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
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