Sutures

Question 1

How are natural vs synthetic sutures absorbed/broken down?

Answer 1

Natural = proteolysis (inflammatory rxn and rapid degradation)

Synthetic = Hydrolysis (Less inflammation and more slowly degraded)

Question 2

What are the advantages of a monofilament suture?

Answer 2

Slides more easily through tissue, harbor fewer bacteria, and low-minimal inflammatory rxn

Question 3

What are some disadvantages of monofilament sutures?

Answer 3

Decreased knot security (increased memory and lower coefficient of friction); poor “ease of handling” because of decreased pliability and increased memory

Question 4

What are some advantages of multifilament suture?

Answer 4

Increased ease of handling, increased strength, and increased knot security

Question 5

What are some disadvantages of multifilament suture?

Answer 5

Increased risk of bacterial infection (2/2 increased capillarity), and increased inflammatory response

Question 6

What are capillarity and what types of sutures have higher capillarity?

Answer 6

The ability of a suture to wick moisture/fluid from the wound surface to inside the wound

Increased capillarity in multifilament/braided suture

Question 7

How does the strength of the suture affect the size (USP size)?

Answer 7

A stronger suture will be smaller for the same USP size. Example: 4-0 polypropylene is smaller in diameter than 4-0 fast-absorbing gut (polypropylene is much stronger)

Question 8

How does tying a knot affect the tensile strength of a knot?

Answer 8

After tying a knot the tensile strength is decreased by 1/3

Question 9

What are the two main determinants of knot security?

Answer 9

Coefficient of friction and memory (decreased coefficient of friction and decreased memory –> increased ease of handling and more secure knots

Question 10

What is the definition of the coefficient of friction for suture?

Answer 10

It is the degree of friction encountered when you try to pull the suture through tissue

Question 11

What is suture elasticity and when is it important?

Answer 11

Elasticity is an ideal characteristic and it allows the suture to stretch and returns to its same shape.

It is important for wounds that swell and get larger and then the swelling goes down (can accommodate these changes)

Question 12

What is suture plasticity?

Answer 12

Ability to retain tensile strength after being stretched into a new shape (also important for wound edema/swelling changes)

Question 13

What sutures have increased plasticity?

Answer 13

Polypropylene has more than nylon

Question 14

What two sutures have the highest elasticity?

Answer 14

Polybutester and poliglecaprone-25

Question 15

What is the configuration, time to 50% tensile strength, and time to absorption for fast-absorbing gut?

Answer 15

Monofilament, 3-5 days, and 21-42 days

Question 16

What type of procedure is fast-absorbing gut often used for?

Answer 16

Skin grafts

Question 17

What is the configuration, time to 50% tensile strength, and time to absorption for fast-absorbing polyglactin 910 (Vicryl Rapide^TM)?

Answer 17

Braided, 5 days, 52 days,

Question 18

What is the configuration, time to 50% tensile strength, and time to absorption for plain gut?

Answer 18

Monofilament, 7-10 days, 70d

Question 19

What is the configuration, time to 50% tensile strength, and time to absorption for Polyglecaprone-25?

Answer 19

Monofilament, 7-10 days, 90-120 days

Question 20

What is special about polyglecaprone-25 as compared to other absorbable sutures?

Answer 20

Increased knot security and ease of handling compared to other monofilaments, least inflammatory, highest initial tensile strength

Question 21

What is the configuration, time to 50% tensile strength, and time to absorption for polyglycolic acid (Dexon^TM)?

Answer 21

Braided, 14d, 90d

Question 22

What is the configuration, time to 50% tensile strength, and time to absorption for chromic gut?

Answer 22

Monofilament, 21-28d, 90d

Question 23

What is the configuration, time to 50% tensile strength, and time to absorption for polyglactin 910 (Vicryl^TM)?

Answer 23

Braided, 21d, 56-70d

Question 24

How does suture spitting compare between polyglecaprone-25 and polyglactin 910?

Answer 24

Polyglactin 910 has an increased rate of spitting sutures relative to monocryl

Question 25

What is the configuration, time to 50% tensile strength, and time to absorption for polyglyconate?

Answer 25

Monofilament, 30-40d, 180d

Question 26

What is the configuration, time to 50% tensile strength, and time to absorption for polydioxanone (PDS II^TM)?

Answer 26

Monofilament, 30-50d, 180-240d

Question 27

Rank the absorbable sutures from shortest to longest absorption times?

Answer 27

Fast-absorbing gut, Fast-absorbing polyglactin 910, Polyglactin 910, plain gut, polyglycolic acid, chromic gut, polyglecaprone-25, polyglyconate, polydioxanone

Question 28

Rank the absorbable sutures from shortest to longest time to 50% tensile strength?

Answer 28

Fast-absorbing gut, fast-absorbing polyglactin 910, plain gut, polyglecaprone-25, polyglycolic acid, chromic gut, polyglactin 910, polyglyconate, polydioxanone (1-1.5 months)

Question 29

What are the two most inflammation-causing sutures?

Answer 29

1. Plain gut
2. Silk

Question 30

What suture has the best handling and what is it often used for?

Answer 30

Silk (gold standard in handling), often used on mucosal surfaces, causes sig tissue inflammation

Question 31

What non-absorbable sutures are multifilament?

Answer 31

Silk and polyester (Ethibond/Dacron/Mersiline^TM​)

Question 32

What suture has the lowest tissue reactivity?

Answer 32

Polypropylene (Prolene^TM)

Question 33

Which of the non-absorbable sutures has the highest tensile strength?

Answer 33

Polyester

Question 34

What type of surface is polyester sutures often used on?

Answer 34

Mucosal surfaces, handles like silk but is less inflammatory (minimally inflammatory)

Question 35

What type of suture would be best for a wound where signifcant edema is expected?

Answer 35

Polybutester (highest elasticity), polypropylene is also a good suture for this

Question 36

What are the most reactive absorbable sutures (greatest to least)?

Answer 36

Surgical gut >polyglycolic acid >polyglactin 910/lactomer >polydioxanone >polyglyconate=poliglecaprone 25

Question 37

What are the most reactive non-absorbable sutures (greatest to least)?

Answer 37

Silk >>nylon >polyester/polybutester >prolene

Question 38

Which sutures have the highest initial tensile strength? (most to least)

Answer 38

Poliglecaprone 25 >polyglyconate >polydioxanone >polyglactin 910/lactomer >polyglycolic acid >surgical gut

Question 39

What are highest initial tensile strength non-absorbable closure materials (highest to lowest)?

Answer 39

Stainless steel > polyester >nylon/polybutester >polypropylene >silk

Question 40

What is the most common antibiotic coating used on multifilament sutures?

Answer 40

Triclosan

Question 41

What are the two types of tissue adhesives?

Answer 41

Octyl (octyl cyanoacrylate/Dermabond^TM)

Butyl: butyl cyanoacrylate and N-butyl 2-cyanoacylate

Question 42

What are the differences between octyl and butyl tissue adhesives?

Answer 42

Butyl: Dry faster than octyl type (30 vs 150 seconds), more rigid

Question 43

Where are staples used and what are the advantages?

Answer 43

They are often used on the scalp by dermatologic surgeons

• They are quick, easy to apply, lower risk of strangulation, and decreased infection rates compared with sutures
• Disadvantage = more pain after closure

Question 44

What absorbable suture can be used on cartilage?

Answer 44

It is absorbable, has low reactivity, and is long-lasting

Question 45

What is the best location for a running locked suture?

Answer 45

The helical rim, cysts on the scalps

Remember that this is not good for high tension areas as it is still a running suture

Question 46

Which one, monofilament or multifilament, has more memory?

Answer 46

Monofilament