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Suture Materials Flashcards

1
Q

Sutures hold a wound in apposition until…

A

the natural healing process is established enough to make support from the suture material unnecessary.

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2
Q

What is the adequate duration on average for sutures being left in the body?

A

14-21 days on avg, except tendon

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3
Q

In the early stages of wound healing, wound strength is due to…

A
  • fibrin from inflammatory reaction
  • vascular endothelial ingrowth
  • epithelial migration into wound
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4
Q

What factors are likely to influence wound healing?

A

infection
tension
severe protein depletion
poor vascularisation

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5
Q

What biological properties of suture material have to be considered?

A
  • the likelihood of the material to potentiate infection
  • calculogenic?
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6
Q

suture strength should match…

A

tissue strength

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7
Q

The rate of loss of suture strength must be compatible w/ the…

A

the rate of gain of wound strength

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8
Q

Define: ‘Straight pull’ tensile strength

A

Represents the maximum longitudinal force a strand can bear before breaking

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9
Q

Define: ‘Knot-pull’ tensile strength

A

The force which a suture strand can resist before it breaks when a knot exists

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10
Q

Define: ‘Out of packet’ tensile strength

A

This is the ‘straight pull’ tensile strength
AKA the original tensile strength

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11
Q

Define: Tensile strength

A

Time suture will mechanically support the wound, usually measured in days

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12
Q

Define: Mass absorption

A

Time in days for suture to be totally absorbed by the body

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13
Q

What is the Critical wound healing period (CWHP)?

A

The time in days a wound requires mechanical support

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14
Q

What is the metric number used in the metric system of suture size?

A

Metric number = the thread in diameter in tenths of a mm

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15
Q

Explain the USP system of suture size.

A

System has a standard range in diameter for each size or grade
Denoted in zeros with the finest is (14-0) and a max diameter is at 7.

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16
Q

What are the ideal properties of suture material?

A
  • low cost
  • easily sterilised
  • pliable
  • high tensile strength
  • non-capillary
  • secure knots
  • no tissue rxn
  • absorbed/encapsulated
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17
Q

What are the 3 classifications of suture?

A
  • Absorbable or non-absorbable
  • Multifilament or monofilament
  • Natural or synthetic
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18
Q

What are the different types of absorbable suture that are commonly found?

A

Catgut, Chromic catgut, Polyglycolic acid (Dexon), Polyglactin 910 (Vicryl/Vicryl RAPIDE), Polydioxanone (PDS), Polyglyconate (Maxon), Poliglecaprone 25 (Monocryl), Glycomer 631 (Biosyn), Polyglytone 6211 (Caprosyn)

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19
Q

Catgut is …

A

natural, absorbable, monofilament

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20
Q

Catgut is made from the submucosa of…

A

sheep/cattle

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21
Q

Plain gut (catgut) evokes…

A

severe sterile pyogenic reaction

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22
Q

Catgut loses tensile strength…

A

rapidly

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23
Q

How long does it take the body to absorb catgut?

A

about 7 days

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24
Q

What is important to remember about plain gut (catgut)?

A

Plain gut should not be used in Surgery

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25
Chromic catgut is...
natural, absorbable, monofilament suture
26
What differs chromic catgut from plain gut?
Chromic catgut has a chromic oxide treatment to reduce inflammatory reactions in the body. It has a higher tensile strength for longer and a more even absorption pattern
27
What are some advantages of chromic catgut?
- relatively cheap if purchased in cassettes - easy to handle
28
What are some disadvantages of chromic catgut?
- severe inflammatory rxn - poor knot security - questionable sterility in cassettes - variability in strength & loss of strength - swells & weakens when wet - weakens when knotted - capillary action
29
Polyglycolic acid (aka Dexon)
Synthetic, multifilament, absorbable
30
How is Polyglycolic acid broken down? What does this do to the body?
It is broken down by hydrolysis thus making it less reactive to the body than catgut.
31
Polyglycolic acid has better... than catgut.
knot security
32
The strength of polyglycolic acid is ... by knotting than catgut
less affected
33
polyglycolic acid has some .... due to the ....
tissue drag multifilament synthetic braided suture
34
What suture is the main competitor to polyglycolic acid?
Polyglactin 910
35
Polyglactin 910 (Vicryl) is a
synthetic, multifilament, absorbable suture
36
Why is polyglactin 910 a competitor for Polyglycolic acid?
it is marginally stronger than the polyglycolic acid
37
When is it ideal to use Vicryl rapide?
Superficial soft tissue (skin & mucosa) where only short-term wound support is required.
38
How long does vicryl rapide last?
about 7-10 days
39
Vicryl rapide should not be used for...
ligation, cardiovascular, GIT, etc
40
Polydioxanone is also known as
PDS
41
polydioxanone is a
synthetic, absorbable, monofilament
42
how is polydioxanone absorbed?
by hydrolysis
43
Polydioxanone is stronger than...
polypropylene or nylon
44
At 4 weeks, polydioxanone has what percent of strength remaining?
50-70%
45
At 6 weeks, polydioxanone has what percent of strength remaining?
25%
46
What type of filament suture is best for infected tissues? why?
Monofilament because it is made of only 1 strand and isn't braided like polyfilament. The braiding allows bacterial to get into the suture material and harbor there.
47
Another name for polyglyconate suture is...
Maxon
48
Polyglyconate suture is
synthetic, absorbable, monofilament
49
Polyglyconate differs from PDS how?
- possibly a little stronger than PDS II - slightly better knot security
50
Poliglecaprone 25 is also known as
monocryl
51
Poliglecaprone 25 is
synthetic, absorbable, monofilament
52
poliglecaprone 25 is rapidly...
absorbed
53
How long does it take poliglecaprone 25 to lose most or all of its significant strength?
14 days
54
When should you use poliglecaprone 25?
in rapidly healing tissues or when you don't want suture material present for long
55
Glycomer 631 is also known as
biosyn
56
Glycomer 631 is
monofilament, synthetic, absorbable suture
57
What is glycomer 631 excellent in?
initial strength and in vivo strength over the CWHP
58
Glycomer 631 has minimal
memory
59
glycomer 631 is used for
general soft tissue approximation
60
Polyglytone 6211 is also known as
caprosyn
61
Polyglytone 6211 is
absorbable monofilament suture
62
How long does complete absorption take in Polyglytone 6211?
56 days
63
polyglytone 6211 has what good characteristics?
- excellent handling - retains up to 30% knot strength, even at 10 days post-implantation
64
rapid absorption limits application in which absorbable suture?
polyglytone 6211 (caprosyn)
65
Any suture degraded by hydrolysis may be at risk of...
premature degradation when used in a bladder infected w/ Proteus spp.
66
What are the types of non-absorbable sutures?
silk, polyamide (nylon), polypropylene (prolene), stainless steel, coated caprolactum (supramid)
67
Silk is...
natural multifilament non-absorbable suture
68
what are advantages with silk suture?
- cheap & easy to handle - tensile strength lost after 6 mos - good knot security
69
When is silk used?
cardiovascular surgery
70
What are the problems with silk suture?
- causes ulceration in the GIT - unsuited in contaminated sites - predisposes to calculi in the bladder
71
polyamide is also known as
nylon
72
polyamide is
synthetic mono or multifilament non-absorbable suture
73
The half life of polyamide
exceeds 6 months
74
what are some key characteristics of polyamide suture?
- minimal tissue reaction - moderate strength - moderate security - little discomfort on removal - commonly used for skin
75
Polypropylene is also known as
prolene
76
polypropylene is
synthetic monofilament non-absorbable suture
77
What are some key characteristics of polypropylene suture?
- minimal tissue drag - moderate knot security - moderate strength - good for skin - least thrombogenic, so great for cardiovascular surgery
78
What is the memory like in polypropylene suture?
slightly difficult to handle
79
What are some key characteristics for stainless steel suture?
- very strong & retains strength - non-capillary & inert - difficult to handle - can be used for skin suture
80
What is another name for coated caprolactum?
Supramid
81
Coated caprolactum is
synthetic, multifilament, non-absorbable suture
82
What are some key characteristics of coated caprolactum?
- twisted multifilament of the nylon family - coated in a proteinaceous material - common for skin closure - chemical disinfection does not sterilise so cannot be used for anyone other than skin closure - intermediate tissue reactivity - superior tensile strength to nylon
83
What are the main problems w/ multifilaments?
- capillary properties - tissue drag/friction - premature locking of knots, especially ligatures
84
How were multi-filaments fixed?
they were coated to solve tissue drag & premature locking
85
When are multi-filament sutures unsuitable?
- slow healing tissues like tendon - delayed healing situations (infections)
86
What are the two types of needles used in suture?
Swaged needles Eyed needles
87
What are some advantages to swaged needles?
- less traumatic - immediately available - always sharp - guaranteed sterile - slim as possible without compromising strength - stable in needle holder - coated w/ silicone to improve sensation of sharpness
88
What are some advantages to eyed needles?
- less expensive - reusable
89
What are some disadvantages to eyed needle suture?
- soft steel, easily bent - larger than swaged due to the eyelet - edge is lost with autoclaving/chemical sterilization
90
Needle bodies can be either...
straight or curved
91
Needle choice depends on the
depth and size of the wound
92
What fraction of a circle in needle curvature is available?
1/4 circle 3/8 circle 1/2 circle 5/8 circle
93
Cutting needles come in what types?
Taper point, reverse cutting, conventional cutting, taper cutting
94
Round-bodied needles have
no sharp edges
95
What are some tissues that taper point needles are used on?
biliary tract nerve vessels dura peritoneum pleura GIT SQ fat muscles myocardium
96
What are some tissues that reverse cutting needles are used on?
fascia ligaments skin tendons
97
What are some tissues that conventional cutting needles are used on?
skin, ligaments, tendons
98
When is a taper cutting needle used?
bronchus, tendons, calcified tissue, trachea, fascia, uterus, ligaments, vessels, ovary
99
When are round-bodied needles used?
parenchyma, fat, muscles
100
straight needles are used...
in open access areas skin, GI
101
1/4 circle needles are used in
ophthalmic or microsurgeries
102
3/8 circle needles are used...
most of the time skin, muscle, GIT, cardiovascular, vascular, tendon, etc.
103
1/2 circle needles are used...
in deeper tissues usually GI, CV, vascular, muscle, oral cavity, etc
104
5/8 circle needles are used
- in tight access areas - urology, pelvic cavity - prostatectomy, pelvic cavity

ICMS (22 decks)

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