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Surgery Exam 2 > Suture Materials and Needles > Flashcards

Suture Materials and Needles Flashcards

1
Q

what does suturing do

A

provide homeostasis
supports wound healing

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2
Q

ideal suture

A

easy to handle
minimally react in tissue
inhibit bacteria growth
secure hold when knotted
resist shrinking in tissue
absorb with minimal reaction

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3
Q

tensile strength

A

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

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4
Q

pliability and flexibility

A

depends on material and size of suture
ease when the suture material is handled
more flexibility good for vessel ligation

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5
Q

memory

A

tendency of suture material to return to original shape
monofilament has mor memory than multifilament

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6
Q

surface friction

A

relates to roughness of outer surface
rough sutures cause more injury than smooth sutures

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7
Q

tissue drag

A

part of surface friction
ease when the suture is pulled through tissue
braided suture has more drag than monofilament suture

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8
Q

knot security

A

ability of suture to hold a knot
inversely proportional to suture size

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9
Q

capillarity

A

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

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10
Q

tissue reactivity

A

degree to which body reacts to presence of suture material
natural fibers much more reactive than synthetic suture
multifilament more reactive than monofilament

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11
Q

fiber origin– natural vs synthetic

A

natural – biological sources (ex silk)
synthetic – man made (ex nylon)

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12
Q

structure – monofilament vs multifilament

A

monofilament – harder to handle, more memory
multifilament – more tissue drag, harbor bacteria

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13
Q

behavior in tissues

A

absorbable vs non absorbable

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14
Q

what are “plus” sutures

A

antimicrobial

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15
Q

non absorbable multifilament

A

silk
polyester

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16
Q

absorbable multifilament

A

polyglactin 910
catgut

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17
Q

non absorbable monofilament

A

polypropylene
nylon

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18
Q

absorbable monofilament

A

poliglecaprone 25

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19
Q

does loss of tensile strength determine rate of absorption

A

no

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20
Q

nonabsorbable suture and tensile strength

A

maintains >50% of tensile strength for greater than 60 days

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21
Q

absorbable suture and tensile strength

A

loses >50% of tensile strength in less than 60 days

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22
Q

absorption of natural fibers

A

causes more reaction
enzymatic digestion
rate of absorption increases with presence of infection and inflammation

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23
Q

absorption of syntehtic fibers

A

hydrolysis
water molecuels penetrate suture material casuing breakdown of polymer chain
less tissue reaction than enzymatic digestion

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24
Q

what does suture duration include

A

loss of tensile strength (loss of suture strength)
absorption

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25
Q

surgical gut (chromic gut, cat gut)

A

absorbable
natural
absorbed by enzymatic digestion, phagocytosis
multifilament
not frequently used in practices
sheep intestine submucosa, bovine serosa
marked inflammatory reaction

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26
Q

uses of surgical gut

A

vascular pedicle ligation

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27
Q

what is the most reactive suture material
what has the most severe reaction in cats

A

surgical gut

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28
Q

polyglactin 910 – vicryl

A

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

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29
Q

uses of polyglactin 910 – vicryl

A

soft tissue approximation
hollow organs
ophthalmic procedures
subcutaneous tissues

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30
Q

polyglactin – vicryl rapide

A

absorbable
synthetic
braided, multifilament
minimal tissue reactivity
50% strength lost by day 5-6, almost 100% by day 14
completely absorbed by 42 days

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31
Q

uses of polyglactin – vicryl rapide

A

skin and mucosa
perineal repair
lacerations
mucosa in oral cavity
periocular skin
skin repairs where rapid absorption beneficial

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32
Q

polyglactin – vicryl rapide – why is it absorbed faster

A

exposed to radiation (cobalt 60) to increase rate of absorption

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33
Q

polyglactin – vicryl plus

A

absorbable
syntehtic
braided, multifilament
minimal tissue reactivity
completely absorbed by 56-70 days

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34
Q

uses of polyglactin – vicryl plus

A

contaminated and infected sites
reproductive tract
ligation
general closure
bowel
orthopedic proceedures

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35
Q

polyglactin – vicryl plus – what makes it plus

A

coated with triclosan (broad spectrum antibacterial agent) to reduce bacterial growth at suture line

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36
Q

polydioxanone

A

absorbable
PDS II vs PDS plus
syntehtic
monofilament
minimal tissue reactivity
completely absorbed at 180 days

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37
Q

uses of polydioxanone

A

soft tissue approximation
fascia closure
blood vessel anastomosis
orthopedics
tissues that require longer term strength (linea alba, bladder)

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38
Q

poliglecaprone 25

A

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

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39
Q

uses of poliglecaprone 25

A

soft tissue approximation
ligations
skin repairs
bowel
peritoneum
uterus
vaginal cuff
subcutaneous

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40
Q

silk

A

nonabsorbable
natural
braided, multifilament
harvested from cocoon of silkworm
moderate tissue inflammatory reaction

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41
Q

reactivity of silk

A

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

42
Q

uses of silk

A

vessel ligation
cardiovascular procedures
ophthalmic procedures
neurological procedures
amputations (wouldn’t use for amputations though)

43
Q

nylon (polyaminde)

A

non absorbable
ethilon
synthetic
monofilament
minimal tissue reaction
minimal break down

44
Q

uses on nylon (polyamide)

A

soft tissue approximation
ophthalmic procedures
ligation

45
Q

polyester

A

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)

46
Q

uses of polyester

A

stabilizing unstable joints

47
Q

polypropylene

A

non absorbable
prolene
synthetic
monofilament
high memory
least reactive nonabsorbable

48
Q

uses of polypropylene

A

vascular surgeries
neurological procedures
tendon repairs

49
Q

stainless steel

A

non absorbable
metallic
monofilament or multifilament
monofilament most common
high tensile strength
hard to handle

50
Q

uses of stainless steel

A

orthopedics
sternotomy repair
hernia repair

51
Q

sizing of needles

A

12-0 – smallest
7 – largest

52
Q

why do you need to choose correct size

A

prevent wound dehiscence
promote wound healing

53
Q

which size causes more tissue reaction and delayed healing

A

larger sizes

54
Q

suture sizes and throws

A

larger sizes require more throws

55
Q

what can cause suture site infection

A

suture reaction
multifilamnet > coated multifilament > monofilament

56
Q

what is wicking

A

fluid and bacteria carried into interstices of multifilament fibers – can lead to infection
capillarity

57
Q

what is dehiscence

A

failure of sutures to hold incision closed

58
Q

causes of dehisence

A

too small suture used
apposition of unlike tissues
sutures too tight
too much tension on sutures
poor suture technique

59
Q

seroma

A

increased dead space

60
Q

description of suture needles

A

stainless steel wire
swaged onto suture
varying parts of a circle

61
Q

with suture neeldes what in trauma proportional to

A

diameter

62
Q

tapered needles

A

minimal trauma
must curve wrist to follow needle

63
Q

cutting needles

A

facilitates tough tissue penetration
cutting edge on concave surface
reverse cutting edge on convex surface

64
Q

what to think of when selecting needle

A

diameter
depth of wound

65
Q

1/4 circle

A

ophthalmic surgery

66
Q

1/2 circle

A

many tissue types and procedures

67
Q

3/8 circle

A

skin and superficial tissue

68
Q

5/8 circle

A

confined locations or deep tissues

69
Q

1/2 curve

A

rarely used

70
Q

straight

A

typically hand held
used in easily accessible areas

71
Q

closed vs french

A
72
Q

taperpoint

A

sharp tip
pierces and spreads tissue without cutting
intestine, submucosa, fascia

73
Q

tapercut

A

combination of reverse cutting and taperpoint
heavy thick fascia, tendons

74
Q

cutting

A

cutting edge on concave portion of needle
tends to cut out of tissue

75
Q

reverse cutting

A

cutting on convex edge surface
reduces risk of tissue being cut out
skin

76
Q

spatula point

A

flat on top and bottom
ophthalmic procedures

77
Q

blunt point

A

dissects through friable tissues without cutting
soft parenchymal organs like liver and kidneys

78
Q

tissue glue

A

cyanoacrylates

79
Q

tissue glue

A

cyanoacrylates
sets in < 1 minute – delayed if area wet
close short skin incisions and lacerations (< 5cm)

80
Q

disadvantages of tissue glue

A

can delay healing
cause tissue reaction
granuloma formation
may promote wound infection

81
Q

what do you never use tissue glue on

A

bite wounds or other heavily contaminated wounds
puncture or deep wounds
lacerations > 5cm
mucous membranes
near the eye
in subcutaneous tissues

82
Q

skin staplers

A

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

83
Q

advantages of skin staples

A

rapid application (can take time to figure out correct pressure)

84
Q

disadvantages of skin staples

A

cost
eversion – if placed incorrectly
rotation – if placed incorrectly
single use
time saved in placement is lost in removal

85
Q

thoracoabdominal (TA) stapler

A

2-3 parallel rows of B shaped staples
lung or liver lobe resection
partial splenectomy
partial gastrectomy

86
Q

gastrointestinal anastomosis (GA) stapler

A

4-6 rows of B shaped staples and cuts in the middle
creates side to side anastomosis

87
Q

end to end anastomosis (EEA) stapler

A

creates circular end to end anastomosis
intestinal anastomosis

88
Q

skin surgical closure

A

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

89
Q

subcutaneous surgical closure

A

rapidly absorbable suture – minimal tissue reactivity
suture – monocryl, vicryl, PDS
size – 4-0, 3-0, +/- 2-0
simple continuous, simple interrupted

90
Q

body wall and fascia surgical closure

A

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

91
Q

stomach surgical closure

A

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

92
Q

small intestine surgical closure

A

slowly absorbable
low tissue reactivity
good knot security
suture – PDS, monocryl
size – 4-0 +/- 3-0
simple interrupted, simple continuous, gambee

93
Q

urinary bladder surgical closure

A

rapidly absorbable
low tissue reactivity
good tensile strength
good knot security
suture – monocryl, PDS
size – 4-0 and 3-0
simple continuous, cushing

94
Q

colon surgical closure

A

slowly absorbable
low tissue reactivity
good knot security
suture – PDS
size – 4-0 +/- 3-0
simple interrupted, simple continuous sometimes used

95
Q

vessel and pedicle ligations

A

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)

96
Q

tendons and ligaments surgical closure

A

nonabsorbable
good tensile strength
good knot security
suture – nylon
size – 3-0 to 1

97
Q

bird and reptile skin

A

tend to invert – everting patterns recommended

98
Q

oral mucosa in dogs and cats

A

tend to invert – everting patterns recommended

99
Q

larger hollow organs with aggressive eversion of mucosa (stomach, uterus)

A

inverting or modified gambee patterns recommended

100
Q

one layer or two layer closure?

A

one layer preferred
two layer acceptable for hollow organ repair

101
Q

one layer or two layer closure – bladder and stomach

A

double layer commonly seen
two layer closure have disadvantage of compromising lumen, large cuff (source for bleeding and irritation)

102
Q

one layer or two layer – small lumen organs

A

one layer closure

Surgery Exam 2 (6 decks)

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