Surgery & Suture Material Flashcards
what are halsted’s 7 principles of surgery
- gentle tissue handling
- aseptic technique during prep and surgery
- preservation of blood supply
- careful hemostasis
- eliminate dead space
- avoid tension
- accurate tissue apposition
what are additional surgical principles to adhere to
- use appropriate instruments/materials
- keep tissues moist
- use appropriate incision length
- appropriate duration of procedure
- appropriate case management
too small vs too large incision
too small: increased tension, trauma, and risk of injury
too large: increased risk of disrupting blood supply and longer closing time
where should you grasp the needle with needle drivers
2/3 to 3/4 along the curve of the needle from the tip
swaged on needles
needle attaches directly to the suture
recommended due to less tissue drag
taper point needle
fine point with a rounded/circular cross section
used in delicate or luminal tissues
cutting needle
triangular shaped cross section
used in tougher tissue with higher collagen (skin, fascia, etc)
standard vs reverse cutting needle
standard: flat part of triangle is on the bottom
reverse: flat part of the triangle is on the top
polydioxanone (PDS) characteristics
absorbable - LONG
synthetic
monofilament
used for fascia
polyglecaprone 25 (monocryl) characteristics
absorbable - SHORT
synthetic
monofilament
strong initial tensile strength
polyglycolic acid (vicryl) characteristics
absorbable - long and short
synthetic
multifilament
chromic gut characteristics
absorbable - SHORT
biologic
monofilament
nylon characteristics
non-absorbable
synthetic
monofilament
silk characteristics
non-absorbable
biologic
multifilament
polypropylene (prolene)
non-absorbable
synthetic
monofilament
what are the 5 considerations for suture choice
- rate of tensile strength loss
- knot security
- tissue reactivity
- handling characteristics
- initial suture strength
what is the guideline for choosing a suture based off of rate of tensile strength loss
want the suture to maintain tensile strength long enough until the tissue is able to regain its own strength
rate differs by type of tissue
critical healing period
period during which the wound is completely dependent on suture for holding strength
want suture tensile strength to be > clinically relevant tissue strength until tissue regains that amount of its original strength
what can affect rate of healing/tissue regaining strength
comorbidities
what is the primary holding layer for body wall closure
fascia
has the strength to be self supporting at 4 weeks post-op
continuous suture pattern
greater tensile strength
entire line depends on 2 knots - if you lose one, you lose entire line
interrupted suture pattern
slightly less strong compared to continuous
less risk of entire line failure
Jenkins rule for fascial closure
minimum bite width of 1 cm from edge of fascial incision
(modified to 5-10 mm in animals)
each bite should be <1 cm away from the previous bite along the length of the incision
what two suture characteristics contribute to decreased risk of incisional hernia
non absorbable sutures
long lasting absorbable sutures
ex. PDS and prolene
what does knot security depend on
type and size of suture
knotting pattern
technical skill
how many knots should be thrown in interrupted and continuous sutures
interrupted: 4 minimum
continuous: 5 minimum
- start: 5
- end: 6-7
how does intrinsic friction affect knot security
greater friction = less likely to unravel = greater security
how does coating affect knot security
coating = decreased intrinsic friction = decreased security
how does stiffness affect knot security
greater stiffness (monofilament) = low knot security
less stiffness (multifilament) = high knot security
what is the size scale for suture diameter
smallest: 11-0
moderate: 0
largest: 7
does monofilament or multifilament cause more tissue reactivity
multifilament - silk, polyester
what increases the likelihood of a suture site infection
amount of suture material
increased amount = less bacteria required to get an SSI
use monofilament when possible
effects of too much/too little suture tension
too tight: reduced blood supply –> edema, necrosis, crushing injury
too loose: incision gap, delayed healing, risk of infection
does monofilament or multifilament have greater suture memory
monofilament
