Lecture 9 9/4/24 Flashcards
Why is suture used?
-optimize wound healing
-maintains apposition during lag/weak phase of wound healing around day 3
What is the downside to using suture?
suture is a foreign material that enhances susceptibility to infection
How does the number of CFUs differ between a wound with and without suture?
with suture: 100 CFU/ml to cause infection
without suture: 10^6 CFU/ml to cause infection
Why is it important to prevent suture contamination?
once suture material is contaminated, local mechanisms of wound decontamination become ineffective
What are the qualities of ideal suture material?
-high initial tensile strength followed by rapid absorption
-consistent uniform diameter
-sterile
-good handling and knot security
-low tissue reaction
-predictable performance
-cheap
Which suture is most ideal?
one that will lose tensile strength at a rate similar to that with which the tissue gains strength
How is suture size indicated?
-0/ought is the middle ground
-anything smaller than 0/ought is named with a number and ought
-anything larger than 0/ought is named with just a number
How does knotted suture strength compare to unknotted suture strength?
knotted suture is 50% weaker
What are the main characteristics of suture type?
-monofilament vs multifilament
-synthetic vs natural
-absorbable vs non-absorbable
What are the characteristics of monofilament suture?
-single strand
-low tissue resistance
-decreased surface area for bacterial adherence
-does not wick
-high memory
-decreased knot security
-clamping suture can damage it
What are the characteristics of multifilament suture?
-multiple strands twisted/braided together
-increased tissue resistance
-greater tensile strength
-better pliability and flexibility
-increased knot security
-increased surface area may harbor bacteria
-does wick
How does synthetic suture differ from natural suture?
-synthetic is made of man-made polymers
-natural is derived from plant or animal
What are the characteristics of chromic gut suture?
-purified connective tissue
-stimulates significant foreign body reactions/adhesions
-inconsistent absorption times
-maintains strength over 10-14 days
-suture material may swell; need longer suture tags
What are the characteristics of silk suture?
-multifilament
-excellent handling
-non-absorbable
-marked tissue reactivity
-avoided in infection
How does absorbable suture differ from non-absorbable suture?
absorbable: degradation and loss of strength within 60 days
non-absorbable: retains tensile strength for 60 days or more
What are the characteristics of synthetic absorbable suture breakdown?
-hydrolysis via esterase enzyme activity
-constant rate of absorption and loss of strength
What are the strengths of common synthetic absorbable suture?
strongest: monocryl
middle: PDS
weakest: vicryl
What are the characteristics of biosyn suture?
-synthetic
-absorbable
-monofilament
-initially strongest but absorbed quickly
What are the characteristics of monocryl suture?
-synthetic
-absorbable
-monofilament
-good for rapidly healing tissues
-good for procedures that need high initial tensile strength
What are the characteristics of maxon suture?
-synthetic
-absorbable
-monofilament
-long lasting absorbable
What are the characteristics of PDS II suture?
-synthetic
-absorbable
-monofilament
-remains the strongest for longest of the synthetic absorbable suture
-must have 4 throws for a secure knot
What are the characteristics of vicryl suture?
-synthetic
-absorbable
-multifilament
-25% loss of strength at 2 weeks
-50% loss of strength at 3 weeks
-rapidly absorbed; full loss of strength in 5 weeks, gone by 8-10 weeks
What are the characteristics of dexon suture?
-short/moderate duration
-absorbable
-multifilament
What are the general characteristics of non-absorbable synthetic suture?
-maintain full strength for over 60 days
-walled off or encapsulated by fibroblasts
-used in areas where they can be removed or that require long term strength
What are the characteristics of nylon suture?
-synthetic
-non-absorbable
-mono-filament
-high tensile strength
-minimal tissue reaction
-poor handling and knot security; add additional throw
-good for skin sutures
What are the characteristics of polypropylene suture?
-synthetic
-non-absorbable
-monofilament
-good tensile strength
-good memory, poor handling
-minimal tissue drag
-best knot security among synthetic monofilaments
What are the uses of polypropylene?
-skin sutures
-cardiac surgery
-fascia
-ligaments and tendons
-cavity closures in immunocompromised patients
What are the characteristics of suture needles?
-designed to carry suture through tissue with minimal trauma
-rigid enough to resist bending while flexible enough to bend before breaking
-sterile and corrosion-resistant
What determines a needle’s strength?
its ability to resist deformation during repeated passes through tissue
How does a swaged needle differ from an eyed needle?
swaged:
-suture and needle are approximately the same size
-saves time
-more expensive
eyed:
-more traumatic
-two strands of suture must pass through tissue
-more time consuming
-cheaper
What are the most commonly used needle shapes?
-1/2 curve
-3/8 curve
What are the most common needle point geometries?
-taper
-cutting
What are the characteristics of taper needles?
-used in soft tissue
-dilate, but do not cut
-good for delicate tissue
What are the characteristics of cutting needles?
-sharp to reduce trauma through tough tissue
-cutting surface is concave
What are the characteristics of reverse cutting needles?
-cutting surface on convex side
-stronger than regular cutting needles
-less chance of cutting through tissue
-less traumatic
