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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?

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
synthetic absorbable monofilament - long - examples - tissue interaction - tensile strenght - handling and knotting - use
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
synthetic non absorbable monofilament - examples - tissue interaction - tensile strength - handling and knotting - use
- 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
synthetic non absorbable multifilament - esamples - tissue interaction - tensile strength - handling and knots - use
- 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
natural absorbable multifilament - examples - tissue interaction - tensile strength - handling and knots - use
- 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
natural non-absorbable multifilament - examples - tissue interaction - tensile strength - handling and knots - use
- EXAMPLE = silk - TISSUE INTERACTION = marked infl - TENSILE STRENGTH = weaks, slow loss - HANDLING AND KNOTS = best - USE = large vessel ligation
30
What size would you use for a cat?
2 metric
31
What size for a dog?
3 metric
32
what size for delicate tissue?
~1.5 -2 metric
33
what size for tough tissue?
~3.5-4 metric
34
When would you use staples to close a wound?
speed approximate tissues seal hollow organs first intention healing
35
What are the advantages of using staples?
``` 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
What are the disadvantages of using staples?
``` cost lack of familiarity failure if use improperly too big? ethylene oxide sterilisation needed need stapler remover ```
37
What are the advantages of ligature clip applicators?
simple and rapid access to deep tissue inert strong and secure ligature
38
Disadvantages of ligature clip applicators?
``` instability of clip in applicator permanence of clips cost only small vessel absorbable ones bulky ```
39
How to tissue adhesives work?
monomer converts to polymer on surface contact
40
what are the advantages of tissue adhesives?
``` 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
Disadvantages of tissue adhesives?
``` 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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