Suture Material Flashcards
what 4 parameters does suture material have?
- type
- size
- length
- needle
what is on a suture package?
- Type, size, length, color
- Expiration date, lot number, reorder number
- Needle: curve, point, length
what guides your decisions in choosing what suture to pick?
Healing properties of a particular tissue
Wound healing potential of the patient Characteristics of chosen suture material
what is the goal with suture material?
suture to retain strength until the wound sufficiently heals
what are the 3 suture characteristics?
- synthetic vs natural
- monofilament vs multifilament
- absorbable vs nonabsorbable
monofilament vs multifilament
mono: single strand, smooth passage thru tissue- less traumatic
multi: braid of a number of strands together- stronger
what loses tensile strength faster, nonabsorbable or absorbable suture?
absorbable- loses retention by 15 days vs nonabsorbable loses it after 45 days
what type of organ has the quickest return of tissue strength?
bladder»_space;> stomach»_space; colon»_space; skin > fascia
what is the ideal suture material?
- predictable and uniform loss of strength
- minimal tissue reaction
- excellent handling and knot security
what are the 2 big suture companies?
- medtronic: used at VTH
- ethicon: not used at VTH
what are the 2 types of natural suture?
- surgical gut
- silk
surgical gut (basics)
natural, multifilament, absorbable
silk (basics)
natural, multifilament, nonabsorbable
surgical gut (details)
- submucosa of sheep SI or serosa of bovine intestine
- 90% collagen, broken down by phagocytosis
- marked inflammatory rxn !!
- unpredictable loss of strength
- unpredictable rate of absorption
- poor knot security when wet
- tissue drag, poor handling
- inexpensive
silk (details)
- excellent handling characteristics
- doesn’t retain tensile strength after 6 months
- avoid in contaminated sites bc of braidedness and capillarity!
- essentially nonabsorbable (>2 years)
large vessel ligation, secure ligature
surgical steel
- metal, monofilament, nonabsorbable
- 316L stainless
- minimal tissue reaction to material: why it’s still sometimes used
- inflammatory reaction to knot ends
- stable in contaminated or infected wounds
- excellent knot security
used for closing sternotomies
synthetic absorbable monofilament (details)
- minimal tissue reaction
- consistent times for tensile strength loss and absorption
- broken down by hydrolysis
- increased stiffness, relatively poor handling
- good knot security
how is synthetic absorbable monofilament broken down?
hydrolysis
how is surgical gut broken down?
phagocytosis - causes severe inflammatory reaction which is a downside
T/F: loss of tensile strength does NOT equal rate of absorption
true. they are not equal!
what has shorter tensile strength loss rates, maxon/PDS or monocryl/biosyn?
monocryl biosyn: lost at 21 days
maxon/PDS: lost at 55 days
maxon
polyglyconate
polyglyconate
maxon
PDS
polydioxanone
polydioxanone
PDS
biosyn
Glycomer 631
glycomer 631
biosyn
poliglecaprone 25
monocryl
monocryl
poliglecaprone 25
maxon, PDS, biosynn and monocryl are all brand names for what class of sutures
synthetic absorbable monofilament
Maxon details
tensile strength loss: 30% at 14 days, 45% at 21 days. complete absorption: 180 days
PDS details
tensile strength loss: 14-20% at 14 days, 31-40% at 42 days
complete absorption: 180 days
T/F: maxon and PDS are both completely absorbed at 180 days
true
when do maxon and PDS have significant loss of tensile strength?
4-5 weeks
when do maxon and PDS have complete absorption?
six months
monocryl/biosyn details
- rapid absorption
- less stiffness, less memory, better handling
- high initial tensile strength
- complete absorption 90-119 days
- lose 50% of tensile strength at 7 days, 100% loss of tensile strength at 21 days
when do monocryl and biosyn have significant loss of tensile strength?
2-3 weeks
when do monocryl and biosyn have complete absorption?
3 months
vicryl
polyglactin 910
polyglactin 910
vicryl
polysorb
glycolide/lactide copolymer
glycolide/lactide copolymer
polysorb
are vicryl and polysorb absorbable or nonabsorbable?
absorbable
are vicryl and polysorb mono or multi filament?
multifilament
synthetic absorbable multifilament (details)
- minimal tissue reaction
- consistent times for tensile strength loss
- broken down by. hydrolysis
- rate of degradation may increase in presence of infection ***
- faster absorption than monofilaments
- high capillarity
- relative excellent handling ***
- good knot security
are maxon and PDS mono or multifilament?
monofilament
what are versions of vicryl?
coated, plus (antibacterial)
vicryl details
- polyglactin 910
- tensile strength loss: 50% at 21 days
- complete absorption: 60 days
when is vicryl completely absorbed?
60 days
vicryl rapide details
- tensile strength loss: 50% at 5 days, 100% at 10 days
complete absorption: 42 days
when is vicryl rapide completely absorbed?
42 days
what is the difference between vicryl and vicryl rapide?
vicryl rapide you would use in tissue that rapidly heals- loses 100% of tensile loss at 10 days whereas vicryl loses 50% at 21 days
vicryl rapide is completely absorbed at 42 days vs vicryl is completely absorbed at 60 days
velosorb details
- glycolide/lactide copolymer
- 7-10 days of wound support
- absorption between 40-50 days
rapid absorption and loss of strength
polysorb details
- high initial tensile strength, excellent wound support for 3 weeks
- tensile strength loss: 20% at 14 days, 70% at 21 days
- complete absorption: 56 days
what types of antibiotic suture exist?
- triclosan: most commonly used
- PDS, monocryl and vicryl all have a version
what are benefits of antibiotic-impregnanted suture?
- kills bacteria in vitro
- prevents bacterial colonization of suture
conflicting clinical data… study didn’t find a clinical difference in dogs that had suture and didn’t
synthetic nonabsorbable monofilament
- polyamide: nylon: dermalon, ethilon, monosof
- polybutester: novafil
- propylene: prolene, surgilene, surgipro
- polytetrafluorethylene: gore-tex
synthetic nonabsorbable monofilament details
- strong; indefinite tensile strength retention
- minimal tissue reaction; inert
- may predispose to infection or fistulation of buried in tissue: get biofilm: could create a fistula or draining tract
- relatively poor knot security (monofilaments)
what synthetic nonabsorbable monofilaments are the strongest?
polybutester»_space; nylon > polypropylene
synthetic nonabsorbable multifilament
- polymerized caprolactum: vetafil, supramide (Braunamide)
- polyester: dacron, ticron, mersilene, ethibond
larger sizes, stronger, increased tissue reactivity
barbed suture
V-LOC, STRATOFIX, Quill
barbed suture details
- knotless suture
- loop and barb combination: welded loop, unidirectional barbs, circumferential distribution
- minimally invasive surgery: intracorporeal suture: ex in class was a gastropexy
how do you choose suture size?
- smallest size that will do the job! tissue type and size of patient
excessively large suture: more foreign material, increased tissue reaction, alters tissue structure
how is suture size measured?
USP: United States Pharmcopeia
Metric
BSP
how does USP suture sizing work?
single digits increasing in size: larger
5: tow a car
2: horse abdominal surgery
0: average size
2-0
3-0: subcutaneous
4-0: subcutaneous
5-0: vein/artery repair
9-0: ophthalmic
what is the smallest suture size?
12-0
what is the largest suture size?
9
T/F: 1-0 suture size is used subcutaneously
false, there is no 1-0
1-0 = 0
1-0 =
0
small animal suture size based on tissue types
Skin: 4-0 to 3-0
SQ tissue: 4-0 to 3-0
Fascia: 4-0 to 0
Muscle: 4-0 to 0
Viscera: 5-0 to 3-0
what are the types of surgical needle attachments?
- swaged: needle and suture are a continuous unit (needle attached to suture)
- eyed: suture must be threaded: not as common anymore
what are the 2 types of surgical needle bodies?
- curved
- straight
what are the 4 types of surgical needles?
- cutting: cutting edge on concave surface
- taper: sharp point with round needle, commonly used for viscera. makes a tiny hole
- reverse-cutting: cutting edge on convex surface
- taper-cut: combination of taper and reverse-cutting at point
