Properties and Selection of Suture Material

Question 1

Which is smaller- 3-0 or 2-0?

Answer 1

3-0

Question 2

What are the main disadvantages of using natural suture?

Answer 2

Unpredictable loss of tensile strength, diameter/size, strength

Question 3

What is the main disadvantage to synthetic suture?

Answer 3

Decreased handling due to increased memory

Question 4

Describe the pros and cons of monofilament suture

Answer 4

Pros:
- lower tissue drag
-decreased capillarity
-decreased risk of nidus
Cons:
-less pliable
-increased memory
-more susceptible to damage

Question 5

Describe the pros and cons of multifilament suture

Answer 5

Pros:
-increased strength
-increased pliability
Cons:
-increased tissue drag/fraction
-increased capillarity
-increased tendency for bacterial colonization

Question 6

What is the definition of absorbable suture?

Answer 6

Suture that loses tensile strength within 60-90 days in living mammalian tissue
-may be present >60 days but with negligible tensile strength

Question 7

What are the mechanisms by which natural suture gets broken down?

Answer 7

Phagocytosis by macrophages, enzymatic breakdown or via hydrolysis

Question 8

What are some examples of natural and synthetic suture that is absorbable?

Answer 8

Natural: catgut, chromic gut
Synthetic: vicryl, monocryl, PDS

Question 9

What are examples of non-absorbable suture in natural and synthetic forms?

Answer 9

Natural- silk
Synthetic: prolene, nylon, stainless steel

Question 10

What is catgut/chromic gut made out of?

Answer 10

Porcine small intestinal mucosa

Question 11

What are the pros and cons of using gut?

Answer 11

Pros: works well in rapidly healing tissues, completely absorbed in 2-3 weeks, good handling, minimal capillarity, good knot security when dry, cheap
Cons: high tissue reactivity, poor knot security when wet, cannot be autoclaved, disappears quickly in infected wounds

Question 12

Describe the characteristics of Monocryl

Answer 12

Absorbed via hydrolysis, loses 50% of tensile strength at one week, 70-80% in 2 weeks

Question 13

Monocryl pros and cons

Answer 13

Pros: good handling, very pliable, good strength, absorbed predictably, minimally reactive, can be used in contaminated wounds, fair knot security
Cons: expensive

Question 14

Describe the characteristics of Vicryl

Answer 14

Braided soft multifilament, absorbed via hydrolysis (50% strength lost at 2-3 weeks though vicryl rapide lost at 5 days)
-good handling and knot security, soft, minimally reactive but increased tissue drag and capillary action

Question 15

What are the properties of PDS?

Answer 15

Monofilament, absorbed via hydrolysis, 50% tensile strength lost at 5-6 weeks

Question 16

PDS pros and cons

Answer 16

Pros: minimally reactive, no capillarity or tissue drag, good handling and knot security, absorbed predictably, can be used in contaminated wounds
Cons: Expensive

Question 17

Of the absorbable synthetic sutures, which is the quickest to be absorbed?

Answer 17

Vicryl

Question 18

Describe the properties of silk

Answer 18

Natural, braided, multifilament, high tissue reactivity, absorbed via phagocytosis, retains 56% tensile strength at 12 weeks

Question 19

Describe the properties of prolene

Answer 19

Monofilament, resistant to degradation due to lack of hydrolysable bonds, lack of tissue reactivity so can be used anywhere

Question 20

Pros and cons of prolene

Answer 20

Pros: minimally reactive, can be used in contaminated wounds

Cons: poor handling (slippery, memory), poor knot security

Question 21

Describe the characteristics of nylon

Answer 21

Monofilament, absorbed via hydration, retains 50% tensile strength in 12 weeks in acidic environment

Question 22

Pros and cons of nylon

Answer 22

Pros: minimal reactivity, biologically inert, no capillarity, antibacterial end products, inexpensive

Cons: Lots of memory, poor knot security, irritation can occur from suture ends

Question 23

When should you use staples?

Answer 23

Linear incisions, thicker skin

Question 24

When should you use reverse cutting vs taper point needles?

Answer 24

Reverse cutting with the skin and very tough tissues, taper point with basically everything else (soft tissues and luminal organs)

Question 25

When should you use surgical glue?

Answer 25

For minor appositional adjustments (dont put into wounds, put on skin after apposing as you want then dab with gauze)