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FA2 Principles of Surgery > Lecture 9 9/4/24 > Flashcards

Lecture 9 9/4/24 Flashcards

1
Q

Why is suture used?

A

-optimize wound healing
-maintains apposition during lag/weak phase of wound healing around day 3

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2
Q

What is the downside to using suture?

A

suture is a foreign material that enhances susceptibility to infection

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3
Q

How does the number of CFUs differ between a wound with and without suture?

A

with suture: 100 CFU/ml to cause infection
without suture: 10^6 CFU/ml to cause infection

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4
Q

Why is it important to prevent suture contamination?

A

once suture material is contaminated, local mechanisms of wound decontamination become ineffective

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5
Q

What are the qualities of ideal suture material?

A

-high initial tensile strength followed by rapid absorption
-consistent uniform diameter
-sterile
-good handling and knot security
-low tissue reaction
-predictable performance
-cheap

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6
Q

Which suture is most ideal?

A

one that will lose tensile strength at a rate similar to that with which the tissue gains strength

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7
Q

How is suture size indicated?

A

-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

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8
Q

How does knotted suture strength compare to unknotted suture strength?

A

knotted suture is 50% weaker

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9
Q

What are the main characteristics of suture type?

A

-monofilament vs multifilament
-synthetic vs natural
-absorbable vs non-absorbable

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10
Q

What are the characteristics of monofilament suture?

A

-single strand
-low tissue resistance
-decreased surface area for bacterial adherence
-does not wick
-high memory
-decreased knot security
-clamping suture can damage it

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11
Q

What are the characteristics of multifilament suture?

A

-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

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12
Q

How does synthetic suture differ from natural suture?

A

-synthetic is made of man-made polymers
-natural is derived from plant or animal

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13
Q

What are the characteristics of chromic gut suture?

A

-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

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14
Q

What are the characteristics of silk suture?

A

-multifilament
-excellent handling
-non-absorbable
-marked tissue reactivity
-avoided in infection

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15
Q

How does absorbable suture differ from non-absorbable suture?

A

absorbable: degradation and loss of strength within 60 days
non-absorbable: retains tensile strength for 60 days or more

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16
Q

What are the characteristics of synthetic absorbable suture breakdown?

A

-hydrolysis via esterase enzyme activity
-constant rate of absorption and loss of strength

17
Q

What are the strengths of common synthetic absorbable suture?

A

strongest: monocryl
middle: PDS
weakest: vicryl

18
Q

What are the characteristics of biosyn suture?

A

-synthetic
-absorbable
-monofilament
-initially strongest but absorbed quickly

19
Q

What are the characteristics of monocryl suture?

A

-synthetic
-absorbable
-monofilament
-good for rapidly healing tissues
-good for procedures that need high initial tensile strength

20
Q

What are the characteristics of maxon suture?

A

-synthetic
-absorbable
-monofilament
-long lasting absorbable

21
Q

What are the characteristics of PDS II suture?

A

-synthetic
-absorbable
-monofilament
-remains the strongest for longest of the synthetic absorbable suture
-must have 4 throws for a secure knot

22
Q

What are the characteristics of vicryl suture?

A

-synthetic
-absorbable
-multifilament
-rapidly absorbed; loss of strength in 5 weeks, gone by 8-10 weeks

23
Q

What are the characteristics of dexon suture?

A

-short/moderate duration
-absorbable
-multifilament

24
Q

What are the general characteristics of non-absorbable synthetic suture?

A

-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

25
Q

What are the characteristics of nylon suture?

A

-synthetic
-non-absorbable
-mono-filament
-high tensile strength
-minimal tissue reaction
-poor handling and knot security; add additional throw
-good for skin sutures

26
Q

What are the characteristics of polypropylene suture?

A

-synthetic
-non-absorbable
-monofilament
-good tensile strength
-good memory, poor handling
-minimal tissue drag
-best knot security among synthetic monofilaments

27
Q

What are the uses of polypropylene?

A

-skin sutures
-cardiac surgery
-fascia
-ligaments and tendons
-cavity closures in immunocompromised patients

28
Q

What are the characteristics of suture needles?

A

-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

29
Q

What determines a needle’s strength?

A

its ability to resist deformation during repeated passes through tissue

30
Q

How does a swaged needle differ from an eyed needle?

A

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

31
Q

What are the most commonly used needle shapes?

A

-1/2 curve
-3/8 curve

32
Q

What are the most common needle point geometries?

A

-taper
-cutting

33
Q

What are the characteristics of taper needles?

A

-used in soft tissue
-dilate, but do not cut
-good for delicate tissue

34
Q

What are the characteristics of cutting needles?

A

-sharp to reduce trauma through tough tissue
-cutting surface is concave

35
Q

What are the characteristics of reverse cutting needles?

A

-cutting surface on convex side
-stronger than regular cutting needles
-less chance of cutting through tissue
-less traumatic

FA2 Principles of Surgery (15 decks)

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