Sutures Flashcards

1
Q

Suture

A
  • a strand of material that is used to ligate blood vessels or approximate tissue
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2
Q

History of sutures/needles

A
  • traced back centuries
  • Egyptians documented using silk, cotton, horsehair, and animal tendons/intestines
  • needles have similar long history that has led to evolved designs
  • absorbable sutures introduced in the early 1970’s
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3
Q

What is the suture device composed of?

A

1) the suture strand
2) the surgical needle
3) the packaging material used to protect both of these

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4
Q

Suture packaging

A
  • non-absorbable sutures are placed in Tyvek packaging
  • absorbable sutures are packed in sealed foil (Hermetic seal) to maintain a sterile, gas/moisture resistant barrier
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5
Q

Suture Needle

A
  • supplied attached to the suture material, either through crimping to the end of the strand or using adhesive
  • different needle points: tapered (for tissues easy to penetrate like blood vessels), conventional cutting (penetrating tough tissue like skin), reverse cutting (reduced risk of cutting through tissue, eye surgery)
  • inert (stainless steel), slim and strong, sharp, balance of rigidness and ductility, and corrosion resistant
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6
Q

Suture materials

A
  • natural, synthetic, and metallic
  • suture size from 7 (largest) to 11-0 (smallest)
  • most are between 6 and 2
  • size 0 and smaller, the number of 0s in description increases as the diameter decreases (00 = 2-0)
  • use lowest size possible that still supports the wound, minimizing trauma and mass of foreign material left in the body
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7
Q

Synthetic suture fabrication

A
  • melt extruded or gel spun for fiber formation, then oriented (extrudate is heated and drawn to reduce fiber size and align chains)
  • mono- or braided multifilament
  • heat treated to anneal the material, then surface coated to increase lubricity, reduce capillarity (??), and maybe add antimicrobial agents
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8
Q

Monofilament vs. Braided multifilament

A
  • monofilament strands exhibit lower tissue drag
  • multifilament have more compliance and physical resilience to damage (but can also have void spaces that harbor bacteria)
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9
Q

Absorbable Natural Suture Material

A
  • surgical gut sutures derived from bovine intestines, based on collagen (formaldehyde treated, ground/polished, if treated with chromium salts increases functionality from 1-2 weeks to 2-3 weeks)
  • tend to fray at tie points, can be inconsistent in performance
  • long history of use and less costly
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10
Q

Non-adsorbable natural suture materials

A
  • silk: protein fiber derived from silkworm cocoon, braided to make thread and coated, not absorbable but does degrade
  • cotton: composed of cellulose, twisted multifilament with wax coating, not as strong and not absorbable
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11
Q

Non-adsorbable synthetic suture materials

A
  • polyester: PET (most common) and PBT, extruded multifilament fiber that is braided and coated
  • nylon: nylon 6 and 6,6 (slightly softer) are used with similar mechanical properties, either braided or monofilament, lose strength due to hydrolysis
  • polypropylene: isotactic for crystallization, low immune response, good for monofilament but hard to tie
  • UHMWP: very strong, crystalline, can use smaller diameters, gel spinning, inherent lubricity can cause creep/slippage
  • stainless steel: surgical procedures, very strong but prone to kinks
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12
Q

Absorbable synthetic suture materials

A
  • polymerized from hard/soft segment monomers
  • hard: PG, PL, p-dioxane are major constituents
  • soft: TMC, CI, PEG are minor constituents alter material properties
  • degrade by hydrolysis via ester groups
  • rate of degrading: glycolide > dioxane > lactide-based
  • PEG imparts degree of swellability
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13
Q

Coatings

A
  • primary purpose is to reduce tissue drag/prevent fraying
  • fill void spaces and can carry antimicrobial agents
  • silicone/PTFE based for non-adsorbable sutures
  • polyurethanes, PEG, caprolactone, lactide/glycolide copolymers for absorbable sutures
  • alternatives to sutures include staples, tapes, clips, sealants/adhesives
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