Suture Material and Needles Flashcards
Suture is a strand of material used to ___ ___ blood vessels and approximate tissues.
tie off
Suturing plays an important role in wound ____ by providing _______ and supports wound _____.
repair, hemostasis (ligating vessels), healing
Different types of tissue have different requirements regarding suture _____.
1. Muscle, subcutaneous tissue, skin –> few days to weeks to heal)
2. Fascia
3. Tendons
4. Ligament (takes months)
etc.
support
The ideal suture should:
Be ____ to handle
Minimally react in tissue
Inhibit bacterial growth
Secure hold when knotted
Resist shrinking in tissue
Absorb with minimal reaction
easy
Tensile strength measures of the ability of the material to resist breakage or deformation
Exponentially proportional to size
*
Time it takes for suture to lose 70-80% of its intial strength. Proprtional to size, bigger the size or tensile strength.
Pliability/Flexibility
- Depends on material and ___ of ___
- ___ when the suture material is handled
- More flexibility is better for vessel _____
size, suture, Ease, ligation b/c you can see how tightly it falls; some sutures are “flimsy” and the knot doesn’t fall as well as with other suture types.
- Memory is the tendency of suture material to return to its _____ shape. _______ suture will always have more memory than ______ suture.
original, Monofilament, multifilament
- Surface friction (surface characteristics/coating) relates to the “______” of outer surface.
- Tissue “drag” – ___ when the suture is pulled ____ the tissue
- _____ suture has more drag tan monofilament suture.
roughness, Ease, through, Braided
Rough sutures are going to cause more injury than smooth suture types b/c smooth sutures fall nicely but need more tension to ensure good apposition.
Knot security is the ability of suture material to ____ knot and is ______ proportional to suture size. Tensile strength is proportional to size.
hold, inversely
- Capillarity is the process by which ___ and _____ are carried into the interstices of ______ fibers. This is bad because _____ can persist in suture. Do NOT use ______ suture in infected/contaminated tissues. (caveat with this?)
- Monofilament are considered ______. Why?
- All braided sutures have ______.
fluid, bacteria, multifilament, infection, multifilament, noncapillary b/c 1 strand/fiber so there is no crevices for any fluid or bacteria to get into, capillarity
- Tissue reactivity is the degree to which the body tends to react to the presence of a particular suture material.
- Natural fibers have a _____ tissue reactivity than synthetic suture/fiber.
- Multifilament has a greater tissue reactivity than our _____
Suture is a foreign body so the body will react to it. Varying degrees of reactivity - patient dependent.
larger, , monofilament
List the Properties of Ideal Suture Material:
* _____ tissue reaction
* ____ passage through tissues
* High knot ____ and _____
* No _____
* Maximum _____ strength
High _____ strength
* ______ performance
_______ to handle
* Good and predictable _____
Minimal, Gentle, safety, security, capillarity, tensile, breaking, Consistent, Comfortable, absorption
“No single suture is ideal for every surgical situation…
Certain suture materials are better suited for different
wound environments and uses”
Suture Classification is based on what factors?
- Fiber Origin –? Synthetic vs. natural
- natural originate from biological sources such as silk
- synthetic is mand made nylon= common - Structure
- Monofilament = one fiber vs. multifilament = multiple fibers
- Multifilament sutures have more tissue drag b/c more fibers involved and can harbor bacteria. Multifilament can be braided or coated–>(to make sure tissue drag is reduced).
- Monofilament pass through smoothly and less likely to harbor bacteria; can be harder to handle because have more memory than multifilament. - Behavior in tissue
Absorbable vs. nonabsorbable - Antimicrobial
- “Plus” sutures = antimicrobial component associated to it - Size
Nonabsorbable:
- Maintains ___ _____% of tensile strength for greater than ___ days.
> 50, 60
Absorbable suture loses __ ____% of tensile strength in less than ___ days
> 50, 60
Loss of tensile strength does not equal ?
rate of absorption b/c tensile strength just means its ability to resist being broken.
Accelerated and premature absorption may lead to?
post-operative complications
We want to make sure suture stays in right place for appropriate amount of time.
Natural fibers are absorbed via
1. _____ digestion
2. Rate of absorption increases in the presence of ____ and _____.
Enzymatic, infection, inflammation
Synthetic suture are absorbed via
1. ________
2. ____ molecules penetrate suture material causing breakdown of suture ____ chain
3. Less tissue reaction than enzymatic digestion
Hydrolysis, Water, polymer
Suture duration includes loss of ____ strength (loss of suture strength) and ____.
IMPORTANT
tensile, absorption
When Choosing Suture Consider…
* How long will the sutures need to be in?
* How does the suture material affect the
tissue and the process of healing?
* How great is the risk of infection?
* What strength of suture is required?
* Is the material flexible enough for the
given purpose and is it possible to knot
the suture in the space provided?
- Slow healing tissues (_____ and ______) use _______ sutures
- Rapidly healing tissues like ______, ____, and _____ use ______ sutures
- Avoid multifilament sutures when dealing with a potentially ______ tissue because it will most likely convert the ______ wound into an _____ one. Instead, use ________ (________)
fascia, tendons, absorbable stomach, colon bladder, absorbable, contaminated, contaminated, infected, monofilament, absorbable
Surgical Gut is a _____ form of suture.
1. It is broken down by ?
2. Monofilament or Multifilament?
3. Is this type of suture commonly used in practice?
4. What is this suture made up of?
5. Describe the type of reaction this suture may cause.
6. Which species is this suture NOT appropriate for?
7. What procedure(s) is this suture used for?
natural
enzymatic digestion/phagocytosis
Multifilament
Not frequently used in practice
Made from sheep intestine submucosa or bovine
serosa [<90% collagen]
Marked inflammatory reaction
- Most reactive suture material (plain vs. chromic = coated in chromic acids so that decreases a bit of host reactivity)
Most severe reaction in cats
Use: Vascular pedicle ligation/old school vets
Polyglactin 910 aka ____ and is a ____ form of suture.
1. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? _____ tissue ______, _______ organs, ______ procedures, ______ tissues
Vicryl, synthetic
1. Braided, Multifilament
- Monofilament only 9-0 and 10-0
3. Minimal tissue reactivity
4. 25% of strength lost by day 14
- Completely absorbed ~60-70 days.
5. Soft, approximation, Hollow, ophthalmic, subcutaneous
Polyglactin 910 is another Vicryl, but it is Vicryl _____. Exposed to _____ (Cobalt 60) to increase its rate of ____.
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? ____ and _____
______ repair
_______
Mucosa in ____ cavity
_______ skin
Skin repairs where ____ absorption may be beneficial [excluding over ____ and high ____/_____ areas]
Rapide
radiation, absorption
1. Synthetic
2. Braided, Multifilament
3. Minimal tissue reactivity
4. 50% of strength lost by day 5-6, almost 100% by day 14
- Completely absorbed ~42 days
5. Skin, mucosa, Perineal, Lacerations, oral, Periocular, rapid, joints, stress, tension
Do not use for your spay, closing body wall.
Polyglactin 910 is another Vicryl, but it is Vicryl _____. Coated with ____ (broad spectrum ________ agent) to reduce bacterial growth at suture line.
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? ______ and infected sites, _______ tract, _____, General _____, _____, _____ procedures
Plus
Triclosan, antibacterial
1. Synthetic
2. Braided, Multifilament
3. Minimal tissue reactivity
4. Completely absorbed between 56-70 days
5. Uses: Contaminated, Reproductive, Ligation, closure, Bowel, Orthopedic
Multifilament normally should not be used in a contaminated area, but this has a coating so it is less bad.
Polydioxanone
–> Also called?
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? Soft tissue ______, ___ closure, blood vessel ______, ______, Tissues that require _____ term _____ (ie?)
- PDS II vs. PDS Plus
1. Synthetic
2. Monofilament
3. Minimal tissue reactivity
4. Complete absorption at 180 days (6 months)
Usually between 180-210 days
5. Uses: approximation, Fascia, anastomosis, orthopedics, longer, strength (linea alba, bladder = heals quickly but does not necessarily mean that you want a quickly absorbable suture. )
Very common in spays to give linea alba time to heal;
Polyglecaprone 25
–> Also called?
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? ____ tissue _____, ______
_____ repairs, ______, ____, _____ cuff, ______
- Monocryl vs. Monocryl Plus
- Synthetic
- Monofilament
- Minimal tissue reactivity
- High initial strength
- 70-80% strength loss at 14 days
Complete absorption ~100 days (between 90-120 days) - Uses: Soft, approximation, Ligations, Skin, Bowel, Peritoneum, Uterus, Vaginal, Subcutaneous
Silk
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? Vessel _____, _________ procedures, _______ procedures, _______ procedures, ______ -> not ideal for this b/c of _____
- Natural –> Harvested from cocoon of silkworm
- Braided, Multifilament
- Moderate tissue/inflammatory reaction. Most reactive of non absorbable material. Potential nidus = (spot bacteria can stay and keep forming on top of one another) for calculus formation [ie: bladder or gallbladder]
* Uses: ligation, Cardiovascular, Ophthalmic, Neurological, Amputations, reactivity
Nylon (Polyamide)
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? ____ tissue ________, _______ procedures b/c removing suture a lot of the time, _____
- Ethilon
- Synthetic
* Monofilament
* Minimal tissue reaction
* Minimal breakdown
* Uses: Soft, approximation, Ophthalmic, Ligation
Polyester
–> Also called?
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? Stabilizing unstable ____
- Mersilene
- Synthetic
- Multifilament +/- coating
- Monofilament 10-0 and 11-0 only
- Strongest non-metallic suture material
- Intermediate suture reaction
- Causes more reaction than any other
SYNTHETIC suture - Uses: joints
Polypropylene
–> Also called?
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? _____ surgeries, _______ surgical procedures, _______ repairs
- Prolene
1. Synthetic
2. Monofilament
3. High memory - Least reactive nonabsorbable suture
- Uses: Vascular, Neurologic, Tendon
Stainless Steel
–> Also called?
1. Natural or synthetic?
2. Monofilament or Multifilament?
3. Describe the type of reaction this suture may cause.
**4. Describe the strength of this suture type.
5. What procedure(s) is this suture used for? _________, _______ repair
______ repair
- Metallic
- Monofilament or multifilament
Monofilament most common - High tensile strength
- Hard to handle
- Uses: Orthopedics, Sternotomy, Hernia
Trachea vs. skin vs. vessel ligation
Suture material differences
Do not memorize
Suture Size
* Most commonly notated by the standard
USP (United States Pharmacopeia)
12-0 (______) through 7 (_____)
Dimensions for cat gut is different
2-0 catgut is _____ than 2-0 ___
* Choosing appropriate size prevents wound _______ and promotes wound ____
* Larger material leads to increased tissue _____ and _____ healing
* Veterinarians tend to use excessively large sutures
smallest, largest, larger, PDS, dehiscence, healing, reaction, delayed
0 behind it is getting larger in size.
Suture Size: Security
* 4-0 requires ___ throws than 2-0
* 0 size, __ throws necessary
- Large suture throws tend to ____.
* The larger the suture, the ____ throws are needed for
knot security (secure knot = 4 throws).
fewer, 5, unravel, more
Suture Complications
1. Surgical Site Infection:
- Suture reaction
- Multifilament > coated -multifilament > monofilament
- Multifilament sutures should not be used in contaminated environments
- Wicking –> fluid and bacteria are carried into the interstices of multifilament fibers (–>
can lead to infection)
2. Dehiscence is a ____ of sutures to hold incision closed OR _____ of unlike tissues, sutures too tight, too much tension on sutures, OR __
suture technique
3. Seroma
- Increased dead space –> fill with fluid.
failure, Apposition, poor
Characteristics of the Surgical Needle
Suture Needles
1. Made of ?
* _____ on to suture
* Trauma proportional to _____
Size shouldn’t be _____ than suture
* Varying parts of a circle
* Taper
- causes _____ trauma
- Must _____ wrist to follow needle
* Cutting
- Facilitates ____ tissue penetration
- Cutting edge on ____ surface
- Reverse cutting edge on ____ surface
stainless steel wire
Swaged
diameter
larger
Minimal
curve
tough
concave
convex
Suture Needle Shapes
* When selecting needle think of _____ and _____ of wound
* _____ needle is typically hand-held and used in easily accessible areas
* ____ curved rarely used
* Examples:
____ circle used for ophthalmic surgery
____ circle commonly used with many tissue types and procedures
_____ circle commonly used for skin/superficial tissue
_____ circle is useful in confined locations or deep tissues
diameter, depth, Straight, Half, 1/4, 1/2, 3/8, 5/8
cutting needle = tough tissue like skin
Suture Needle Shapes
* Taperpoint: Sharp tip that ____ and spreads tissue ____ cutting. Used on?.
* Tapercut: Combination of _____ cutting and ____. Used for ?
* Cutting
Cutting edge on ____ portion of needle
Tends to cut ___ of tissue
* Reverse cutting
Cutting on edge of _____ surface reducing risk of tissue being cut out
Skin
* Spatula point
____ on top and bottom
_______ procedures
* Blunt point: Blunt point that dissects through _____ tissues ______ cutting. Used on ?
pierces, without, Intestine, subcutaneous tissue, fascia
reverse, taperpoint, Heavy thick fascia, tendons
concave, out, convex
Flat, Ophthalmic, friable, without, Soft parenchyma organs like liver and kidneys
Label accordingly
Tissue Adhesives aka Tissue Glue
* Cyanoacrylates is a Liquid that become _____ within seconds of contacting ____ in the tissues. Make sure tissue is ___ because if wet, will not have _____ properties.
* Sets in ___ __ minute
Delayed when applied to ___ area
* Close ____ skin incisions and lacerations
* Can delay _____, especially if done incorrectly, can cause tissue ____, _____ formation, and/or may promote wound ______
* Never use on ____ wounds or other heavily ______ wounds, puncture, or deep wounds; lacerations __ ___ ___; _____ membranes, near the ____; in __________ tissues
solid, water, dry, adhesive, <1, wet, short, healing, reaction, granuloma, infection, Bite, contaminated, >5cm, mucous, eye, subcutaneous
Skin Staplers is a _______ shaped ______ staples.
* Skin _______
* Apply skin staples __________ to the incision after _______ and ________ the
edges with thumb forceps
* Apply _______ pressure before the trigger is compressed
* Space staples placed ~__-___ ____ apart
* Advantages:
____ application (somewhat)
* Disadvantages:
_____
________ & _______ if not used correctly
_____ use
_____ saved in placement is lost in removal
rectangular, appositional
apposition, perpendicular, aligning, apposing, moderate, 5-6mm, Rapid, Cost, Eversion, Rotation, Single, Time
Specialized Staplers
* Thoracoabdominal (TA) Staple makes __ or __ parallel rows of __ shaped staples (color coding corresponds to staple ____)
Uses:
____ or ____ lobe resection
Partial ______
Partial ______
* Gastrointestinal Anastomosis (GIA) Stapler
Places ___- _____ rows of __ staples and cuts in the ___
Creates side to side ________ (Gastrointestinal Anastomosis)
* End to End Anastomosis (EEA) Stapler
Creates _______ end to end anastomosis
______ anastomosis
2, 3, B, height, Lung, liver, , splenectomy, gastrectomy, 4, 6 , B, middle, anastomosis, circular, Intestinal
Peritoneum closing is controversial.
Skin
Non-absorbable if you are doing regular ______ _______ (to be ______)
Intradermal –> never use ___-________ suture.
* _____ tissue reactivity
* Suture options:
* _____ = non absorbable
* _______ = non absorbable
* _____ = absorbable
* Size
* _____-____ depending on patient
simple interrupted, removed, non absorbable, Minimal, Nylon, Polypropylene, Monocryl, 4-0 to 2-0
Skin
Suture pattern (no tension)?
* Suture pattern (tension)?
Simple interrupted
Simple continuous
+/-Cruciate
Intradermal
Ford interlocking
Horizontal or vertical mattress
Cruciate
Near Far patterns
Subcutaneous Tissues heal very quickly.
* Choose _____ absorbable
_____ tissue reactivity
* Suture Options?
* Size is _____ dependent
4-0, 3-0, +/- 2-0
* Suture Pattern of choice
1. _____ _____ easier for sub cu; less ____ ______ risk
2. ?
Rapidly, Minimal
Monocryl
Vicryl
PDS
patient
Simple continuous
dead space
Simple interrupted
Body Wall and Fascia
* _____ absorbable
______ tensile strength
______ _______ ____ is holding layer (don’t take a bite of ____ muscle; easier in ____, harder in ____)
* Good knot ____
* Suture options?
* Size?
* Suture Pattern?
Slowly, High, External rectus sheath, entire, dogs, cats, security, PDS, 3-0 to 0 (larger dog = 0).
Simple interrupted
Simple continuous
Cruciate
Stomach
* ____ absorbable
* ____ tissue reactivity
* ____ tensile strength
* ____ knot security
* Suture options?
* Size?
* Suture Pattern:?
Slowly
Low
Good
Good
PDS
Monocryl
4-0 to 3-0 +/- 2-0
Simple continuous
Lembert
Halstead
Connell/Cushing
Small intestine
* _____ absorbable
* ____ tissue reactivity
* ____ knot security
* Suture options?
* Size?
* Suture Pattern?
Slowly
Low
Good
PDS
Monocryl
4-0 +/- 3-0
Simple interrupted
Simple continuous
Gambee= used to be use more back in the day
Urinary Bladder
* _____ absorbable (don’t pick super rapid though, despite the fact that the urinary bladder heals quickly)
___ tissue reactivity
* ___ tensile strength
* ____ knot security
* Suture Options?
* Size?
* Suture Pattern?
Rapidly
Low
Good
Good
Monocryl
PDS
4-0 and 3-0
Simple continuous
Cushing
Colon
* ____ absorbable
* ____ tissue reactivity
* ____ knot security
* Suture options?
* Size?
* Suture Pattern?
Slowly, Low, Good, PDS, 4-0 +/- 3-0, Simple interrupted
Vessel and Pedicle Ligation
* ____ knot security
* ____ tensile strength
* ____ absorbable
* Suture options?
* Size?
neuter = ?
* Knots:?
Good, Good, Slowly, PDS, 3-0 to 0 (pedicle)
4-0 to 3-0 (vessel), 2.0 or 0.
Square knot, modified miller’s, surgeons knot
Tendons and Ligaments use ________ suture
* ____ tensile strength
* ____ knot security
* Suture options?
* Size?
Nonabsorbable, Good, Good, Nylon, 3-0 to 1
Special Circumstances
* Bird and reptile skin tends to ____ so _____/____ relieving patterns recommended
* ____ _____ in dogs and cats tends to invert
______ patterns are recommended
* _____ ______ organs with aggressive eversion of mucosa
(stomach, uterus)
________ or _____ Gambee patterns are recommended
invert, Everting/tension, Oral mucosa, Everting, Larger hollow, Inverting, modified
One or Two Layer Closure?
* One-layer closures preferred but for ______ organ repairs; ____-layer is acceptable
* Stomach and bladder
_____-layer commonly seen
Two-layer closures have disadvantage of compromising _____, large ____- source for
bleeding and irritation
hollow, two, Double, lumen, cuff
