Wound Closure Flashcards
Suture physical characteristics
Physical configuration
Capillarity (the ability to soak up fluid along a strand)
Diameter
Knot tensile strength (the force, measured in pounds, that the suture strand can withstand before it breaks when knotted)
Elasticity (the ability to regain original form and length after being stretched)
Memory (the capacity to take back former shape after being tied)
Coefficient of friction (the ability to glide through tissue and retain a knot)
Pliability (the ability to bend easily)
Sutures are classified into two main types:
Absorbable sutures
- derived from the collagen of healthy animals or from a synthetic polymer
- material can be digested, hydrolyzed and/or assimilated by tissue during the healing process
Nonabsorbable sutures
- derived from natural or synthetic material
- No change to the suture during the healing process
- Sutures become encapsulated or must be removed.
Examples of synthetic absorbable sutures:
Monocryl, Vicryl, PDS/PDS II
Monocryl facts
Monofilament
Dyed (violet)/Undyed
Available in control release (CR)
Good for:
Wound closure, bowel surgery (mucosa), cosmetic closure
Specialties: General, plastics
Vicryl facts
Used for ophthalmic procedures and when absorption is desired
Available in:
- Uncoated monofilament or “vicryl” suture
- Dyed violet and comes in sizes 9-0 to 10-0 (TINY!!)
Maxon facts
Indicated for soft tissues EXCEPT cardiovascular, neural and ophthalmic tissues
Suture comes dyed green or clear, sizes 2 to 7-0
Coated vicryl is not to be used on eyes, but can be used for general soft tissue
PDS/PDS II facts
May be used in slow healing tissues and for extended wound support
Applications may include abdominal and thoracic closure, subcutaneous tissue and colorectal surgery
Plain catgut (Type A) use:
Ligation of small vessels and to suture subcutaneous fat and tissue under tension while healing
Chromic gut (Type C) use:
Infected tissues and slow-healing tissue and ligation of larger vessels, biliary, urinary tracts and muscle and fascia closure
PDS use:
Abdominal and thoracic closure, subcutaneous tissue and colorectal surgery
Maxon use:
Soft tissue except CV, neural and ophthalmic tissues
Vicryl use:
Ophthalmic procedures and when absorption is desired
Dexon use:
Peritoneal, fascial, and subcutaneous closure
Three types of silk used as suture material:
Dermal, Virgin, Surgical
Stainless steel uses
Closure of the abdominal wall or sternum
Retention sutures
Secondary repairs
Respiratory tract
Orthopedics
Neurosurgery
*Can be used in presence of infection but NOT in the presence of another alloy [titanium])
Natural nonabsorbable sutures:
Silk
Surgical cotton
Linen
Stainless steel
Dermal silk:
Differs in that the strands are encased in gelatin or protein substance
Prevents the in-growth of tissue cells and facilitates removal
Used for skin sutures
Comes in black in sizes 0 to 5-0
Virgin silk:
Composed of natural fibers
Used for ophthalmic surgery
Comes in white or black in sizes 8-0 and 9-0
Surgical silk:
Animal product made from silkworm
Fibers are braided or twisted into a multifilament suture strand and treated to render it noncapillary
Gives good support during early ambulation and promotes rapid healing
Used in the serosa of the GI tract and to close fascia when no infection is present
Comes dyed black or white in sizes 5 to 9-0.
Surgical cotton:
Weakest of the nonabsorbable material choices; gains strength when wet