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Principles of Surgery > Suture Material and Needles > Flashcards

Suture Material and Needles Flashcards

1
Q

Suture is a strand of material used to ___ ___ blood vessels and approximate tissues.

A

tie off

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2
Q

Suturing plays an important role in wound ____ by providing _______ and supports wound _____.

A

repair, hemostasis (ligating vessels), healing

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3
Q

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.

A

support

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4
Q

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

A

easy

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5
Q

Tensile strength measures of the ability of the material to resist breakage or deformation
– Exponentially proportional to size
*

A

Time it takes for suture to lose 70-80% of its intial strength. Proprtional to size, bigger the size or tensile strength.

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6
Q

Pliability/Flexibility
- Depends on material and ___ of ___
- ___ when the suture material is handled
- More flexibility is better for vessel _____

A

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.

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7
Q
  • Memory is the tendency of suture material to return to its _____ shape. _______ suture will always have more memory than ______ suture.
A

original, Monofilament, multifilament

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8
Q
  • 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.
A

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.

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9
Q

Knot security is the ability of suture material to ____ knot and is ______ proportional to suture size. Tensile strength is proportional to size.

A

hold, inversely

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10
Q
  • 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 ______.
A

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

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11
Q
  • 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 _____
A

Suture is a foreign body so the body will react to it. Varying degrees of reactivity - patient dependent.
larger, , monofilament

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12
Q

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 _____

A

Minimal, Gentle, safety, security, capillarity, tensile, breaking, Consistent, Comfortable, absorption

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13
Q

“No single suture is ideal for every surgical situation…
Certain suture materials are better suited for different
wound environments and uses”

A
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14
Q

Suture Classification is based on what factors?

A
  1. Fiber Origin –? Synthetic vs. natural
    - natural originate from biological sources such as silk
    - synthetic is mand made nylon= common
  2. 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.
  3. Behavior in tissue
    – Absorbable vs. nonabsorbable
  4. Antimicrobial
    - “Plus” sutures = antimicrobial component associated to it
  5. Size
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15
Q
A
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16
Q

Nonabsorbable:
- Maintains ___ _____% of tensile strength for greater than ___ days.

A

> 50, 60

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17
Q

Absorbable suture loses __ ____% of tensile strength in less than ___ days

A

> 50, 60

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18
Q

Loss of tensile strength does not equal ?

A

rate of absorption b/c tensile strength just means its ability to resist being broken.

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19
Q

Accelerated and premature absorption may lead to?

A

post-operative complications
We want to make sure suture stays in right place for appropriate amount of time.

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20
Q

Natural fibers are absorbed via
1. _____ digestion
2. Rate of absorption increases in the presence of ____ and _____.

A

Enzymatic, infection, inflammation

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21
Q

Synthetic suture are absorbed via
1. ________
2. ____ molecules penetrate suture material causing breakdown of suture ____ chain
3. Less tissue reaction than enzymatic digestion

A

Hydrolysis, Water, polymer

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22
Q

Suture duration includes loss of ____ strength (loss of suture strength) and ____.
IMPORTANT

A

tensile, absorption

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23
Q

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?

A
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24
Q
  • 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 ________ (________)
A

fascia, tendons, absorbable stomach, colon bladder, absorbable, contaminated, contaminated, infected, monofilament, absorbable

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25
Q
A
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26
Q

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?

A

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

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27
Q

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

A

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

28
Q

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]

A

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.

29
Q

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

A

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.

30
Q

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?)

A
  • 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;
31
Q

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, ______

A
  • 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
    –
32
Q

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 _____

A
  1. Natural –> Harvested from cocoon of silkworm
  2. Braided, Multifilament
  3. 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
33
Q

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, _____

A
  1. Ethilon
  2. Synthetic
    * Monofilament
    * Minimal tissue reaction
    * Minimal breakdown
    * Uses: Soft, approximation, Ophthalmic, Ligation
34
Q

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 ____

A
  • 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
35
Q

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

A
  • Prolene
    1. Synthetic
    2. Monofilament
    3. High memory
  • Least reactive nonabsorbable suture
  • Uses: Vascular, Neurologic, Tendon
36
Q

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

A
  • Metallic
  • Monofilament or multifilament
    – Monofilament most common
  • High tensile strength
  • Hard to handle
  • Uses: Orthopedics, Sternotomy, Hernia
37
Q
A

Trachea vs. skin vs. vessel ligation
Suture material differences
Do not memorize

38
Q

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

A

smallest, largest, larger, PDS, dehiscence, healing, reaction, delayed

0 behind it is getting larger in size.

39
Q

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).

A

fewer, 5, unravel, more

40
Q

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.

A

failure, Apposition, poor

41
Q
A
42
Q
A
43
Q

Characteristics of the Surgical Needle

A
44
Q

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

A

stainless steel wire
Swaged
diameter
larger
Minimal
curve
tough
concave
convex

45
Q

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

A

diameter, depth, Straight, Half, 1/4, 1/2, 3/8, 5/8

cutting needle = tough tissue like skin

46
Q

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 ?

A

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

47
Q

Label accordingly

A
48
Q

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

A

solid, water, dry, adhesive, <1, wet, short, healing, reaction, granuloma, infection, Bite, contaminated, >5cm, mucous, eye, subcutaneous

49
Q

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

A

rectangular, appositional
apposition, perpendicular, aligning, apposing, moderate, 5-6mm, Rapid, Cost, Eversion, Rotation, Single, Time

50
Q
A
51
Q

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

A

2, 3, B, height, Lung, liver, , splenectomy, gastrectomy, 4, 6 , B, middle, anastomosis, circular, Intestinal

52
Q
A
53
Q
A

Peritoneum closing is controversial.

54
Q

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

A

simple interrupted, removed, non absorbable, Minimal, Nylon, Polypropylene, Monocryl, 4-0 to 2-0

55
Q

Skin
Suture pattern (no tension)?
* Suture pattern (tension)?

A

Simple interrupted
Simple continuous
+/-Cruciate
Intradermal
Ford interlocking

Horizontal or vertical mattress
Cruciate
Near Far patterns

56
Q

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. ?

A

Rapidly, Minimal
Monocryl
Vicryl
PDS
patient
Simple continuous
dead space
Simple interrupted

57
Q

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?

A

Slowly, High, External rectus sheath, entire, dogs, cats, security, PDS, 3-0 to 0 (larger dog = 0).
Simple interrupted
– Simple continuous
– Cruciate

58
Q

Stomach
* ____ absorbable
* ____ tissue reactivity
* ____ tensile strength
* ____ knot security
* Suture options?
* Size?
* Suture Pattern:?

A

Slowly
Low
Good
Good
PDS
Monocryl
4-0 to 3-0 +/- 2-0
Simple continuous
Lembert
Halstead
Connell/Cushing

59
Q

Small intestine
* _____ absorbable
* ____ tissue reactivity
* ____ knot security
* Suture options?
* Size?
* Suture Pattern?

A

Slowly
Low
Good
– PDS
– Monocryl
– 4-0 +/- 3-0
– Simple interrupted
– Simple continuous
– Gambee= used to be use more back in the day

60
Q

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?

A

Rapidly
Low
Good
Good
– Monocryl
– PDS
– 4-0 and 3-0
– Simple continuous
– Cushing

61
Q

Colon
* ____ absorbable
* ____ tissue reactivity
* ____ knot security
* Suture options?
* Size?
* Suture Pattern?

A

Slowly, Low, Good, – PDS, – 4-0 +/- 3-0, – Simple interrupted

62
Q

Vessel and Pedicle Ligation
* ____ knot security
* ____ tensile strength
* ____ absorbable
* Suture options?
* Size?
neuter = ?
* Knots:?

A

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

63
Q

Tendons and Ligaments use ________ suture
* ____ tensile strength
* ____ knot security
* Suture options?
* Size?

A

Nonabsorbable, Good, Good, – Nylon, – 3-0 to 1

64
Q

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

A

invert, Everting/tension, Oral mucosa, Everting, Larger hollow, Inverting, modified

65
Q

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

A

hollow, two, Double, lumen, cuff

Principles of Surgery (13 decks)

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