Suture Material Flashcards
1
Q
Natural
A
- biological origin
- causes intense inflammatory rxn
- chromic gut, silk
2
Q
Synthetic
A
- synthetic polymer
- does not cause tissue rxn
- nylon, polymer (PDS, vicryl)
- most suture materials are synthetic!
3
Q
Absorbable
A
- loss of tensile strength in 60-90 days
- degraded via inflammatory rxn or hydrolysis
- internal or buried sutures
4
Q
Non-absorbable
A
- may eventually degrade
- potential nidus for infection
- external sutures
- intentional internal use (as a marker)
5
Q
Monofilament
A
- single strand, parallel fibers
- less tissue drag –> less trauma!
- resists microorganisms
- ties smoothly
- requires more knots than braided
- possesses memory
6
Q
Multifilament
A
- fibers are twisted (braided)
- greater resistance in tissue –> drag
- provides good handling and ease of typing
- fewer knots required
7
Q
Capillary action, increased infection risk, less smooth, less strength, better handling and knot security
A
Braided
8
Q
No capillary action, less infection, smooth tissue passage, higher strength, memory, more throws
A
Monofilament
9
Q
Surgical catgut
A
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
10
Q
Plain vs chromic gut
A
- plain: loss of >67% strength by 7 days
- chromic: loss of 50% strength by 7 days, 83% by 14 days, 100% by 21 days
11
Q
Polydioxanone (PDS)
A
Loss 26% strength by 14 days, 42% by 28 days, 86% by 56 days
12
Q
Polyglyconate (PGT, MAXON)
A
Polymer of polytrimethylene carbonate and glycolic acid
- loss 19% strength by 14 days, 41% by 28 days
13
Q
PDS and Maxon - characteristics
A
- 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
14
Q
What is commonly used to close the body wall and linea alba?
A
PDS, Maxon
15
Q
Poliglecaprone 25
A
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
16
Q
What is used as a buried suture?
A
Monocryl
17
Q
Polyglactin 910
A
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
18
Q
Silk
A
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
19
Q
Stainless steel
A
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
20
Q
Nylon
A
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!
21
Q
Polymerized caprolactam
A
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
22
Q
Polyester fibers
A
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!!!
23
Q
Polypropylene
A
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
24
Q
Polybutester
A
Novafil
- monofilament
- nonabsorbable
- good tensile strength, knot security
- biologicaly inert
- excellent handling
25
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)
26
Skin staples
- expensive
- easy/quick
- secure
- little tissue rxn
27
Tissue adhesive
Little strength, should not be placed in subcutaneous tissue or inside body!!
28
Suture size _____ with increasing number
Increases!
- 2: horse abdomen
- 9-0: opthalmic
29
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
30
Eyed needles
- more traumatic
- only thread through once
- tends to unthread itself easily
31
Swaged on needles
- less traumatic
- suture = width of needle
- single use
- more expensive
- sterile
32
Taper
- atraumatic
- internal organs
- dulls quickly
33
Cutting
- cutting edge on inside of circle
- tough/fibrous tissue
- traumatic
34
Reverse cutting
- cutting edge on outside of circle
- tough/fibrous tissue
- less traumatic than cutting
35
Classification of suture patterns
Based on anatomical site of suture line
| - need for: apposition, inverting, everting, tension-relieving
36
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
37
Continuous
- quicker to perform
- less foreign material
- failure --> complete dehiscence
- better seal on incision
- create purse string effect especially in hollow organs!!
38
I or C: simple interrupted
Appositional
| - I
39
I or C: cruciate
Appositional
| - I
40
I or C: gambee
Appositional
| - I/C
41
I or C: subcuticular or intradermal
Appositional
| - I/C
42
I or C: simple continuous
Appositional
| - C
43
I or C: ford interlocking
Appositional
| - C
44
Inverting
Turns tissue edges towards center of hollow organ
- halstead
- lembert
- cushing
- connell (l for lumen)
45
I or C: halstead
I
46
I or C: lembert
I/C
47
I or C: cushing
C
48
I or C: connell
C
49
Cushing or connell: full thickness?
Connell
- cushing uses partial thickness
- use either for a water tight seal
50
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
51
I or C: quilled/stented
I
52
I or C: far-near-near-far
I
53
I or C: vertical mattress
I/C
54
I or C: horizontal mattress
I/C
55
Chinese finger trap
Repeated loops around the tube, used to secure tubes exiting the body in place
- friction on tube increases if distracted
56
2 throws of a square knot =
One knot!
57
Knot recommendations
- interrupted: 4 throws
- continuous: 6 throws
- larger suture requires more throws
- suture tags: 3-5 mm
- leave tags longer with larger suture
58
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%!!
