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Surgery I > Suture Materials and Suturing > Flashcards

Suture Materials and Suturing Flashcards

1
Q

Obj: Compare and Contrast common needle types

A
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2
Q

Obj: What scenario is appropriate for the different needle types

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3
Q

Obj: Compare and contrast the broad classifications of suture types

A
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4
Q

Obj: what scenarios are each of the sutures appropriate?

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5
Q

Obj: Compare/Contrast suture patterns

A
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6
Q

Obj: what are the appropriate scenarios for the different suture patterns

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7
Q

What are the uses of Suture?

A
  • Appose tissues that have been separated (intentionally/unintentionally)
  • Tightly constrict vascular pedicles or individual vessels to provide hemostasis or prevent anomalous blood flow
  • Permanently or temporarily secure a foreign implant to tissue/close an orifice
  • Permanently or temporarily mimic the function of a normal anatomic structure (ligament/tendon)
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8
Q

What is the difference between a Swaged and Non-swaged needles?

A
  • Swaged:
    • Designed for single use
    • minimizes tissue trauma
    • Required for ocular, vascular, urogenital, and intestinal surgery
  • Nonswaged:
    • Manually tread suture
    • Reusable
    • More tissue trauma
    • needles can become dull
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9
Q

What are the different shapes of needle? Their uses?

A
  • Straight needles
    • take very wide bites
    • typically only used in skin
    • placed by hand
  • Curved needles
    • most common
    • important measurements are fraction of a circle and needle diameter length
  • Other shapes - specific procedures
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10
Q

What are the different types of needle points?

A
  • Taper point
  • Reverse cutting
  • other - less common
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11
Q

What is a taperpoint needle, what is it used for?

A
  • Pierces tissue and then spreads it around the body of the needle
    • small needle hole for delicate tissues
  • More likely to dull
  • Ex: Ethicon SH or CT
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12
Q

What is a reverse cutting needle, what is it used for?

A
  • Triagnular shaped point cuts through thick tissues
    • creates a larger needle hole
  • Sharper needles for dense tissue (skin, tendon, periosteum)
  • Ex: Ethicon FS
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13
Q

What issues can suture cause?

A
  • Irritation
  • rejection
  • nidus of infection
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14
Q

What are the different suture sizes?

A
  • Large sutures - whole numbers
    • 1, 2, 3,….
  • Smaller sutures - #-0
    • 2-0, 3-0,…
    • NO 1-0
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15
Q

What are the most common suture sized for small animal medicine

A

between 3-0 and 2

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16
Q

What suture would be used on external skin sutures?

A
  • 3-0 dog
  • 4-0 cat
  • Monofilament nylon (Ethilon) on a reverse cutting needle
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17
Q

What type of suture is used for the subcuticular pattern?

A
  • 3-0 medium/large dog
  • 4-0 small dog/cat
  • Monocryl on a reverse cutting needle
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18
Q

What suture is used for the subcutaneous layer?

A
  • 3-0 or 4-0 Monocryl or PDS on a taper needle
    • Always use Monocryl on cats
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19
Q

What suture is used for body wall closure?

A
  • PDS on a taper needle
  • 1 for 25kg+
  • 0 for 11-25kg
  • 2-0 for dogs under 10kg and large cats
  • 3-0 for small cats with interrupted sutures
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20
Q

What suture is used for vessel ligations?

A
  • PDS on a taper needle
  • 2-0 PDS for average sized pedicles
  • 0 PDS for large fatty pedicles
  • 3-0 for most cats and small dogs
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21
Q

What is the difference between monofilament and multifilament?

A
  • Monofilament:
    • Less tissue drag and trauma
    • Worse knot security and handling
    • More easily damaged
  • Multifilament:
    • More tissue drag (can be coated to reduce)
    • Can harbor bacteria and wick fluids
    • Greater knot security and handling
    • Stronger in general
22
Q

What are the differences between absorbable and nonabsorbable suture?

A
  • Absorbable:
    • Degrades within a known period of time
      • typically less than 6 months for full degradation
      • Speed of degradation may be influenced by other factors (e.g. presence of enzymes)
    • More likely to cause a ‘suture reaction’
  • Non-absorbable:
    • Stay forever or break down very slowly
      • If they become infected they can act as a nidus and have to be removed
    • Typically less reactive
    • Used if suture must remain present forever, if animal has severely decreased haling or for external skin sutures
23
Q

What are the Absorbable sutures?

A
  • Catgut and chromic gut
  • Monocryl (poliglecaprone 25) / Biosyn (Glycomer 631)
  • Caprosyn (polyglytone)
  • Vicryl (polyglactin 910) / Dexon (polyglycolic acid) / Polysorb (lactomer)
  • PDS (polydioxanone) / Maxon (polyglyconate)
24
Q

What is Catgut / Chromic gut? Pros / Cons?

A
  • Made from bovine or ovine intestines
  • Chromium salts added to decrease inflammation and delay absorption
  • Absorbed by enzymatic degradation
    • Highly unpredictable
    • Loss of strength in 2-3 weeks
    • Loss of strength may be < 24 hours in GI or Urinary surgery
  • Use in rapidly healing tissues that don’t need support
25
Q

What is Monocryl? Pros / Cons?

A
  • Synthetic, monofilament, rapidly absorbable
  • High initial strength
  • Good knot security
  • Good for use in urinary bladder, subcutaneous tissue and for subcuticular pattern
  • Lose 50% of strength by ~2weeks; fully absorbed in 3-4 months
  • Use for tissue that does not need long lasting sutures
26
Q

What is Caprosyn? Pros / Cons?

A
  • Synthetic, monofilament, very rapidly absorbable
  • All strength lost in 2-3 weeks; fully absorbed by 2 months
  • one of the MOST rapidly absorbable sutures available
27
Q

What is Vicryl? Pros / Cons?

A
  • Synthetic, multifilament, rapidly absorbable
  • Excellent suture handling
  • Good knot security
  • Lose ≥50% of strength by 2-3 weeks; fully absorbed in 1 month (Vicryl/polysorb) to 3 months (Dexon)
  • Vicryl Rapide absorbed in 42 days
  • Soft/non-irritating - use in the mouth/mucous membranes
  • Do not use in infected areas, GI tract, or urogenital tract
28
Q

What is PDS? Pros / Cons?

A
  • Synthetic, monofilament, ‘prolonged’ absorbable
  • Worse knot security than other absorbable sutures
  • Implicated in suture reactions
  • Lose ≥50% strength by 5 weeks; fully absorbed in 6 months
  • Use in tissues with slower healing (body wall, tendons/fascia, GI tract) or patients with delayed wound healing
29
Q

When are nonabsorbable sutures used?

A
  • Use when long lasting effects are desired
    • severe immunocompromise
    • suture must remain forever (e.g. PDA, perineal hernia repair)
  • Less reactive than absorbable suture
    • use as skin sutures
  • Can be monofilament or multifilament synthetic or natural
30
Q

What is silk suture? Pros / Cons?

A
  • Natural, braided suture
  • Will degrade over ~2 years
  • Excellent suture handling and knot security
  • Will cause inflammatory response
  • Used for PDA ligation
31
Q

What is Nylon? Pros / Cons?

A
  • Synthetic, multifilament or monofilament
  • Extremely strong suture
  • lose 50% strength over 12 weeks in acidic environment
  • Often used for skin sutures/lateral fabellar suture
  • Multifilament has some tissue reactivity
    • monofilament doesn’t
32
Q

What is Polymerized caprolactum?

A
  • Synthetic, multifilament
  • ONLY for skin
  • Causes intense inflammatory reaction in deeper tissues
33
Q

What is Polpropylene? Pros / Cons?

A
  • Synthetic, monofilament
  • Strongest (non metal) suture but poor knot security
  • Less desirable handling characteristics than most other sutures
  • Very low tissue reactivity - little chance of suture reaction
  • Essentially never absorbs
  • Used in skin or can be implanted in deep tissues
34
Q

What is Polyester? Pros / Cons?

A
  • Synthetic, braided or monofilament
  • numerous different compounds often used in orthopedic polyblend materials (e.g. FiberWire)
  • Average knot security and moderate tissue reactivity
35
Q

What is Stainless steel suture? pros / cons?

A
  • Synthetic, monofilament or multifilament
  • Extremely strong with high knot security
  • Terrible suture handling
  • Very low tissue reactivity and never absorbs
  • Usually used to appose cat bone ends (sternum / pubis)
36
Q

What are the types of nonabsorbable suture?

A
  • Silk
  • Nylon (Ethilon / surgilon)
  • Polymerized caprolactum (Vetafil)
  • Polpropylene (Prolene / Surgipro)
  • Polyester (Ethibond / Novafil)
  • Stainless steel
37
Q

What are some alternatives to suture? uses?

A
  • Staplers
    • Variety of types with different uses
    • Skin staples are fast to place, but must be removed
  • Stainless steel clips
    • rapidly seal vessels
  • Electrosurgical devices
    • cauterize and/or cut tissue
38
Q

What are some surgical knots?

A
  • Overhand knot
  • Surgeons throw
  • Square knot
  • Granny knot
  • Slip Knot
39
Q

What is a overhand knot?

A
  • A single twist of the suture around itself
  • NOT secure by itself -
    • forms the foundation for numerous types of knots
    • a “throw”
40
Q

What is a Surgeons knot?

A
  • double twist of suture around itself
  • Can oppose mild tension
  • Bulkier
  • not secure by itself
41
Q

What is a Square Knot?

A
  • “Reef Knot”
  • Most commonly used
  • 2 overhand knots that alternate direction
  • Most ‘knots’ consist of at least 2 square knots (4 ‘throws’)
42
Q

What is a Square Knot?

A
  • “Reef Knot”
  • Most commonly used
  • 2 overhand knots that alternate direction
  • Most ‘knots’ consist of at least 2 square knots (4 ‘throws’)
43
Q

What is a Granny knot?

A
  • Mistake
  • 2 overhand knots that don’t alternate direction
    • since crossings are opposite, a granny knot results in a twist that makes your knot crooked and that comes undone more easily
  • Less secure than square knot
44
Q

What is a Slip knot?

A
  • A square knot with uneven tension on the two strands
  • Not secure by itself
  • Usually a mistake
  • Can be used intentionally but must be followed by square knots
45
Q

What are the types of suture patterns?

A
  • Number of knots tied
    • Interrupted
    • Continuous
  • Effect of Tissue
    • Appositional
    • Inverting
    • Everting
46
Q

What is an Interrupted pattern? Pros/ Cons? types?

A
  • Suture is tied and cut after every few bites into tissue
    • More secure, better for areas with tension
    • More time consuming
    • Uses more suture
  • Types:
    • Simple interrupted
    • Cruciate mattress
    • Vertical mattress
    • Horizontal mattress
    • Lembert
47
Q

What is a Continuous pattern? Pros / Cons? types?

A
  • Suture is tied at the beginning and ending of the incision only
    • faster to perform and uses less suture
    • Less secure
  • Types:
    • simple continuous
    • Ford interlocking
    • horizontal mattress
    • Lembert
    • Cushing / Connell
    • Utrecht
48
Q

What are appositional suture patterns? uses? types?

A
  • Brings the edges of the tissue together
  • Commonly used, especially on skin and body wall
  • Types:
    • Simple interrupted
    • Simple continuous
    • Cruciate mattress
    • Ford interlocking
49
Q

What are Inverting patterns? uses? types?

A
  • Pushes the cut edges inward, away from the surgeon
    • sometimes used on luminal organs (e.g. GI tract, bladder)
  • Types:
    • Lembert
    • Cushing
    • Connel
    • Utrecht
50
Q

What are Everting Patterns? uses? types?

A
  • Pulls the cut edges outward, toward the surgeon
    • used on reptile skin to evert scales
  • Types:
    • Horizontal mattress
    • Vertical Mattress
51
Q

Which suture pattern has more than one effect?

A
  • Vertical mattress
    • everts with moderate tension
    • appositional with less
52
Q

What are the general rules for suturing skin?

A
  • If it is buried in the tissue - use absorbable
  • If it is an external suture that WILL be removed - use non-absorbable
  • Use smallest size that provides the strength needed
  • Minimize the amount of suture left in the wound, but make sure to prioritize closing dead space
    • less layers, less knots
  • Use a pattern adequate to relieve tension
    • interrupted better than continuous
  • Appose the tissue edges

Surgery I (37 decks)

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