Suture Material Flashcards
Natural
- biological origin
- causes intense inflammatory rxn
- chromic gut, silk
Synthetic
- synthetic polymer
- does not cause tissue rxn
- nylon, polymer (PDS, vicryl)
- most suture materials are synthetic!
Absorbable
- loss of tensile strength in 60-90 days
- degraded via inflammatory rxn or hydrolysis
- internal or buried sutures
Non-absorbable
- may eventually degrade
- potential nidus for infection
- external sutures
- intentional internal use (as a marker)
Monofilament
- single strand, parallel fibers
- less tissue drag –> less trauma!
- resists microorganisms
- ties smoothly
- requires more knots than braided
- possesses memory
Multifilament
- fibers are twisted (braided)
- greater resistance in tissue –> drag
- provides good handling and ease of typing
- fewer knots required
Capillary action, increased infection risk, less smooth, less strength, better handling and knot security
Braided
No capillary action, less infection, smooth tissue passage, higher strength, memory, more throws
Monofilament
Surgical catgut
Submucosa of sheep SI or serosal layer of bovine SI
- multifilament (resembles monofilament)
- absorbed via phagocytosis –> slowed by chromic salt
- > 90 days to absorb, but becomes significantly weak
- poor knot security
- good handling
- cannot be autoclaved! –> radiation or ethylene oxide
Plain vs chromic gut
- plain: loss of >67% strength by 7 days
- chromic: loss of 50% strength by 7 days, 83% by 14 days, 100% by 21 days
Polydioxanone (PDS)
Loss 26% strength by 14 days, 42% by 28 days, 86% by 56 days
Polyglyconate (PGT, MAXON)
Polymer of polytrimethylene carbonate and glycolic acid
- loss 19% strength by 14 days, 41% by 28 days
PDS and Maxon - characteristics
- monofilament
- degraded via hydrolysis
- excellent tensile strength –> is initially better than nylon and polypropylene
- good knot security
- little/no tissue rx
- memory
- minimal tissue drag
What is commonly used to close the body wall and linea alba?
PDS, Maxon
Poliglecaprone 25
PGC25, Monocryl
- synthetic, monofilament
- absorbed by hydrolysis –> complete by 90-120 days
- loss of 50% strength by 10 days, 100% by 21 days
- good knot security
- minimal/no tissue rxn
- good tissue handling
- no drag
What is used as a buried suture?
Monocryl
Polyglactin 910
PG910, Vicryl
- polymer of glycolic acid and lactic acid in a ratio of 9:1
- multifilament
- absorbed via hydrolysis –> rate is increased in an alkaline environment and at higher temps!!!
- complete absorption by 40-90 days, independent of suture size
- good tensile strength –> lost 50% by 14 days, 80% by 21 days
- little/no tissue rxn, considerable tissue drag
Silk
Cocoon of silk worm, dyed black
- multifilament, treated with oil to reduce capillarity
- nonabsorbable, some breakdown over time
- slow loss of strength –> 30% by 14 days, 50% at 1 year, 100% by 2 yrs
- good knot security
- some tissue rxn via ulceration of GIT lumen
- gold standard of handling characteristics
Stainless steel
Surgical grade, alloy of chromium, nickel, and molybdenum
- mono or multifilament
- nonabsorbable
- highest tensile strength of any suture!!
- greatest knot security of all suture!
- poor handling
- used in infected surgical sites
Nylon
Amine coated thermoplastic
- mono or multifilament
- nonabsorbable
- intermediate in strength
- monofilament will lose tensile strength by 30% after 2 yrs
- multifilament will lose tensile strength by 70-90% by 180 days
- memory!
Polymerized caprolactam
Polyamide suture of nylon family (vetafil, supramid, braunamid)
- coated in proteinaceous material
- multifilament, nonabsorbable
- loses 15-20% strength when wet!
- coating can break with repeated sterilization
- autoclave reduces strength, no chemical sterilization with disinfectants, dispensing vials are not sterile
Polyester fibers
Mersilene, dacron, polydek, tevdek
- multifilament, nonabsorbable
- high initial strength
- uncoated drag, good knot security
- coated less drag, poor knot security
- significant tissue rxn, greatest of all sutures!!!
Polypropylene
Prolene, flurofil
- monofilament
- nonabsorbable
- fair-poor tensile strength and knot security
- biologically inert
- least thrombogenic of any suture (often used in vascular surgery)!!
- poor handling, memory
Polybutester
Novafil
- monofilament
- nonabsorbable
- good tensile strength, knot security
- biologicaly inert
- excellent handling
Plus suture
Triclosan-phenolic compound
- found in hand disinfectant
- antifungal, bacteriocidal/static!!
- in vitro zone of inhibition around suture
- resistance is possible (S. aureus, E. coli, Pseudomonas)
Skin staples
- expensive
- easy/quick
- secure
- little tissue rxn
Tissue adhesive
Little strength, should not be placed in subcutaneous tissue or inside body!!
Suture size _____ with increasing number
Increases!
- 2: horse abdomen
- 9-0: opthalmic
Surgical needles must be:
- sharp enough to penetrate tissue w/ minimal resistance
- rigid to resist bending, but flexible to bend before breaking
- sterile and corrosion resistant
Eyed needles
- more traumatic
- only thread through once
- tends to unthread itself easily
Swaged on needles
- less traumatic
- suture = width of needle
- single use
- more expensive
- sterile
Taper
- atraumatic
- internal organs
- dulls quickly
Cutting
- cutting edge on inside of circle
- tough/fibrous tissue
- traumatic
Reverse cutting
- cutting edge on outside of circle
- tough/fibrous tissue
- less traumatic than cutting
Classification of suture patterns
Based on anatomical site of suture line
- need for: apposition, inverting, everting, tension-relieving
Interrupted
- slower to do
- more foreign material (knots)
- more secure
- easier to adjust tension along incision line
- allows stretching of tissues between suture –> no purse-string effect
Continuous
- quicker to perform
- less foreign material
- failure –> complete dehiscence
- better seal on incision
- create purse string effect especially in hollow organs!!
I or C: simple interrupted
Appositional
- I
I or C: cruciate
Appositional
- I
I or C: gambee
Appositional
- I/C
I or C: subcuticular or intradermal
Appositional
- I/C
I or C: simple continuous
Appositional
- C
I or C: ford interlocking
Appositional
- C
Inverting
Turns tissue edges towards center of hollow organ
- halstead
- lembert
- cushing
- connell (l for lumen)
I or C: halstead
I
I or C: lembert
I/C
I or C: cushing
C
I or C: connell
C
Cushing or connell: full thickness?
Connell
- cushing uses partial thickness
- use either for a water tight seal
Everting/tension releaving
Turns tissue edges outward away from the patient and towards the surgeon
- quilled/stented
- far-near-near-far
- vertical mattress
- horizontal mattress
I or C: quilled/stented
I
I or C: far-near-near-far
I
I or C: vertical mattress
I/C
I or C: horizontal mattress
I/C
Chinese finger trap
Repeated loops around the tube, used to secure tubes exiting the body in place
- friction on tube increases if distracted
2 throws of a square knot =
One knot!
Knot recommendations
- interrupted: 4 throws
- continuous: 6 throws
- larger suture requires more throws
- suture tags: 3-5 mm
- leave tags longer with larger suture
Suture failure
Commonly due to the knot!!
- unless suture has be damaged
- re-sterilization
- grasping suture with instruments
- repeated knot tying
- knotting reduces tensile strength by 10-40%!!
