99
Q

what is surgical yield

A

amount of angular deformation a needle can withstand

100
Q

what is ductility

A

the needles resistance to breaking under a specified amount of bending

101
Q

what is sharpness

A

related to the angle of the point and taper ratio of the needle

102
Q

what are the most common size of needles used

A

3/8 and 1/2 circle

103
Q

what is appositional

A

one tissue edge apposed to another

104
Q

what is everting

A

turn the tissue edges outward, away from the patient and toward the surgeon

105
Q

what is inverting

A

turn tissue away from surgeon or towards the lumen of a hollow viscus organ

106
Q

what is the purpose of subcutaneous sutures and what type of suture pattern do we use

A

to eliminate dead space and usually placed in a simple continuous

107
Q

when do we use subcuticular suture

A

can be used in place of skin sutures to reduce scarring and eliminate the need for a suture removal

108
Q

how do you do subcuticular sutures

A

suture line is begun by burying the knot in the dermis, it is advanced in the dermal tissue, and bites are parallel to the long axis incision

109
Q

what type of suture pattern is this

A

subcuticular

110
Q

what type of suture pattern is this

A

subcutaneous

111
Q

what are the 6 types of interrupted suture patterns

A

simple interrupted, horizontal matters, cruciate, vertical mattress, halstead, and gambee

112
Q

describe how to do simple interrupted sutures

A

knot is offset so it does not rest on the incision, sutures are placed about 2-3mm from skin edge, they are appositional

113
Q

what are the benefits of simple interrupted? what are the disadvantages?

A

advantage - disruption of a single suture does not cause entire suture line to fail

disadvantage - more foreign material and takes more time

114
Q

when do you use a horizontal mattress suture pattern

A

in areas of tension

115
Q

what are the advantages and disadvantages of horizontal mattress suture patterns

A

advantages - placed rapidly, can be bolstered using stents/buttons

disadvantages - often cause tissue eversion

116
Q

what are the benefits to using cruciates

A

can relieve low to moderate tension, less suture material is used, and has the security of an interrupted pattern

117
Q

what type of suture pattern

A

simple interrupted

118
Q

what type of suture pattern

A

horizontal mattress

119
Q

what type of suture pattern is this

A

cruciate

120
Q

when should you use a vertical mattress suture pattern

A

preferred when addressing tension in skin closure

121
Q

what are the advantages and disadvantages of vertical mattress pattern

A

advantages - stronger than horizontal mattress, less disruption of blood supply to wound edges

disadvantage - time consuming

122
Q

what is halstead suture pattern

A

interrupted mattress pattern that is a modification of continuous lembert pattern

123
Q

what is a gambee suture pattern

A

interrupted pattern used in intestinal surgery to reduce mucosal eversion

124
Q

what are the 6 types of continuous suture patterns

A

simple continuous, running, ford interlocking, lembert, connel, and cushing

125
Q

describe the benefits of a simple continuous pattern

A

maximum tissue apposition, relatively air and fluid tight, frequently used to close the linea alba and SQ tissue

126
Q

what is the difference between simple continuous and running patterns

A

simple - needle is passed through the tissue from one side to the other in a perpendicular fashion to the incision and then advanced above the incision line at a diagonal

running - similar to simple BUT the suture is advanced above and then below the incision line

127
Q

what type of suture pattern

A

running

128
Q

what type of suture pattern

A

simple continuous

129
Q

what is ford interlocking suture pattern

A

a modification of a simple continuous by each pass is linked to the previous passage

130
Q

what are the benefits and disadvantages of ford interlocking

A

benefit - may appose better than simple interrupted, greater stability than simple continuous

disadvantage - larger amount of suture is used and they may be more difficult to remove

131
Q

what type of suture pattern

A

ford interlocking

132
Q

what is a lembert suture pattern

A

variation of vertical matress pattern applied in a continuous fashion used to close hollow viscera

133
Q

what are cushing and connell suture patterns

A

inverting patterns used to close hollow organs and have a watertight seal

134
Q

what is the difference between connell and cushing

A

connell - enters the lumen

cushing - extends only to the submucosal layer

135
Q

what is parker-kerr oversew

A

2 layer closure for inverted closure of a transected, clamped, stump of hollow tissue

136
Q

what is important to remember about tendon sutures

A

specific configurations are used to approximate severed ends of a tendon or to secure one end of a tendon to bone/muscle

137
Q

what type of tendon suture pattern

A

far-near-near-far

138
Q

what type of tendon suture

A

bunnell-mayer technique

139
Q

what type of tendon suture

A

three-loop pulley

140
Q

what type of tendon suture

A

locking loop

2025 - Intro to Surgery 737A (19 decks)

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