Suture materials Flashcards by Emily Stacey

What are the functions of suture material?

Wound closure
Ligation
Attachment of tubes
Stay sutures

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What are features of the ideal suture material?

INTERACTION WITH TISSUES - maintains strength until wound strength develops, rapid resorption when no longer required, encapsulated without post-op complications, easily removed, minimal tissue reaction, doesn’t favour bacterial growth, minimal drag through tissues, suitable for all wounds
INTERACTION WITH SURGEON - easy to handle (pliable, low memory), good knot security
MATERIAL PROPERTIES - easy to sterilise, non-capillary, non-electrolytic, non-corrosive, non-allergenic, non-carcinogenic
PRACTICAL CONSIDERATIONS- cheap, readily available, range of sizes

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How is suture material classified?

ORIGIN: Natural vs synthetic
PERSISTENCE: absorbable/non-absorbable
STRUCTURE: multifilament/monofilament

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Describe the tissue reaction and absorption of natural and synthetic fibres.

NATURAL: tissue inflammatory reaction, variable absorption
SYNTHETIC: less reaction, predictable absorption

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Describe the persistence of absorbable and non-absorbable fibres.

ABSORBABLE: temporary wound support, loss of strength (21d)

NON-ABSORBABLE: elicits tissue reaction –> encapsulation, strength persists >60d

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Contrast multifilaments and monofilaments

MULTIFILAMENT: easier to handle, better knot security, capillarity
MONOFILAMENT: less tissue drag, can weaken when crushed, prone to kinking

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How can ‘other items’ affect suture classification? 3

COATING - coated vs uncoated. Coating improves handling and reduces tissue drag.
COLOUR (dyed/undyed) - improves visibility
PACKAGING - cassette, individual packet

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What does FACTS stand for in the context of suture material?

Interaction with tissue:
Absorption Completion
Tensile Strength and loss.

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List some examples of SYNTHETIC ABSORBABLE MULTIFILAMENT 4

Important to know!!!!

Vicryl - Polyglactin 910
Dexon - Polyglycolic acid
Polysorb - Lactomer 9-1
Panacryl - Poly(L-lactide,glycolide)

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Describe for SYNTHETIC ABSORBABLE MUTLIFILAMENT, the:

tissue interaction
tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete at 60-90d.
Speed: Polysorb>Vicryl>Dexon

TENSILE STRENGTH AND LOSS: loss 33% (7d), 80% (14d), 100% (21d). Strength: Polysorb>Vicryl>Dexon

HANDLING AND KNOTTING: good handling/knotting, tissue drag - improved by coating

USE: vessel ligation, general soft tissue closure (skin, mouth)

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List examples of SYNTHETIC ABSORBABLE MONOFILAMENT - SHORT DURATION - 2

Monocryl - Polyglecaprone

Caprosyn - Polyglytone

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Describe for SYNTHETIC ABSORBABLE MONOFILAMENT - SHORT DURATION, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete @90-120d, speed Caprosyn>Monocryl

TENSILE STRENGTH AND LOSS: high tensile strength, loss 50% (7d), 60% (14d), 100% (21d)

HANDLING AND KNOTTING: monocry - soft and pliable, low memory. Caprosyn - more sticky

USE: general soft tissue closure, visceral closure - monocryl

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List examples of SYNTHETIC ABSORBABLE MONOFILAMENT - LONG DURATION - 3

PDS 2- Polydioxanone
Maxon - Polyglyconate
Biosyn - Glycomer 631

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Describe for SYNTHETIC ABSORBABLE MONOFILAMENT - LONG DURATION, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete @110-210d

TENSILE STRENGTH AND LOSS: strong materials (>nylon, prolene), loss 26% (14d), 40% (28d), 75% (42d), Strength: PDS 2> Maxon>Biosyn

HANDLING AND KNOTTING: PDS - memory, tendency to coil, 7 knots

USE: soft tissues needing long support, muscle, fascia, linea alba, viscera.

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List 3 Synthetic non-absorbable monofilament

Prolen/SurgiPro - Polypropylene
Ethilon/Monosof - Polyamide
Flexon - Steel

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Describe for SYNTHETIC NON-ABSORBABLE MONOFILAMENT, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: minimal - inert

TENSILE STRENGTH: strong, 25% loss at 2 years -nylon

HANDLING AND KNOTTING: Memory Propylene>Nylon, knot security - prolene>nylon

USE: Inert - skin, stoma, vessels, prolonged support - hernia, tendon

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List 3 Synthetic non-absorbable MULTIfilament

Mersilene, Ethibond - polyester
Novafil - Polybutester
Supramid - Caprolactam

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Describe for SYNTHETIC NON-ABSORBABLE MONDOFILAMENT, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: moderate inflammation

TENSILE STRENGTH: stronger than nylon, very little loss of strength

HANDLING AND KNOTTING: fair handling, slight elasticity, sheath cracks on knotting

USE: ligament prosthesis, skin closure

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List 2 NATURAL ABSORBABLE MULTIFILAMENTS

Catgut - plain or chromic

Collagen - ophthalmic surgery

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Describe for SYNTHETIC NON-ABSORBABLE MULTIFILAMENT - LONG DURATION, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete @60-70d, tissue reaction marked, faster in infected/vascular/acidic wounds, unpredictable - absorption via phagocytosis cf hydrolysis

TENSILE STRENGTH AND LOSS: 33% loss (7d), 67% loss (14d)

HANDLING AND KNOTTING: knots weaker when wet, poor knot security so leave ends long, good handling

USE: vessel ligation, ophthalmic surgery

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Give an example of a suture material that is Natural, non-absorbable multifilament

Mersilk, PermaHand - Silk

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Describe for NATURAL NON-ABSORBABLE MULTIFILAMENT, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: moderate-marked inflammation, encapsulation in fibrous tissue

TENSILE STRENGTH: weak - will break, very slow absorption - 2yr

HANDLING AND KNOTTING: handling good (silk)

USE: large vessel ligation, NOT in viscera - ulcers and calculi

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What are general points to consider when doing a rational selection of suture material? 3

Tensile strength should match that of tissue which depends on collagen content (fascia/skin> viscera> muscle/fat)

Rate of loss of strength = gain in wound strength (rate of healing: viscera>skin>fascia)

Will suture alter healing biologically? (tissue reaction, potentiation of infection, sinus formation, potentiation of calculi, thrombi and ulcers

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What are some general rules to avoid complications?

avoid multifilament in contaminated wounds
avoid non-absorbable sutures in hollow organs
use inert material in the skin
avoid reactive material for stoma creation
use slowly/non - absorbable material in fascia/tendons
avoid burying any suture from a multi-use cassette
avoid catgut in inflamed, infected or acidic wounds

What materials might you use for skin?

non-abs, mono - nylon, prolene | abs, multi - vicryl

What material might you use for the subcutis?

abs, mono/multi - monocryl, vircryl, caprosyn

What material might you use for fascia?

abs/non-abs, mono - PDS, biosyn, prolene

What material might you use for muscle?

abs, mon - PDS, biosyn, maxon

What material might you use for viscera?

abs, mono - Monocryl, PDS

What material for tendon?

non-abs, mono - prolene, nylon

What material for nerve?

non-abs, mono - prolen, nylon

What material for vessel ligation?

abs , multi - vicryl, polysorb OR non-abs, mono - prolene, silk

What material for vessel repair?

non-abs, mono - prolene, surgiPro

How is suture material size categorised?

``` in 1/10smm ascending scale linear no missing value same for all sutures Metric - UK, USP = USA Metric guage 4/5/6 last longer. 0.2/0.3/0.4 less reaction, less discomfort ```

How should you choose a suture?

``` less tissue trauma - tissue tract less suture material volume smaller knots - reduced bulk greater knot security encourages gentle handling ```

``` Rounghy what size suture should you use for: dogs cats delicate tissue tough tissue ```

DOG = 3 metric CAT = 2 metric Delicate tissue - reduce by 1-2 metric Tough tissue - increase by 0.5-1 metric

What suture size should you use for skin?

1.5-3 metric

What suture size should you use for s/c?

1.2-2 metric

What suture size should you use for fascia?

2-3.5 metric

What suture size should you use for muscle?

2-3 metric

What suture size should you use for viscera?

1-2 metric

What suture size should you use for tendon?

2-3.5 metric

What suture size should you use for vessel ligation - small?

1.5-2 metric

What suture size should you use for vessel ligation - large?

3-4 metric

What is a swaged needle?

a needle with no eye, having suture attached to a hollow end

What are the advantages of a swaged needle?

``` available for use immediately unlikely to detach suture material less handling of suture material less fraying of suture material less tissue trauma likely to be sharper guaranteed sterile greater range of needles available. ```

How are surgical needles classified?

SIZE (length, diameter) SHAPE (straight, curved, curved on straight, compound curve, j-shape) CURVE SHAPE (3/8 circle, 1/2 circle, 5/8 circle) POINT - NON-CUTTING (round bodied, taper point), CUTTING (taper cut, standard cutting, reverse cutting, side-cutting (spatula))

What are the features of a reverese cutting needle?

as sharp as cutting needle | the third cutting edge is located on the outer convex curvature of the needle.

What are the advantages of a cutting needle?

reverse cutting needles are stronger than cutting needle danger of tissue cutout is greatly reduced hole left by the needle leaves a wide wall of tissue against which the suture is to be tied

What are the considerations for a rational choice of surgical needle?

sharp enough to pass through tissue no change to tissue architecture needle resists bending/breakageTrue needle hole just big enough for suture Tissue characteristics - strength and friability Wound characteristics - depth and accessibility Surgeon's preference - hand versus instruments

What is least important when deciding most appropriate material? (initial tensile strength, tissue characteristics, handling ease, rate of tissue healing)

Ease of handling

True/False: knot security is better for monofilament material

False

True/False: use non-absorbable material in the creation of a permanent stoma

True

Why is multi-filament better than monofilament for ligating blood vessels?

Less physically irritant to tissues

Out of these options, when would you use (Polyglytone = synthetic absorbable, multifilament)? [closure of bladder/GIT/fascia/SC tissue}

closure of SC tissue

What is polyglecaprone (monocryl)?

synthetic absorbable monofilament (has high tensile strength)

What is the surgical advantage of having a suture material with a high tensile strength?

compared with weaker material, a smaller guage may be used.

Is polyglecaprone (monocryl) or polyamide (ethilon) easier to handle?

polyglecaprone (monocryl)

How long does it take visceral wounds to heal?

2-3 weeks