Suture, Instruments, etc. Flashcards
Stapling devices
Green: 30-45-60-90; 4.8mm => 2.0mm (2 rows)
Blue: 30-45-60-90; 3.5mm => 1.5mm (2 rows)
White: 30; 2.5mm => 1mm (3 rows)
Polyglactin 910
- Vicryl
- Braided multifilament
- 50% tensile strength at 2-3 weeks (0% for Rapid)
- 25% loss at 14d
- Absorbed in 8-10 weeks (6 for rapid)
- Excellent suture handling, fair knot security, minimal tissue reactivity
Catgut (intestinal serosa/submucosa)
- Twisted multifilament
- 0% tensile strength at 2-3 weeks
- Unpredictable absorption (proteolytic), 2-10 weeks
- Fair suture handing, poor knot security, extreme tissue reaction
- Made from the small intestinal submucosa of sheep or the intestinal serosa of cattle
Polyglycolic Acid
- Dexon
- Braided multifilament
- 50% tensile strength at 2-3 weeks
- Absorption in 60-90 days - initially slow for 2 weeks then more rapid hydrolysis
- Minimal tissue reactivity, fair handling, good knot security
- More rapid loss of strength in urine (sterile), very rapid in infected urine (esp. Proteus)
Poliglecaprone 25
- Monocryl
- Monofilament
- 50% tensile strength at 1-2 weeks
- 60% loss at 14d
- Absorption in 119 days
- Fair knot security, good suture handling, minimal reactivity
- Degrade more rapidly in alkaline environement (glycolide)
- Complete loss of strength/dissolution in 7d in proteus urine (less dramatic reduction in sterile or e.coli urine)
Polyglytone 6211
- Caprosyn
- Monofilament
- 0% tensile strength at 2-3 weeks
- 80% loss at 10d
- Minimal tissue reactivity, good handling, fair knot security
- Absorbed 56d
Polydiaoxanone
- PDS II
- Uncoated monofilament
- 50% tensile strength at 5-6 weeks
- 20% loss at 14d
- Absorbed 180 days
- Minimal tissue reaction, good handling, fair knot security
- One study had loss of strength in 3d in sterile urine, 1d in proteus urine
- Minimum 5 throws for secure knot at start or end of SC pattern, 3 turns & knot for abderdeen
Glycomer 631
- Biosyn
- Monofilament
- 50% tensile strength at 2-3wk
- 60% loss at 3 weeks
- Absorbed at 90-110d
- Minimal tissue rxn, good handling, fair not security
Polyglyconate
- Maxon
- Monofilament
- 50% tensile strength at 4-5 weeks
- 25% loss at 14d
- Absorbed in 180d
- More memory than PDS = worse handling
- Minimal tissue reaction, fair handling, good knot security
Silk
- Silk
- Braided multifilament
- Crystalline structure (fibroin & sericin) slowly degraded by hydration over 2 years, 56% of tensile strength at 12 weeks
- High tissue reactivity - potential for gradual vessel attenuation but not documented
- Excellent handling, good knot security
Polypropylene
- Prolene
- Monofilament synthetic suture
- Strong suture with highest break point (AUC displacement-load) compared to silk, nylon, polyester, gut, Dexon
- Significant memory - poor handling & knot security
- Minimal tissue reactivity - used for tendons, ligaments, joints, fascia, etc.
- No hydrolyzable bonds - resistant to degradation
Nylon
- Ethilon
- Monofilament (or multi version)
- Strong with 2nd highest break point, high maximal tensile load
- Classified as nonabsorb but subject to degradation via hydration
- In acidic environment loss of 50% tensile strength in 12 weeks
- Fair handling, poor knot security, low tissue rxn (mono; moderate multi)
Polymerized Caprolactam
- Vetafil
- Sinus formation - only skin
- Strong, good knot security, fair handling
- Twisted nylon multifilament
Polyester
- Variety of polyester sutures: polyethylene, polybutester, composites
- Mono or multifilament, moderate tissue reactivity
- Polyethylene used in thrombogenic coils
- Polybutester has marked elasticity
- Polyblends (e.g. FiberWire) - very strong and fray resistant, good knot security, good strength in 3-point bending
Steel
- 304, 316, 316L stainless steel
- Replaced by polyblend as strongest sutures, poor handling characteristics
- Mostly used for ortho; less displacement/more stable sternotomy closure comapred with polybutester (duh…)
Cerclage
- Twist: Tension 70-100, load before loosening 260
- SL: Tension 150-200, load before loosening 260
- DL: Tension 300-500, load before loosening 666
Gas Canisters
-Oxygen: Green E - 1900 PSI, 660L H - 2200 PSI, 6900L -Medical Air: Yellow E - 2200 PSI, 6550L -Nitrous: Blue E - 745 PSI, 1590L H - 745 PSI, 15,800L -CO2: Grey E - 838 PSI, 1590L -Nitrogen: Black H - 2200 PSI, 6400L
Anesthetic Depth/Planes
-Stage I - Awake/aware through all levels of obtundation until loss of consciousness
-Stage II - Stage of excitement/spontaneous muscle movements, cessation of which and development of normal breathing => stage III
-Stage III - Surgical stage of anesthesia, subdivided (4 JT, 5 LJ):
1 (Light) - Eye central, large pupil, tight jaw tone, intact PLR/palpebral, physiologic +/- movement response to nociception. rapid resp rate.
2 (light-medium) - Ventromedial eye position, small to medium pupil, intact PLR, some jaw tone (JT/LJ difference) and possible physiologic response to nociception
3 (medium JT only) - Ventromedial eye, moderate jaw tone, even resp rate
4 (deep-medium) - Ventromedial eye, medium to large pupil, no PLR, mild jaw tone, slow RR, no response to nociception
5 (deep) - Central eye, large pupil, absent PLR, absent jaw tone, apneic, no response to nociception
-Stage IV - Extreme CNS depression and respiratory arrest, cardiac arrest to follow
ASA
1 - No systemic illness, healthy patient
2 - Mild compensated systemic illness (e.g. hypothyroid, obese)
3 - Moderate to severe compensated illness (e.g. heart disease, CKD, liver disease, DM)
4 - Patient has disease that is constant threat to life (decompensated - e.g. CHF, sepsis, GDV, pneumothorax)
5 - Moribund patient not expected to survive 24h with or without treatment
