Suture Materials and Suturing Flashcards
1
Q
Obj: Compare and Contrast common needle types
A
2
Q
Obj: What scenario is appropriate for the different needle types
A
3
Q
Obj: Compare and contrast the broad classifications of suture types
A
4
Q
Obj: what scenarios are each of the sutures appropriate?
A
5
Q
Obj: Compare/Contrast suture patterns
A
6
Q
Obj: what are the appropriate scenarios for the different suture patterns
A
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)
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
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
10
Q
What are the different types of needle points?
A
- Taper point
- Reverse cutting
- other - less common
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
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
13
Q
What issues can suture cause?
A
- Irritation
- rejection
- nidus of infection
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
15
Q
What are the most common suture sized for small animal medicine
A
between 3-0 and 2
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
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
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
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
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
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’
- Degrades within a known period of time
- 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
- Stay forever or break down very slowly
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
What is Monocryl? Pros / Cons?
* 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
What is Caprosyn? Pros / Cons?
* 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
What is Vicryl? Pros / Cons?
* 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
What is PDS? Pros / Cons?
* 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
When are nonabsorbable sutures used?
* 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
What is silk suture? Pros / Cons?
* Natural, braided suture
* Will degrade over ~2 years
* Excellent suture handling and knot security
* Will cause inflammatory response
* Used for PDA ligation
31
What is Nylon? Pros / Cons?
* 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
What is Polymerized caprolactum?
* Synthetic, multifilament
* ONLY for skin
* Causes intense inflammatory reaction in deeper tissues
33
What is Polpropylene? Pros / Cons?
* 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
What is Polyester? Pros / Cons?
* Synthetic, braided or monofilament
* numerous different compounds often used in orthopedic polyblend materials (e.g. FiberWire)
* Average knot security and moderate tissue reactivity
35
What is Stainless steel suture? pros / cons?
* 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
What are the types of nonabsorbable suture?
* Silk
* Nylon (Ethilon / surgilon)
* Polymerized caprolactum (Vetafil)
* Polpropylene (Prolene / Surgipro)
* Polyester (Ethibond / Novafil)
* Stainless steel
37
What are some alternatives to suture? uses?
* 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
What are some surgical knots?
* Overhand knot
* Surgeons throw
* Square knot
* Granny knot
* Slip Knot
39
What is a overhand knot?
* A single twist of the suture around itself
* NOT secure by itself -
* forms the foundation for numerous types of knots
* a “throw”
40
What is a Surgeons knot?
* double twist of suture around itself
* Can oppose mild tension
* Bulkier
* not secure by itself
41
What is a Square Knot?
* “Reef Knot”
* Most commonly used
* 2 overhand knots that alternate direction
* Most ‘knots’ consist of at least 2 square knots (4 ‘throws’)
42
What is a Square Knot?
* “Reef Knot”
* Most commonly used
* 2 overhand knots that alternate direction
* Most ‘knots’ consist of at least 2 square knots (4 ‘throws’)
43
What is a Granny knot?
* 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
What is a Slip knot?
* 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
What are the types of suture patterns?
* Number of knots tied
* Interrupted
* Continuous
* Effect of Tissue
* Appositional
* Inverting
* Everting
46
What is an Interrupted pattern? Pros/ Cons? types?
* 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
What is a Continuous pattern? Pros / Cons? types?
* 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
What are appositional suture patterns? uses? types?
* 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
What are Inverting patterns? uses? types?
* 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
What are Everting Patterns? uses? types?
* Pulls the cut edges outward, toward the surgeon
* used on reptile skin to evert scales
* Types:
* Horizontal mattress
* Vertical Mattress
51
Which suture pattern has more than one effect?
* Vertical mattress
* everts with moderate tension
* appositional with less
52
What are the general rules for suturing skin?
* 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
