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CPS > Surgical materials > Flashcards

Surgical materials Flashcards

1
Q

What 4 things do we want of the suture material in terms of the body?

A
  1. non-electrolytic (not metal)
  2. non-capillary (a downfall of monofilament)
  3. non-allergic
  4. non-carcinogenic
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2
Q

What are 6 things that the surgeon will want from the suture material?

A
  1. Easy to use
  2. Minimal tissue ‘drag’
  3. Good knot security
  4. Inexpensive
  5. Easily available
  6. Easy to sterilise without alteration
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3
Q

What is tensile strength?

A

The breaking strength per unit area.

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4
Q

What is memory?

A

The tendency to retain original configuration.

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5
Q

What is ‘chatter’ and tissue ‘drag’?

A

Lack the smoothness when passing through tissue.

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6
Q

Tissue reaction?

A

This is when the body responds to the presence of suture material like they would other foreign bodies and there is an inflammatory response.

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7
Q

Name two reasons multifilament is more prone to infection than monofilament?

A

Multifilament has a greater surface area and more access to the body.

The body finds it hard to access some areas of multifiliament compared to monofilament.

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8
Q

Which cause more reaction, natural materials or man-made materials?

A

Natural materials - man-made materials have been designed with minimal reaction.

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9
Q

What are the three parts to the needle?

A
  1. the point
  2. the body
  3. the eye
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10
Q

A needle’s radius of curvature is expressed in what?

A

The proportion of the circle

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11
Q

Which two types of needle will we most commonly be using?

A

3/8ths or 1/2 circle

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12
Q

What are straight and curved needles handled with?

A

Straight needles are handled manually whereas curved needles are held with needle holders.

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13
Q

What are the three types of needle cutting points?

A
  1. Blunt (circular, elliptic)
  2. Sharp (Polygonal)
  3. Compound (tapercut)
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14
Q

How big is the tapercut point in comparison with the rest of the body?

A

It will never be wider than the rest of the body.

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15
Q

Do we mostly use standard cut or the reverse cut?

A

We mostly use the reverse cut.

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16
Q

What two types of needle can you get?

A

Eyed or swaged

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17
Q

Name three different types of eye?

A
  1. Closed
  2. Open
  3. Split
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18
Q

Name 3 disadvantages of using eyed needles?

A
  1. Double width of suture material
  2. Multiple use leads to blunting
  3. increased tissue trauma
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19
Q

Name three benefits of swaged needles?

A
  1. minimal trauma
  2. Single-use
  3. Optimal penetration properties
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20
Q

What are needles made out of?

A

Stainless alloys

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21
Q

What is ‘Ductility’?

A

This is when the needle bends before breaking and tells the surgeon that the force being placed on them is too great.

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22
Q

What is the curve of the needle proportional to?

A

The wound depth or the difficulty of access.

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23
Q

Which two needles should you use wherever possible?

A

Blunt or compound.

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24
Q

When should you use triangular needles?

A

For very resistant material

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25
Q

What three things would be considered about the wound when selecting a suture material?

A
  1. tensile strength
  2. bacterial charge
  3. current of planned therapies
26
Q

To support wound healing and prevent infection, what 5 things would you need to do with your suturing?

A
  1. Limit dead space
  2. As little suture material as possible in the wound
  3. Chose a biologically inert suture material
  4. Minimise tissue trauma
  5. Limit ischaemia - leave enough space between each bit and tighten without excess.
27
Q

How to determine if absorbable or non-absorbable?

A

If unchanged after 60 days, non-absorbable.

28
Q

What is elasticity?

A

This is when you stretch the material, how well it returns to its original shape.

29
Q

What is plasticity?

A

This is how well the material loses its original shape when stretched.

30
Q

What three things does the suture composition determine?

A
  1. tensile strength
  2. Biologic behaviour
  3. Handling
31
Q

Name three examples of natural material?

A
  1. catgut
  2. silk
  3. surgical steel
32
Q

Name 3 benefits of monofilament?

A
  1. Has smooth surface that allows easy passage through tissues
  2. Reduced bacterial growth
  3. Reduced capillary action
33
Q

What is a disadvantage of monofilament?

A
  1. High memory which can make handling difficult

2. Stiff ends can cause irritation if they are not buried.

34
Q

Name 3 diasadvantages of multifilament?

A
  1. Rough surface which increases tissue drag
  2. Gaps between the filaments act as a nidus for infection
  3. Capillary action/ wicking
35
Q

Name 2 advantages of multifilament?

A
  1. easy to handle

2. soft and pliable and well tolerated by patients.

36
Q

What is wicking?

A

This is when moisture is drawn away from the body - capillary action.

37
Q

name a commonly used monofilament?

A

Vicryl.

38
Q

What is USP?

A

United States Pharmacopia - diameter/size of suture material

39
Q

What is USP based on?

A

Tensile strength rather than diameter.

40
Q

What is the range for USP?

A

11-0 –> 7 (11-0 is the smallest and 7 is the biggest)

41
Q

What is the other scale for measuring diameter of suture material and how is it graded?

A

Metric EP.

1/10mm e.g. ‘2’ = 0.2mm

42
Q

What is the range of the metric EP scale?

A

0.1-10

43
Q

Originally, what was the scale of suture diameter?

A

1-6 with 1 being the smallest.

44
Q

What does knot security relate to?

A

The surface frictional characteristics of the material (monofilament vs multifilament)

45
Q

What type of material will require more knot throws?

A

Material with higher memory

46
Q

What is required for knot security of biosyn?

A

2x1x1x1

47
Q

What is required for knot security of polysorb?

A

2x1x1

48
Q

What is required for knot security of biosyn?

A

2x1x1x1

49
Q

How many throws for square knot? what happens if more than this?

A

1 throw only, more will convert to slip knot - this is dangerous

50
Q

How many throws for a granny knot?

A

1x1

51
Q

How many throws on a surgeons knot square?

A

2=1

52
Q

When would you use a surgeons knot?

A

Only when required e.g. if the wound was under lateral tension.

53
Q

What are the 4 interrupted skin patterns for closure?

A
  1. Simple interrupted
  2. Cruciate mattress
  3. Vertical mattress
  4. Horizontal mattress
54
Q

Name 6 types of continuous suture patterns?

A
  1. Simple continuous
  2. Subcuticular
  3. Ford interlocking
  4. Cushing
  5. Connel
  6. Lambert
55
Q

What is the difference between cushing and connel?

A

The connel penetrates all layers of the wall with each needle bite however the cushing only penetrates the serosa, passing through muscularis only for 5 mm.

56
Q

What is Lembert designed to do?

A

Invert the edges of the wound/

57
Q

What would you use Lembert?

A

Bowel surgery or following casarean in the uterus.

58
Q

What are the 4 main reasons for suture dehiscence?

A
  1. Knot slippage
  2. knot breakage
  3. Tissue laceration
  4. Weakening of the knot during handling, crushing and shearing etc
59
Q

If you do what to the material, it is more likely to break down?

A

Crush the material.

60
Q

What are the pros and cons or staples?

A

They are not very cheap, are painful and irritating.

They are however quick e.g. if you have a big wound and you want the animal out of theatre quickly, or if a wound keeps opening up.

CPS (21 decks)

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