Suture Material Selection Flashcards
What is arguably the MOST important characteristic of suture?
tensile strength
there are a few “regions” of strain you can place on your suture when using it. You start in the elastic region and as you begin placing more stress on your suture, you enter a plastic region. You want to stop applying stress when you transition from elastic to plastic regions BEFORE you enter the breaking point in which the suture will break.
T/F: size 3 suture is bigger than size 3-0
true
What type of suture are the following:
catgut, chromic gut, vicryl, and vicryl rapide
multi-filament absorbable suture
what type of sutures are monocyrl and PDS?
monofilament absorbable
which absorbs faster – monocryl or PDS?
monocryl
which absorbs faster – monocryl or vicryl?
vicryl
what type of suture is silk?
multifilament non-absorbable
what type of suture are nylon and prolene?
monofilament non-absorbable
what are the biggest downsides to natural suture?
not uniform
unpredictable (loss of tensile strength, diameter, size, strength in general)
synthetic suture has more predictable loss of tensile strength. what is the biggest downside to synthetic suture?
decreased handling –> increased memory
stiffer.
what are the 4 important areas of information on suture packaging?
US gauge
Needle type
Brand name of material
Suture material
what are the 3 “pros” of monofilament suture?
- lower tissue drag
- decreased capillarity
- decreased risk of nidus
what are the 3 “cons” of monofilament suture?
- less pliable
- increased memory
- susceptible to damage
what are the 2 “pros” of multifilament suture?
- increased strength
- increased pliability
what are the 3 “cons” of multifilament suture?
- increased tissue drag/friction
- increased capillarity
- increased tendency for bacterial colonization
Absorbable suture has loss of tensile strength within _____ days in living mammalian tissue
60-90
how is absorbable suture absorbed?
phagocytosis by macrophages
enzymatic hydrolysis
Non-absorbable suture retains almost ALL tensile strength for greater than ___ days.
60
how fast is catgut/chromic gut absorbed?
2-3 weeks completely absorbed
T/F: catgut and chromic gut have high tissue reactivity.
true
what types of things is catgut/chromic gut appropriate for?
ligation of SMALL vessels
rapidly healing tissues (ie mucosas/gingiva)
How fast is monocryl absorbed?
50% loss of tensile strength by 1 week
70-80% loss at 2 weeks
compeltely absorbed in 119 days
which synthetic suture has the BEST handling?
monocryl
if monocryl and PDS have good handling, good pliability, good strength, predictable absorption, are minimally reactive, and are good to be used in contaminated wounds, what is the one downside to these suture types?
expensive!
how fast is vicryl absorbed?
50% loss of tensile strength at 2-3 weeks
absorbed in ~ 1 month
T/F: vicryl rapide has 50% loss of tensile strength in 12 days
false – 5 days!
its completely absorbed at 42 days.
why is vicryl NOT good for use in infected wounds?
it is a multifilament suture that has increased tissue drag and capillarity.
how fast is PDS absorbed?
50% loss of tensile strength at 5-6 weeks
completely absorbed at 182 days.
T/F: silk is non reactive
false – high tissue reactivity
how is silk absorbed and how fast?
phagocytosis
56% loss of tensile strength by 3 months
completely absorbed by 2 years.
T/F: prolene (a monofilament suture) lacks hydrolysable bonds and therefore is resistant to degredation
true
What is the LEAST thrombogenic suture type making it great for use in tendons, ligaments, joint capsules, and fascia?
prolene (polypropylene)
T/F: prolene (polypropylene) can be used in contaminated wounds
true
what is the biggest downside to prolene (polypropylene)?
it has poor handling and poor knot security because its so slippery and has lots of memory.
how fast does Nylon (polyamide) degrade?
50% loss of strength by 12 weeks in acidic environments
why is nylon non reactive?
its biologically inert.
T/F: nylon suture can cause irritation from the sharp suture ends, so you should leave tags longer.
true
what suture needle is BEST for soft tissues and luminal organs?
taper point
what suture needle is BEST for skin and tougher tissues?
reverse cutting
what is a non-swaged needle?
a needle that is not connected to the suture itself. You must manually insert the suture to this needle. These needles are commonly reused and therefore more dull and cause more tissue drag/damage. They are very cheap.
when should you consider using staples?
large, linear incisions
thicker skin
non-contaminated wounds that are relatively well-apposed
when you need to close quicker (ex. pt having systemic issues like low BP)
what is the purpose of surgical glue?
minor appositional adjustments
