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
Linen:
Tensile strength is inferior to other nonabsorbables; used for gastrointestinal surgery
Advantages/Disadvantages of synthetic polymers
Advantages:
Higher tensile strength
Less tissue reaction
Material retains its strength in tissue
Disadvantage:
Knot tying is somewhat difficult because the material is slick
Most commonly used surgical nylon sutures
Monofilament
Coated
Uncoated
Monofilament nylon
Ethilon/Dermalon
Smooth, single strand of noncapillary material that is used for
- microsurgery
- ophthalmic procedures
- plastic/cosmetic skin closure
Comes in clear, black, blue and green and in sizes from 2 to 11-0
Coated multifilament nylon
Surgilon
Braided strand treated with silicone- enhances passage through tissue
similar to silk and uncoated multifilament nylon
Uncoated multifilament nylon
Neurolon
Strand is tightly braided to prevent capillary action, handles much like silk, is strong, causes less reaction and may be used on all tissues for which multifilament nonabsorbable sutures are acceptable
Comes in black and white with sizes ranging from 1 to 7-0
Polyester fiber sutures
Coated:
- surface is lubricated to provide a smooth passage through tissues
- Used mainly for CV anastomosis and prostheses placement
- Retains its strength
- Ticron, ETHIBOND, Teflon
Uncoated:
- Braided flexible, pliable strands that are easy to handle
- May cause drag
- Cardiovascular/respiratory surgery
- Mersilene and Dacron
Monofilament nylon example:
Ethilon and Dermalon
Coated multifilament nylon example:
Surgilon
Uncoated polyester fiber example:
Mersilene and Dacron
Coated polyester fiber example:
Ticron, Ethibond, Teflon, Polydek and Tevdek
Polybutester example:
Novafil
Polyethylene example:
Dermalene
Polypropylene example:
Prolene and surgilene
Three types of needle points:
Cutting point
Taper point
Blunt point
Conventional cutting point:
Cutting edge on inside of curvature creating a small path that heals quickly
Conventional points are used for ligaments, in the nasal/oral cavities and in pharynx, skin, tendon applications
Reverse cutting point:
Curved needles with cutting edges on outer curvature
Used for fascia, ligaments and in the nasal/oral cavities for oral mucosa, skin and tendon sheath
Side cutting point:
Do not penetrate underlying tissues but rather split tissue layers
Used for ophthalmic surgery
Trocar point:
Used to penetrate tough tissues
Taper point needles:
Smooth point with no cutting edges
Pushes the tissue aside when passing through.
Used for aponeurosis, biliary tract, dura, fascia, GI tract, muscle, myocardium, nerve, peritoneum, pleura, subcutaneous fat, vessels (Vascular anastomosis)
Taper cut:
Cutting edges at the point only
Used for bronchus, calcified tissue, fascia, ligament, nasal cavity, oral cavity, ovary, perichondrium, periosteum, pharynx, tendon, trachea, uterus, and vessels.
Blunt point needle:
Rounded blunt tip and will not cut tissue making it the point of choice for use on organs bc it is less apt to puncture the vessels in organs
used for dissection of FRIABLE tissue (kidney, liver, spleen, uterine cervix ligation)
Suture material can be attached to eyeless or swaged needles in 4 ways:
Single (One needle is swaged to one end of the strand)
Double (2 needles are swaged, one to each end of strand. do not have to be the same size and shape)
Permanent (secured so the needle will not separate from the strand under normal use, has to be cut off)
Control (does not release inadvertently, but will release when intentionally pulled “pop-offs!”
Advantages of using surgical staples:
Rapid method to ligate, anastomose, and approximate tissues
In-depth healing is accelerated with minimal trauma and a nonreactive nature
Result produces an even surface and an airtight, leak-proof closure
Skin staplers are used to
Approximate skin edges
Linear staplers are used:
Throughout the alimentary tract and in thoracic procedures
Intraluminal circular staplers are used for:
Intraluminal anastomosis of a tubular hollow organ, usually the GI tract
Ligating and dividing staplers are used to:
ligate and divide mental vessels or soft tubular structures
Skin clips are used to:
secure stockinet or towels to the skin
Skin closure strips are used to:
approximate the edges of superficial lacerations or as a primary closure
