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Surgical principles > Suture material > Flashcards

Suture material Flashcards

1
Q

What material and pattern would you use to close the linea alba and why?

A
  • slowly absorbed, synthetic monofilament (PDS , maxon , biosyn)
  • simple continuous
  • Fascia is high collagen and holds sutures well but poorly vascularised so takes a long time
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2
Q

What material and pattern would you use to close the subQ fat and why?

A
  • rapidly absorbed synthetic monofilament (monocryl, caprosyn)
  • simple continuous
  • little collagen and heals quickly
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3
Q

closure of the skin on the ventral midline , what pattern and material and why?

A
  • synthetic monofilament non-absorbable (nylon , prolene)
  • if apposition of sub Q pattern is good then ford interlocking
  • if poor apposition at subQ level then simple interrupted
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4
Q

suture pattern and material to close the GIT (except colon) and why?

A
  • rapidly absorbed synthetic monofilamnet (monocryl)
  • simple continuous / interrupted
  • material persists for 2-3 weeks which allows healing
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5
Q

Suture pattern and material to close / anastomosis of the colon and why?

A
  • slowly absorbed synthetic monofilament (PDS , maxon , biosyn)
  • simple interrupted / continuous
  • colon takes longer to heal than rest of the GIT
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6
Q

suture pattern and material for closing the bladder and why?

A
  • rapidly absorbed synthetic monofilament (monocryl)
  • simple continuous
  • heals quickly and urine not shown to affect it
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7
Q

suture pattern and material for closing the uterus after caesarean section and why?

A
  • slow / rapidly absorbed synthetic monofilament (monocryl, PDS , maxon, biosyn)
  • simple continuous with inverting pattern oversewn
  • visceral would so rapid ish absorbable
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8
Q

What are the ideals for suture material for tissue interaction?

A
  • maintains strength till wound is strong enough
  • rapid resorption / encapsulated without complications
  • easily removed
  • minimal tissue reaction
  • doesnt favour bacteria
  • minimal drag
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9
Q

What are the ideals for suture material for the surgeon?

A

pliable
low memory
good knot security

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10
Q

What are the ideals for suture material for its material properties?

A

easy to sterilise

non-capillary / electrolytic / corrosive / allergenic / carcinogenic

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11
Q

What are the ideals for suture material for its practicality?

A

cost
availability
size

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12
Q

How can suture material be classified?

A
  • natural vs synthetic
  • absorbable vs not
  • multifilament vs monofilament
  • coated
  • colour
  • packaging
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13
Q

What are the differences in natural vs synthetic material?

A
  • NATURAL = more tissue infl , varied absorption rate

- SYNTHETIC = less reaction , predictable

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14
Q

what are the differences between absorbable and non - absorbable material?

A
  • ABSORBABLE = temporary support and strength lost in under 60 d
  • NON = encapsulated by tissue, strength maintained for over 60 d
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15
Q

How is natural vs synthetic material absorbed?

A

synthetic - by hyrdrolysis

natural - by phagocytosis

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16
Q

What are the differences in multifilament vs monofilament material?

A

MULTI - easier to handle, more knot security , higher capillarity
MONO - less tissue drag , can weaken when crushed

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17
Q

What is the capillarity of suture material?

A

Capillarity is the process by which fluid and bacteria are carried into the interstices of multifilament fibers. Capillary suture materials should not be used in contaminated or infected sites. Coating reduces capillarity of some sutures.

18
Q

when should multifilament / catgut material never be used?

A

contaminated wounds

19
Q

why type of suture should be used in the skin?

A

inert

20
Q

for fascia / tendon what property do you need in your suture?

A

slow / non absorbable

21
Q

what should you never do with a multi use casette?

A

bury the suture

22
Q

What are the 7 classes of suture material?

A
  • synthetic absorbable multifilament
  • synthetic absorbable monofilament - short
  • synthetic absorbable monomilament - long
  • synthetic non absorbable multifilament
  • synthetic non absorbable monofilament
  • natural absorabable multifilament
  • natural non absorbable multifilament
23
Q

synthetic absorbable multifilament

  • examples
  • tissue interaction
  • tensile strength and loss
  • handling and knotting
  • use
A
  • EXAMPLE = vicryl , dexon, polysorb, panacryl
  • TISSUE INTERACTION = absorbed by 60-90d
  • TENSILE STRENGTH = 33% (7d) , 80%(14d), 100%(21d)
  • HANDLING AND KNOTS = good, some drag
  • USE = vessel ligation , soft tissue closure
24
Q

synthetic absorbable monofilament - short action

  • examples
  • tissue interactin
  • tensile strength
  • handling and knotting
  • use
A
  • EXAMPLE = monocryl , caprosyn
  • TISSUE INTERACTION = absorbed by 90 - 120 d
  • TENSILE STRENGTH = high , 50%(7d), 100%(21d)
  • HANDLING AND KNOTS = soft, pliable, low memory
  • USE = soft tissue closure , visceral closure
25
Q

synthetic absorbable monofilament - long

  • examples
  • tissue interaction
  • tensile strenght
  • handling and knotting
  • use
A

EXAMPLE = PDS II , maxon, biosyn

  • TISSUE INTERACTION = absorbed by 110-120d
  • TENSILE STRENGTH = strong , 26%(14d) , 75 %(42d)
  • HANDLING AND KNOTS = memory, need 7 knots
  • USE = soft tissue, muscle, fascia, linea alba, viscera
26
Q

synthetic non absorbable monofilament

  • examples
  • tissue interaction
  • tensile strength
  • handling and knotting
  • use
A
  • EXAMPLE = prolene , surgipro, nylon, steel
  • TISSUE INTERACTION = inert
  • TENSILE STRENGTH - strong , 25% (2 yr)
  • HANDLING AND KNOTS = prolene best
  • USE = skin, stoma, vessels, hernia, tendon
27
Q

synthetic non absorbable multifilament

  • esamples
  • tissue interaction
  • tensile strength
  • handling and knots
  • use
A
  • EXAMPLE = mersilene, novafil, supramid
  • TISSUE INTERACTION = moderate infl
  • TENSILE STRENGTH = strong, little loss
  • HANDLING AND KNOTS = slight elastic, sheath may crack
  • USE = ligament prosthesis
28
Q

natural absorbable multifilament

  • examples
  • tissue interaction
  • tensile strength
  • handling and knots
  • use
A
  • EXAMPLE = catgut, collagen
  • TISSUE INTERACTION = absorption at 60-70d, marked reaction
  • TENSILE STRENGTH = 33%(7d), 67%(14d)
  • HANDLING AND KNOTS = weak when wet, poor security, good handling
  • USE = vessel ligation, opthalmic surgery
29
Q

natural non-absorbable multifilament

  • examples
  • tissue interaction
  • tensile strength
  • handling and knots
  • use
A
  • EXAMPLE = silk
  • TISSUE INTERACTION = marked infl
  • TENSILE STRENGTH = weaks, slow loss
  • HANDLING AND KNOTS = best
  • USE = large vessel ligation
30
Q

What size would you use for a cat?

A

2 metric

31
Q

What size for a dog?

A

3 metric

32
Q

what size for delicate tissue?

A

~1.5 -2 metric

33
Q

what size for tough tissue?

A

~3.5-4 metric

34
Q

When would you use staples to close a wound?

A

speed
approximate tissues
seal hollow organs
first intention healing

35
Q

What are the advantages of using staples?

A 
speed and ease
easy in poorly accessible areas
consistent and precise
inert
more rapid healing
secure haemostasis
less risk of contamination
minimal tissue trauma
different techniques
greater bursting strength
36
Q

What are the disadvantages of using staples?

A 
cost
lack of familiarity
failure if use improperly
too big?
ethylene oxide sterilisation needed
need stapler remover
37
Q

What are the advantages of ligature clip applicators?

A

simple and rapid
access to deep tissue
inert
strong and secure ligature

38
Q

Disadvantages of ligature clip applicators?

A 
instability of clip in applicator
permanence of clips
cost
only small vessel
absorbable ones bulky
39
Q

How to tissue adhesives work?

A

monomer converts to polymer on surface contact

40
Q

what are the advantages of tissue adhesives?

A 
quick
easy
dont have to remove
not painful
less trauma
antibacterial
hemostatic
good for exotics
no buster collar needed
good if patient hard to handle
41
Q

Disadvantages of tissue adhesives?

A 
foreign material
dehiscence if tension
can crack / peel
adhere to gloves / other things
new technique to learnt
toxicity?
granulomas
delayed healing
interferes with bone healing
hard for irregular wounds

Surgical principles (9 decks)

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