Suture material Flashcards
functions of suture material
Wound closure
Attachment of tubes
Ligation
Stay sutures
ideal interaction with the tissue
Maintains strength until wound strength develops
Rapid resorption when no longer required
Encapsulated without post-operative complications
Easily removed
Minimal tissue reaction
Does not favour bacterial growth
Minimal drag through tissues
Suitable for all wounds
ideal interaction with the surgeon
easy to handle
good knot security
ideal material properties
Easy to sterilise Non-capillary (fluid doesn't stick to them) Non-electrolytic Non-corrosive Non-allergenic Non-carcinogenic
classification of suture material
natural vs synthetic
absorbable vs non
multi vs monofilament
Natural fibre - properties
Tissue inflammatory reaction
Variable absorption
Synthetic fibre - properties
Less reaction
Predictable absorption
Multifilament - properties
Easier to handle
Better knot security
Capillarity
Monofilament - properties
Less tissue drag
Can weaken when crushed
coating effects
improves handling
reduces tissue drag
Synthetic Absorbable Multifilament - materials
Vicryl - Polyglactin 910
Dexon - Polyglycolic acid
Polysorb - Lactomer 9-1
Panacryl - Poly(L-lactide/glycolide)
Synthetic Absorbable Multifilament - Interaction with tissue
Absorption complete at 60-90d
Speed: Polysorb>Vicryl>Dexon
Synthetic Absorbable Multifilament - Tensile strength & loss
Loss 33% (7d), 80% (14d), 100% (21d)
Strength: Polysorb>Vicryl>Dexon
Synthetic Absorbable Multifilament - Handling & knotting
Good handling/knotting
Tissue drag - improved by coating
Synthetic Absorbable Multifilament - use
Vessel ligation
General soft tissue closure (skin, mouth)
Synthetic Absorbable Monofilament - short duration - Materials
Monocryl - Polyglecaprone
Caprosyn – Polyglytone
Synthetic Absorbable Monofilament - short duration - Interaction with tissue
Absorption complete @ 90-120d
Speed: Caprosyn>Monocryl
Synthetic Absorbable Monofilament - short duration - Tensile strength & loss
High tensile strength
Loss: 50%(7d),60%(14d), 100%(21d)
Synthetic Absorbable Monofilament - short duration - Handling & knotting
Monocryl - soft & pliable, low memory
Caprosyn - more sticky
Synthetic Absorbable Monofilament - short duration - use
General soft tissue closure
Visceral closure - Monocryl
Synthetic Absorbable Monofilament - long duration - Materials
PDS II - Polydioxanone
Maxon - Polyglyconate
Biosyn - Glycomer 631
Synthetic Absorbable Monofilament - long duration - Interaction with tissue
Absorption complete @ 110-210d
Synthetic Absorbable Monofilament - long duration - Tensile strength & loss
Strong materials (>Nylon, Prolene)
Loss: 26% (14d), 40% (28d), 75% (42d)
Strength: PDS II>Maxon>Biosyn
Synthetic Absorbable Monofilament - long duration - Handling & knotting
PDS - memory, tendency to coil, 7 knots
Synthetic Absorbable Monofilament - long duration - use
Soft tissues needing long support
Muscle, fascia, linea alba, viscera
Synthetic Non-absorbable Monofilament - Materials
Prolene/SurgiPro - Polypropylene
Ethilon/Monosof – Polyamide
Flexon – Steel
Synthetic Non-absorbable Monofilament - Interaction with tissue
Minimal reaction – inert
Synthetic Non-absorbable Monofilament - Tensile strength
Strong
25% loss at 2 years - nylon
Synthetic Non-absorbable Monofilament - Handling & knotting
Memory - Prolene>Nylon
Knot security - Prolene>Nylon
Synthetic Non-absorbable Monofilament - Use
Inert - skin, stoma, vessels
Prolonged support-hernia, tendon
Synthetic Non-absorbable Multifilament - Materials
Mersilene, Ethibond - Polyester
Novafil - Polybutester
Supramid - Caprolactam
Synthetic Non-absorbable Multifilament - Interaction with tissue
Moderate inflammation
Synthetic Non-absorbable Multifilament - Tensile strength
stronger than nylon
Very little loss of strength
Synthetic Non-absorbable Multifilament - Handling & knotting
Fair handling, slight elasticity
Sheath cracks on knotting
Synthetic Non-absorbable Multifilament - Use
Ligament prosthesis
? Skin closure
Natural Absorbable Multifilament - Materials
Catgut – plain or chromic
Collagen – ophthalmic surgery
Natural Absorbable Multifilament - Interaction with tissue
Absorption complete @ 60-70d
Tissue reaction marked
Faster in infected, vascular or acidic wounds
UNPREDICTABLE: absorption via phagocytosis cf hydrolysis
Natural Absorbable Multifilament - Tensile strength & loss
33% loss (7d), 67% loss (14d)
Natural Absorbable Multifilament - Handling & knotting
Knots weaker when wet
Poor knot security so leave ends long
Good handling
Natural Absorbable Multifilament - Use
Vessel ligation, ophthalmic surgery
Natural Non-absorbable Multifilament - Materials
Mersilk, PermaHand – Silk
Natural Non-absorbable Multifilament - Tissue interaction
Moderate-marked inflammation
Encapsulated in fibrous tissue
Natural Non-absorbable Multifilament - Tensile strength
Weak - will break
Very slow absorption - 2yr
Natural Non-absorbable Multifilament - Handling & knotting
Handling good (silk)
Natural Non-absorbable Multifilament - use
Large vessel ligation
NOT in viscera – ulcers and calculi
General rules to avoid complications
Avoid multifilament material in contaminated wounds
Avoid non-absorbable sutures in hollow organs
Use inert material in the skin
Avoid reactive material for stoma creation
Use slowly/non-absorbable material in fascia/tendons
Avoid burying any suture from a multi-use cassette
Avoid catgut in inflamed, infected or acidic wounds
Choice of suture size
Use the smallest size possible
Less tissue trauma – tissue tract
Smaller knots – reduced bulk
Advantages of swaged-on needles
Available for use immediately Unlikely to detach suture material Less handling of suture material Less fraying of suture material Less tissue trauma Likely to be sharper Guaranteed sterile Greater range of needles available
advantages of reverse cutting needles
stronger
Danger of tissue cutout is greatly reduced
Hole left by the needle leaves a wide wall of tissue against which the suture is to be tied
needle requirements
Sharp enough to pass through tissue
No change to tissue architecture
Needle resists bending/breakage
Needle hole just big enough for suture