Suture Materials and Needles Flashcards
what does suturing do
provide homeostasis
supports wound healing
ideal suture
easy to handle
minimally react in tissue
inhibit bacteria growth
secure hold when knotted
resist shrinking in tissue
absorb with minimal reaction
tensile strength
time it takes suture material to lose 70-80% of initial strength
measures ability of material to resist breakage or deformation
exponentially proportional to size
pliability and flexibility
depends on material and size of suture
ease when the suture material is handled
more flexibility good for vessel ligation
memory
tendency of suture material to return to original shape
monofilament has mor memory than multifilament
surface friction
relates to roughness of outer surface
rough sutures cause more injury than smooth sutures
tissue drag
part of surface friction
ease when the suture is pulled through tissue
braided suture has more drag than monofilament suture
knot security
ability of suture to hold a knot
inversely proportional to suture size
capillarity
process by which fluid and bacteria are carried into interstices of multifilament fibers
monofilament are non capillary
braided sutures have capillarity
do not use multifilament suture in infected/contaminated tissues
tissue reactivity
degree to which body reacts to presence of suture material
natural fibers much more reactive than synthetic suture
multifilament more reactive than monofilament
fiber origin– natural vs synthetic
natural – biological sources (ex silk)
synthetic – man made (ex nylon)
structure – monofilament vs multifilament
monofilament – harder to handle, more memory
multifilament – more tissue drag, harbor bacteria
behavior in tissues
absorbable vs non absorbable
what are “plus” sutures
antimicrobial
non absorbable multifilament
silk
polyester
absorbable multifilament
polyglactin 910
catgut
non absorbable monofilament
polypropylene
nylon
absorbable monofilament
poliglecaprone 25
does loss of tensile strength determine rate of absorption
no
nonabsorbable suture and tensile strength
maintains >50% of tensile strength for greater than 60 days
absorbable suture and tensile strength
loses >50% of tensile strength in less than 60 days
absorption of natural fibers
causes more reaction
enzymatic digestion
rate of absorption increases with presence of infection and inflammation
absorption of syntehtic fibers
hydrolysis
water molecuels penetrate suture material casuing breakdown of polymer chain
less tissue reaction than enzymatic digestion
what does suture duration include
loss of tensile strength (loss of suture strength)
absorption
surgical gut (chromic gut, cat gut)
absorbable
natural
absorbed by enzymatic digestion, phagocytosis
multifilament
not frequently used in practices
sheep intestine submucosa, bovine serosa
marked inflammatory reaction
uses of surgical gut
vascular pedicle ligation
what is the most reactive suture material
what has the most severe reaction in cats
surgical gut
polyglactin 910 – vicryl
absorbable
syntehtic
braided, multifilament
more drag, less memory
can get monofilament in 9-0 and 10-0
minimal tissue reactivity
25% sterngth lost by day 14
completely absorbed by 60-70 days
uses of polyglactin 910 – vicryl
soft tissue approximation
hollow organs
ophthalmic procedures
subcutaneous tissues
polyglactin – vicryl rapide
absorbable
synthetic
braided, multifilament
minimal tissue reactivity
50% strength lost by day 5-6, almost 100% by day 14
completely absorbed by 42 days
uses of polyglactin – vicryl rapide
skin and mucosa
perineal repair
lacerations
mucosa in oral cavity
periocular skin
skin repairs where rapid absorption beneficial
polyglactin – vicryl rapide – why is it absorbed faster
exposed to radiation (cobalt 60) to increase rate of absorption
polyglactin – vicryl plus
absorbable
syntehtic
braided, multifilament
minimal tissue reactivity
completely absorbed by 56-70 days
uses of polyglactin – vicryl plus
contaminated and infected sites
reproductive tract
ligation
general closure
bowel
orthopedic proceedures
polyglactin – vicryl plus – what makes it plus
coated with triclosan (broad spectrum antibacterial agent) to reduce bacterial growth at suture line
polydioxanone
absorbable
PDS II vs PDS plus
syntehtic
monofilament
minimal tissue reactivity
completely absorbed at 180 days
uses of polydioxanone
soft tissue approximation
fascia closure
blood vessel anastomosis
orthopedics
tissues that require longer term strength (linea alba, bladder)
poliglecaprone 25
absorbable
monocryl vs monocryl plus
synthetic
monofilament
minimal tissue reactivity
high tensile strength
70-80% strength lost at 14 days
complete absorption at 100 days
uses of poliglecaprone 25
soft tissue approximation
ligations
skin repairs
bowel
peritoneum
uterus
vaginal cuff
subcutaneous
silk
nonabsorbable
natural
braided, multifilament
harvested from cocoon of silkworm
moderate tissue inflammatory reaction
reactivity of silk
most reactive of nonabsorbable material
potential nidus for calculus formation (bladder or gallbladder stone formation)
nidus – spot that bacteria can multiply or that stones can stay and form
uses of silk
vessel ligation
cardiovascular procedures
ophthalmic procedures
neurological procedures
amputations (wouldn’t use for amputations though)
nylon (polyaminde)
non absorbable
ethilon
synthetic
monofilament
minimal tissue reaction
minimal break down
uses on nylon (polyamide)
soft tissue approximation
ophthalmic procedures
ligation
polyester
non absorbable
mersilene
synthetic
multifilament +/- coating (to decrease drag)
monofilament in 10-0 and 11-0
strongest non metallic suture material
intermediate reaction (most reactive on syntehtics)
uses of polyester
stabilizing unstable joints
polypropylene
non absorbable
prolene
synthetic
monofilament
high memory
least reactive nonabsorbable
uses of polypropylene
vascular surgeries
neurological procedures
tendon repairs
stainless steel
non absorbable
metallic
monofilament or multifilament
monofilament most common
high tensile strength
hard to handle
uses of stainless steel
orthopedics
sternotomy repair
hernia repair
sizing of needles
12-0 – smallest
7 – largest
why do you need to choose correct size
prevent wound dehiscence
promote wound healing
which size causes more tissue reaction and delayed healing
larger sizes
suture sizes and throws
larger sizes require more throws
what can cause suture site infection
suture reaction
multifilamnet > coated multifilament > monofilament
what is wicking
fluid and bacteria carried into interstices of multifilament fibers – can lead to infection
capillarity
what is dehiscence
failure of sutures to hold incision closed
causes of dehisence
too small suture used
apposition of unlike tissues
sutures too tight
too much tension on sutures
poor suture technique
seroma
increased dead space
description of suture needles
stainless steel wire
swaged onto suture
varying parts of a circle
with suture neeldes what in trauma proportional to
diameter
tapered needles
minimal trauma
must curve wrist to follow needle
cutting needles
facilitates tough tissue penetration
cutting edge on concave surface
reverse cutting edge on convex surface
what to think of when selecting needle
diameter
depth of wound
1/4 circle
ophthalmic surgery
1/2 circle
many tissue types and procedures
3/8 circle
skin and superficial tissue
5/8 circle
confined locations or deep tissues
1/2 curve
rarely used
straight
typically hand held
used in easily accessible areas
closed vs french
taperpoint
sharp tip
pierces and spreads tissue without cutting
intestine, submucosa, fascia
tapercut
combination of reverse cutting and taperpoint
heavy thick fascia, tendons
cutting
cutting edge on concave portion of needle
tends to cut out of tissue
reverse cutting
cutting on convex edge surface
reduces risk of tissue being cut out
skin
spatula point
flat on top and bottom
ophthalmic procedures
blunt point
dissects through friable tissues without cutting
soft parenchymal organs like liver and kidneys
tissue glue
cyanoacrylates
tissue glue
cyanoacrylates
sets in < 1 minute – delayed if area wet
close short skin incisions and lacerations (< 5cm)
disadvantages of tissue glue
can delay healing
cause tissue reaction
granuloma formation
may promote wound infection
what do you never use tissue glue on
bite wounds or other heavily contaminated wounds
puncture or deep wounds
lacerations > 5cm
mucous membranes
near the eye
in subcutaneous tissues
skin staplers
rectangular shaped staples
skin apposition
apply skin staples perpendicular to incision
first align and apposition edges with thumb forceps
moderate pressure needed
staples should be 5-6 mm apart
advantages of skin staples
rapid application (can take time to figure out correct pressure)
disadvantages of skin staples
cost
eversion – if placed incorrectly
rotation – if placed incorrectly
single use
time saved in placement is lost in removal
thoracoabdominal (TA) stapler
2-3 parallel rows of B shaped staples
lung or liver lobe resection
partial splenectomy
partial gastrectomy
gastrointestinal anastomosis (GA) stapler
4-6 rows of B shaped staples and cuts in the middle
creates side to side anastomosis
end to end anastomosis (EEA) stapler
creates circular end to end anastomosis
intestinal anastomosis
skin surgical closure
use non absorbable (unless doing intradermal, then use absorbable)
minimal tissue reactivity
suture – nylon, polyrpopylene, monocryl (absorbable)
size – 4-0 to 2-0 depending on patient
tension patterns – horizontal mattress, vertical mattress, cruciate, near far patterns
no tension patterns – simple interrupted, simple continuous, +/- cruciate, intradermal, ford interlocking
subcutaneous surgical closure
rapidly absorbable suture – minimal tissue reactivity
suture – monocryl, vicryl, PDS
size – 4-0, 3-0, +/- 2-0
simple continuous, simple interrupted
body wall and fascia surgical closure
slowly absorbable - high tensile strength
external rectus sheath is holding layer
don’t want to go through entire muscle, just external rectus sheath (difficult in cats)
good knot security
suture – PDS
size – 3-0 to 0
simple interrupted, simple continuous, cruciate
stomach surgical closure
slowly absorbable
low tissue reactivity
good tensile strength
good knot security
suture – PDS, monocryl
size – 4-0 to 3-0, +/- 2-0
simple continuous, lambert, halstead, connell, cushing
small intestine surgical closure
slowly absorbable
low tissue reactivity
good knot security
suture – PDS, monocryl
size – 4-0 +/- 3-0
simple interrupted, simple continuous, gambee
urinary bladder surgical closure
rapidly absorbable
low tissue reactivity
good tensile strength
good knot security
suture – monocryl, PDS
size – 4-0 and 3-0
simple continuous, cushing
colon surgical closure
slowly absorbable
low tissue reactivity
good knot security
suture – PDS
size – 4-0 +/- 3-0
simple interrupted, simple continuous sometimes used
vessel and pedicle ligations
slowly absorbable
good knot security
good tensile strength
suture – PDS
size – 3-0 to 0 for pedicle, 4-0 to 3-0 for vessel
knots – square, modified millers, surgeons
friction knots stay tighter (millers, modified millers)
tendons and ligaments surgical closure
nonabsorbable
good tensile strength
good knot security
suture – nylon
size – 3-0 to 1
bird and reptile skin
tend to invert – everting patterns recommended
oral mucosa in dogs and cats
tend to invert – everting patterns recommended
larger hollow organs with aggressive eversion of mucosa (stomach, uterus)
inverting or modified gambee patterns recommended
one layer or two layer closure?
one layer preferred
two layer acceptable for hollow organ repair
one layer or two layer closure – bladder and stomach
double layer commonly seen
two layer closure have disadvantage of compromising lumen, large cuff (source for bleeding and irritation)
one layer or two layer – small lumen organs
one layer closure
