EXAM 1: Lecture 6 - Suture materials and patterns Flashcards
why is suture an important role in wound repair
provides hemostasis and supports healing tissues by apposing and supporting tissue layers
what are the 2 main factors when deciding what suture you should use
type of tissue and anticipated duration of healing
T/F: ligature placed on a vessel may only need to function for hours/until a clot is formed
true!
what are some types of tissue only need suture support for a few dyas
muscle, subq, skin
what type of tissue requires suture support for weeks
fascia
what type of tissue requires suture support for months
tendons
what are some things that are patient based that can delay healing
infection, obesity, malnutrition, neoplasia, drugs, collagen disorders, hypoproteinemia, radiation therapy
T/F: You do not need to maintain apposition of tissue until wounds tissue strength returns
false!! you sure do need to maintain apposition of the tissue
describe some characteristics of the ideal suture
easy to handle, reacts minimally in tissue, inhibits bacterial growth, holds securely when knotted, absorbs with minimal reaction, nonallergenic, noncarcinogenic
T/F: The idea suture material does exist
false, it does not! Surgeons must choose a suture that most closely approximates the ideal
what is united states pharmacopeia (USP)
the most commonly used standard for suture size
what does USP tell us
denotes dimensions from fine to coarse
what is the smallest and what is the largest suture sizes
12-0 is the smallest and 7 is the largest
how do you pronounce “3-0” suture
three ought
how do you pronounce “3” for suture size
it is just #3 suture
how do you pick suture size
the smallest diameter suture that will adequately secure wounded tissue should be used
why should you pick the smallest diameter suture…isnt bigger always better??
you want to minimize trauma to the tissue AND reduce the amount of foreign material
when is flexible suture indicated
for ligating vessels or performing continuous suture patterns
T/F: Nylon and surgical gut are stiff compared to silk suture
true
how is flexibility of suture determined
by torsional stiffness and diameter which influence its handling and use
what does the surface characteristics of suture influence
the ease in which it is pulled through the tissue AKA amount of friction or drag
T/F: Rough sutures cause more injury than smooth
true, smooth surfaces are very important in delicate tissues
what do sutures with smooth surfaces require
greater tension to ensure good apposition of tissues and have LESS knot security
do braided materials or monofilament materials have more drag
braided materials
why are braided materials often coated
to reduce capillarity to provide a smooth surface
what is capillarity
the process by which fluid and bacteria are carried into the interstices of multifilament fibers
T/F: Neutrophils and macrophages are too large to enter interstices of the fiber so infection may persist in non-absorbable suture
True!
T/F: Braided materials have degrees of capillarity
true!!!
are monofilament or multifilament considered noncapillary
monofilament1
T/F: Coating does not reduce the capillarity of some sutures
false, it totally does
should capillary suture material be used in contaminated/infected sites?
no! Remember macrophages and nutrophils are too large to get into the braided material
how is knot tensile strength measured
by the force in lbs that the suture strand can withstand before it breaks when knotted
T/F: tensile strength of the suture should not greatly exceed the tensile strength of the tissue
TRUE!!!
what is relative knot security
holding capacity of a suture expressed as a percentage of its tensile strength
what is knot-holding capacity
strength required to untie or break a defined knot by loading the part of the suture that forms the loop
what is tensile strength
the strength required to break an untied fiber with a force applied in the direction of its length
what are the 3 main categories suture material is classified by
structure, behavior in tissue, and origin
what are 2 characteristics of suture structure
monofilament and multifilament
what are the 2 characteristics of suture behavior in tissue
absorbable and nonabsorbable
what are the 3 characteristics of the origin of suture
synthetic, organic, and metallic
what are the characteristics of monofilament
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
what are the characteristics of multifilament
generally more pliable and flexible
may also be coated to reduce tissue drag and enhance handling characteristics
describe monofilament vs multifilament
mono - nonwicking, more memory, does not handle well
multi - wicking, less memory, good handling
T/F: Sutures of organic origin are gradually digested by tissue enzymes and phagocytized
true
T/F: Sutures manufactured from synthetic polymers are also digested by tissue enzymes
FALSE!! They are principally broken down by hydrolysis
T/F: Nonabsorbable sutures are ultimately encapsulated or walled off by fibrous tissue
True
what is the generic name of chromic gut and is it monofilament or multifilament
surgical gut and multifilament
what is the generic name of Dexon and is it monofilament or multifilament
Polyglycolic acid and multifilament
what is the generic name of Vicryl and is it monofilament or multifilament
polyglactin 910 and multifilament
what is the generic name of PDSII and is it monofilament or multifilament
Polydioxanone and monofilament
what is the generic name of maxon and is it monofilament or multifilament
polyglyconate and monofilament
what is the generic name of Monocryl and is it monofilament or multifilament
Poliglecaprone 25 and monofilament
what is the generic name of Biosyn and is it monofilament or multifilament
Glycomer 631 and monofilament
what are some characteristics of absorbable suture material
most lose tensile strength within 60 days, eventually disappear from site because it was phagocytized/hydrolyzed
what is catgut
surgical gut
what are some of the characteristics of catgut
most common non-synthetic absorbable suture material, made from submucosa of sheep intestine or serosa of bovine intestine
how is catgut broken down
via phagocytosis
what is really important to remember about catgut
elicits a notable inflammatory reaction
what type if suture is catgut/surgical gut
organic absorbable suture
what is a major downfall of catgut/surgical gut
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
how is synthetic absorbable suture broken down
via hydrolysis
what are 2 majors benefits of synthetic absorbable suture
it causes minimal tissue reaction and infection/exposure to digestive enzymes does not significantly influence the rate of absorption
T/F: polyglycolic acid, polyglactin 910, and poliglecaprone 24 are not rapidly degraded in infected urine
FALSE, they may be rapidly degraded
what are the 3 types of nonabsorbable suture material
organic nonabsorbable, synthetic nonabsorbable, and metallic sutures
what is the most common organic nonabsorbable suture
silk!
why is silk used in cardiovascular procedures
due to its excellent handling characteristics
when/why should silk not be used
It should be avoided in contaminated sites due to being a braided suture. It also loses tensile strength after 6 months
what are 2 types of synthetic nonabsorbable suture
braided multifilament and monofilament
what is good about synthetic nonabsorbable suture
they are typically strong and induce minimal tissue reaction
what should NEVER be used/implanted in the body
cable ties because they release toxic substances during degradation
what is the most common metal used in metallic sutures
stainless steel
what are the benefits of metallic suture
it is strong and has minimal tissue reaction
what are some disadvantages of metallic sutures
knot ends can create an inflammatory reaction, tendency to cut tissues, and may fragment or migrate
what are 4 things we consider when choosing suture
- length of time the suture is needed
- risk of infection
- effect of suture material on wound healing
- dimension/strength of suture required
why should monofilament be used in skin
to prevent wicking/capillary transport of bacteria to deeper tissue
why is synthetic monofilament nonabsorbable good for skin
they have good knot security and are relatively non-capillary
T/F: Absorbable sutures can be used in skin and do not need to be removed
FALSE!! You may use it in skin BUT they should be removed because absorption requires contact with body fluids
what is important to remember about suture for SQ sutures
they are used to obliterate dead space and reduce tension on skin edges
what suture material is preferred for SQ
multifilament or monofilament absorbable suture
what type of suture pattern can you use to close the rectus fascia
interrupted or continuous suture pattern
what us important to remember about continuous suture patterns
you should use a strong nonabsorbable or standard absorbable monofilament with good knot security
how many square knots or throws should you place for abdominal closure
3-4 square knots or 6-8 throws
T/F: muscle has good holding power and is not very difficult to suture
FALSE!! It has poor holding power and is difficult to suture
T/F: You can use absorbable or nonabsorbable suture for muscle
true
Sutures placed _____ to the muscle fibers are likely to ____
parallel, pull out
what type of suture should you pick for tendons
strong, nonabsorbable, and minimally reactive
what type of suture needle should you pick for suturing tendons
taper or taper-cut needle
what size suture is best for tendons
the largest suture that will pass without trauma
what are parenchymal organs
liver, spleen, kidneys
what type of suture should you pick for parenchymal organs
absorbable monofilament suture
what are hollow viscus organs
trachea, GI tract, bladder
what type of suture should you use for hollow viscus organs
absorbable monofilament
why should we not use non absorbable suture in hollow viscus organs
may be calculogenic when placed in bladder or gallbladder AND may be extruded into the lumen when implanted in intestine
what is important to remember about polyglycolic acid suture and the bladder
it rapidly dissolves when incubated in sterile urine (6 days) or infected urine (3 days)
what should you keep in mind for suture selection with infected or contaminated wounds
they should be avoided in highly contaminated/infected wounds, multifilament should not be used and surgical gut should be avoided
what suture is good for contaminated or infected wounds
absorbable suture
what suture should be used for vessels and vascular anastomoses
absorbable suture
why are most surgical needles made from stainless steel wire
because its strong, corrosion free, and does not harbor bacteria
what is surgical yield
amount of angular deformation a needle can withstand
what is ductility
the needles resistance to breaking under a specified amount of bending
what is sharpness
related to the angle of the point and taper ratio of the needle
what are the most common size of needles used
3/8 and 1/2 circle
what is appositional
one tissue edge apposed to another
what is everting
turn the tissue edges outward, away from the patient and toward the surgeon
what is inverting
turn tissue away from surgeon or towards the lumen of a hollow viscus organ
what is the purpose of subcutaneous sutures and what type of suture pattern do we use
to eliminate dead space and usually placed in a simple continuous
when do we use subcuticular suture
can be used in place of skin sutures to reduce scarring and eliminate the need for a suture removal
how do you do subcuticular sutures
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
what type of suture pattern is this
subcuticular
what type of suture pattern is this
subcutaneous
what are the 6 types of interrupted suture patterns
simple interrupted, horizontal matters, cruciate, vertical mattress, halstead, and gambee
describe how to do simple interrupted sutures
knot is offset so it does not rest on the incision, sutures are placed about 2-3mm from skin edge, they are appositional
what are the benefits of simple interrupted? what are the disadvantages?
advantage - disruption of a single suture does not cause entire suture line to fail
disadvantage - more foreign material and takes more time
when do you use a horizontal mattress suture pattern
in areas of tension
what are the advantages and disadvantages of horizontal mattress suture patterns
advantages - placed rapidly, can be bolstered using stents/buttons
disadvantages - often cause tissue eversion
what are the benefits to using cruciates
can relieve low to moderate tension, less suture material is used, and has the security of an interrupted pattern
what type of suture pattern
simple interrupted
what type of suture pattern
horizontal mattress
what type of suture pattern is this
cruciate
when should you use a vertical mattress suture pattern
preferred when addressing tension in skin closure
what are the advantages and disadvantages of vertical mattress pattern
advantages - stronger than horizontal mattress, less disruption of blood supply to wound edges
disadvantage - time consuming
what is halstead suture pattern
interrupted mattress pattern that is a modification of continuous lembert pattern
what is a gambee suture pattern
interrupted pattern used in intestinal surgery to reduce mucosal eversion
what are the 6 types of continuous suture patterns
simple continuous, running, ford interlocking, lembert, connel, and cushing
describe the benefits of a simple continuous pattern
maximum tissue apposition, relatively air and fluid tight, frequently used to close the linea alba and SQ tissue
what is the difference between simple continuous and running patterns
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
what type of suture pattern
running
what type of suture pattern
simple continuous
what is ford interlocking suture pattern
a modification of a simple continuous by each pass is linked to the previous passage
what are the benefits and disadvantages of ford interlocking
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
what type of suture pattern
ford interlocking
what is a lembert suture pattern
variation of vertical matress pattern applied in a continuous fashion used to close hollow viscera
what are cushing and connell suture patterns
inverting patterns used to close hollow organs and have a watertight seal
what is the difference between connell and cushing
connell - enters the lumen
cushing - extends only to the submucosal layer
what is parker-kerr oversew
2 layer closure for inverted closure of a transected, clamped, stump of hollow tissue
what is important to remember about tendon sutures
specific configurations are used to approximate severed ends of a tendon or to secure one end of a tendon to bone/muscle
what type of tendon suture pattern
far-near-near-far
what type of tendon suture
bunnell-mayer technique
what type of tendon suture
three-loop pulley
what type of tendon suture
locking loop
