suture material Flashcards
how is the choice of suture material made
preference of the surgeon
to hold wound edges in apposition until the wound can endure normal stress without the suture support
purpose of suturing
digested and assimilated by the body during normal healing
absorbable
do all absorbable sutures cause tissue reaction
yes
what does absorption time depend on
location, composition of suture, presence of infection
should suture material be autoclaved
no it weakens it
produced from sub-mucosal layers of sheep or hog intestines
surgical gut (catgut)
what are the 2 types of catgut
plain and chromic
treated with chromic acid salts to prolong absorption time
chromic catgut
how long does it take plain catgut to absorb
3-5 days
how long does it take chromic catgut to absorb
10-15 days
synthetic material made from hydroxyacetic acid
polyglycolic acid
how long does polyglycolic acid last
14-21 days
degrades rapidly in an alkaline environment, dissolves faster in infected urine
dexon and vicryl
made from lactic and glycolic acids
polyglactin 910
how long does polyglactin 910 last
14-21 days
made from glycoside and lactide copolymers; multifilament
polysorb
how long does polysorb last
14-42 days; gone by 70 days
has potential for bacterial wicking
polysorb
newer synthetic polyester with less tissue drag and memory. requires multiple throws and better for slow healing wounds
polydioxanone/polyglyconate
how long does polydioxanone/polyglyconate last
180 days to absorb
monofilament used for fast healing in place of gut
pliglecaprone and gllycomer 631
how long do pliglecaprone and gllycomer 631 last
7-14 days; gone by 90-120 days
how long do non-absorbable keep their strength
at least 60 days
what happens if non absorbable are left in skin
may get encysted
when should non absorbable be removed
7-14 days post op
forms due to a pocket of dead space or unrestricted exercise with sutures
seroma
splitting open of part of surgical wound due to licking or chewing
dehiscence
licking or chewing completely through body wall
complete dehiscence
non-absorbable: excellent handeling, commonly used in cardiovascular surgery, can induce severe soft-tissue reaction, can serve as point of origin for infection
silk
non-absorbable: natural fibers, strengthen when wet, behaves like silk, limited use
cotton and linen
non-absorbable: synthetic, no tissue reaction, strength lasts 7 years, stiff and slippery, significant memory, excellent handling
polyamide
non-absorbable: synthetic plastic, similar to nylon, does not weaken over time, permenent suture support
polypropylene
non-absorbable: elastic, useful for ligament repair and structures under weighted motion
polybutester
non-absorbable: multifilament, requires 5-6 knot throws, significant tissue drag and reaction, may have teflon or silicone coating, may cause chronic infection and draining fistuale
polyester fiber
non-absorbable: coated with plastic-like material, high tensile strength, minimal tissue reaction, outer sheath can break, should never be used below skin level, can predispose fistulas
polymerized caprolactum
what can polymerized caprolactum cause if left in too long
stitch granuloma
useful in infected wounds or tissue that will be stressed in a slow healing process, also active and chewing pts
wire
5 string
ordinary
0 string
ought
10-0
very delicate sx
what do needles vary in
shape, point design, attatchment, size
needle frequently used and reusable with any type of point, but must thread through eye and causes possible tissue damage
eyed needles
needle will not unthread itself, less bulky, always sharp, material attached, but more expensive and one time use
swaged or swedged
what needle is most atraumatic
swaged or swedged
stapler has squeeze trigger, holds 25-35 staples, places single row, used for skin and fascia closure, cannot refill
surgical skin stapler
stapler one time use, GI resection and anastomosis, 4 rows of staples and cuts between middle 2 rows, pre packaged
gastrointestinal stapler
stapler comes pre packaged, used in lung resection, places double or triple row of staples
thoracoabdominal stapler
stapler used for blood vessel ligation, places 2 staples on a vessel and cuts between them
ligate-and-divide stapler
needle driven through by hand, resembles regular sewing needle; aka keith needle
straight
special needle with the eye in the point, requires a special braided tubular suture, used for retaining prolapsed vaginas in large animals
buhner needle
needle with double curve design, goes through skin without wrist pivot, only used in large animal; aka bovine needle
s curve
needle uses holders to drive through tissue, many different curvatures, hundreds of types
curved
when is a curved 1/4 circle used
opthalmic sx
when is a curved 3/8 & 1/2 circle used
general sx (most popular)
needle round all the way to the tip with taper, used for soft tissue, internal tissues, and SQ, atraumatic to tissues
non-cutting or tapered
needle produces “cut out” effect, should not be used with an airtight or watertight suture line, used for skin and tough tissue, triangular shapped point
cutting
needle where triangle is reversed, has less cut out, does not bend as easily most preferred
reverse cutting
K needle aka
reverse cutting
how are suture patterns categorized
continuous or interrupted
how are suture pattern catagories divided
simple and mattress
suture pattern designed to withstand added tension
mattress
turning tissue outward toward surgon; will not close
everting
turning tissue inward toward patient
inverting
brings tissue in direct apposition
apposing
how many throws are used for suturing
2-4
where are needle holders held
inside of sutures
suture pattern used in skin, SQ, fascia, blood vessels, GI, causes puckering and strangulation
simple continuous
suture pattern used in skin, SQ, fascia, blood vessels, nerves, GI
simple interrupted
suture pattern used in skin and fascia, stronger closure, resists tension, faster to apply
interrupted cruciate
suture pattern used on skin and diaphragm, mainly used in large animal
ford interlocking
suture pattern used in skin, SQ, fascia, muscle, tendon, continuous is common in cattle following rumenotomy, potential for strangulation
horizontal mattress
suture pattern used for inversion of visceral stumps or tubes
purse string
suture pattern used for manipulation or retraction of tissue, usually 2 or more are used
stay sutures
suture pattern where suture material is passed through the stump to ligate, tied around half the stump, then around entire stump
transfixation ligature
suture pattern for closing gut, needle penetrates serosa and musculans but not mucosa, continuous or interupted
lembert
