Suture materials Flashcards
Suture material over time
Suture loses strength at same rate that the tissues gain strength
-absorbed by tissues= no foreign material in wound
How long do different tissues need support for?
Days- muscle, SQ, skin
Weeks- fascia
Months- tendons
Factors involved in ideal suture material selection
-easy to handle
-reacts minimally in tissues
-inhibit bacterial growth
-holds securely when knotted (diff coating)
-resists shrinking in tissues
-absorbs (min tissue rxn)
-non capillary
-non allergenic
-non carcinogenic
-non ferromagnetic
Selecting size of suture material
-smallest diameter that will secure tissue (min trauma, reduce amount of foreign material)
-no advantage to stronger suture than tissue
-smaller suture, less tensile strength it has
Size system for sutures
12-0 = smallest
7=largest
What determines flexibility of suture
Torsional stiffness and diameter
*affects handling and use
*important for ligating vessels and continuous suture patterns
most to least flexible suture
- Silk= flexible
- Nylon and surgical gut
- Braided polyester
- Wire= lest flexible
Capillarity
- greater in multifilament fibers
-allows fluid and bacteria to get into interstices… WBCs are large and cannot get in so infection persists
-coating reduce capillarity= do not use with infection
Capillarity vs non capillary suture material
Capillarity= braided (polyglycolic acid and silk)
Noncapillarity= monofilament
Knot tensile strength
Force that the suture can withstand before breaking when knotted
Knot holding capacity
Strength needed to untie or break a defined knot by loading the part of the suture that forms the loop
Tensile strength
Strength needed to break an untied fiber with a force applied in direction of its length
Classifications of suture
- behaviour in tissue (absorbable vs non absorbable
- Structure (monofilament vs multifilament)
- Origin (synthetic, organic, metallic)
Absorption of suture
- Digestion by tissue enzymes and phagocytosis
*organic origin sutures - Hydrolysis
*synthetic fibres
What happens with non absorbable suture?
Encapsulated/walled off by fibrous tissue
Monofilament
Multifilament
Different origin of suture
-synthetic
-organic
- metallic
Absorbable suture materials
Non absorbable suture material
What is the tensile strength or timing of absorbable suture materials?
60 days
Organic absorbable suture materials
-short term
-phagocytosis/inflammatory rxn
-absorption rate increased by infection or digestive enzymes
Catgut
-organic absorbable
-submucosa or sheep or serosa of bovine intestine
-90% collagen
-rapid phagocytosis/inflammatory rxn
Specific characteristics for catgut
-loses strength rapidly
-tanning slows absorption, reduces tissue rxn
-33% reduction in tensile strength at 7days, 50% at 14 days
-poor knot security
-high capillary
Synthetic absorbable suture materials
-hydrolysis (min tissue rxn)
-absorption not as influenced by infection or digestive enzymes
Monofilament long term
-retain tensile strength longer than multifilament
-absorption complete 6mths for PDS and Maxon; 120 days for Biosyn
Polydioxane (PDS II)
Polyglyconate (Maxon)
Glycomer 631 (Biosyn)
Monofilament short to medium term
-includes Poliglecaprone 25 (monocryl) and Polyglytone 6211 (Caprosyn)
-tensile strength deteriorates in 2-3weeks
-rapidly absorbable
*monocryl 60-90days
-caprosyn 56days
-pliable, lack stiffness, good handling
Poliglecaprone 25 (monocryl)
Polyglytone 6211 (Caprosyn)
Multifilament Medium term
-includes polyglycolic acid (dexon) and Polyglactin 910 (vicryl)
-absorption: Dexon= 100-120 d; vicryl 40-90d
-braided (harbour bacteria, increased capillary)
Polyglycolic acid (dexon)
Polyglactin 910 (vicryl)
Nonabsorbable suture material
Silk
Polymerized caprolactim (Supramid)
*don’t use in horses
Polyester (Ethibond)
Polybutester (novafil) and Polypropylene (Prolene)
Polyaminde/nylon (Dermalon)
Stainless steel
What suture material type would you use for skin?
Monofilament nonabsorbable
What suture material type would you use for SQ?
Synthetic absobable
What suture material type would you use for fascia?
-monofilament absorbable or nonabsorbable
What suture material type would you use for tendon?
Monofilament absorbable or nylon
Suture needles
1.swaged on needles
- eyed needles (more traumatic, difficult)
Suture needle shapes
-straight
-3/8 circle
-1/2 curved
-half circle
Suture needle points
-taper
-cutting
-reverse cutting
What needle would you choose for skin?
cutting
What needle would you choose for bowel or SQ?
Taper
What needle would you choose for fascia or tendon?
Taper of nodified cutting
What influences your choice of type of circle?
Depth of wound
Linea alba
-absorbable material
-multifilament ot monofilament
-cutting needle
-long lasting
-eg. PDS, vicryl
SQ
-absorbable
-coated multifilament or monofilament
-taper needle
-quick to absorb
-eg. monocryl
SKin
-non absorbable
-monofilament
-cutting
-non absorbable
-prolene, novofilament, PDS
Parencymal organs (liver, spleen, kidney)
-absorbable
-monofilament
-taper
-quick to absorb
-monocryl
Hollow viscous organs (trachea, GI, bladder)
-absorbable
-monofilament
-taper needle
-in betweeen quick and short
-monocryl, Dexon except in urine
vessel ligation
-absorbable
-multifilament
-no needle needed
-long lasting
-PDS, vicryl, others
Vessel anastomosis
-nonabsorbable
-monofilament
-taper
-long lasting
- prolene
