Sutures

Question 1

Generic name - Brand Name - 50 % reduction of tensile strength - complete absorption

Answer 1

Polygractin 910 - Vicryl - 21 days - 70 days
Poliglecaprone 25 - Monocryl - 7 days - 120 days
Polydioxanone - PDS - 30 days - 180 days

Question 2

Recommended suture material type, size and needle for closure of subcutaneous and subcuticular layers

Answer 2

A 3-0 or 4-0 absorbable suture (e.g., polyglyconate, polydioxanone, poliglecaprone 25, glycomer 631, polyglactin 910) with a swaged taper point needle should be used to close subcutaneous and subcuticular tissue.

Question 3

Recommended suture type, size and needle for closure of skin layers

Answer 3

A 3-0 or 4-0 monofilament, nonabsorbable suture (e.g., nylon, polypropylene, polybutester) with a reverse cutting needle is preferred for most skin sutures.

Question 4

Briefly discuss the effect of closing a wound with simple interrupted versus simple continuous suture patterns as well as a tightly versus loosely approximated wound

Answer 4

Wounds closed with interrupted sutures have less edema, improved microcirculation, and higher initial tensile strength, whereas continuous suture patterns allow for faster wound closure, less use of suture material, and create a better seal across the incision line. Suture tension should just appose edges, as loosely approximated wounds are stronger during the first 21 days.

Question 5

Discuss the use of Tissumend II sterile in the closure of wounds and how it compares to traditional cyanoacrylate skin glu (Vetbond, Liquivet, GLUture)

Answer 5

An absorbable, sterile, methoxypropyl cyanoacrylate tissue adhesive is available (Tissumend II Sterile). It may be used externally and internally, with trials having been performed on lung, liver, spleen, kidney, and cornea. It has hemostatic properties, enhances healing, is nonreactive, and absorbs via hydrolysis in 60 to 90 days.

Of the nonabsorbable tissue adhesives, N-butyl or isobutyl-2 cyanoacrylates (e.g., Vetbond, LiquiVet, GLUture) are preferred over propyl or methyl cyanoacrylates as they are less toxic. These adhesives should not be placed within the wound or incision but rather over the apposed surface to prevent foreign body reactions.

Question 6

Under what conditions can passive drains (penrose) be applied to a surgical wound?

Answer 6

Only if the drain and the wound can be covered by a sterile absorbent dressing