12 . A. Sutures, suture Patterns & Suturing Technique

Question 1

The ideal suture material should:
.

Answer 1

1.Be suitable for use in any situation;

2.Be readily available and inexpensive;

3.Be readily sterilized by steam or ethylene oxide;
4.Show high initial tensile strength, combined with small diameter material; have a good knot security;
5. Produce minimal tissue reaction;
6.Show good handling characteristics;
7.Not create an environment for bacterial growth;
8. Be absorbed after its function has been served

Question 2

Absorbable sutures:

In general, they are used in closing internal tissue layers or organs w/c do not require long term support.

Answer 2

A.Natural absorbable
B.Synthetic absorbable

Question 3

– it is absorbed by phagocytosis & enzyme degeneration.

Answer 3

Natural absorbable

Question 4

Natural absorbable :

Answer 4

Surgical gut (catgut)
Collagen

Question 5

• from sub-mucosa of sheep or cattle small intestine & is composed of formaldehyde treated collagen.

Answer 5

Surgical gut (catgut)

Question 6

– a multi filament that is processed from bovine flexor tendon & is treated with formaldehyde or chromium salts or both.

Answer 6

Collagen

Question 7

– it is absorbed by hydrolysis, not phagocytosis.

Answer 7

Synthetic absorbable

Question 8

Synthetic absorbable :

Answer 8

Polyglycolic acid
Polyglactin 910
Polydioxanone
Polyglyconate

Question 9

• is a braided multi filament polymer of glycolic (hydroxyacetic) acid.

Answer 9

Polyglycolic acid

Question 10

• this material is a co-polymer of lactide & glycolide.

Answer 10

Polyglactin 910

Question 11

• a polymer of paradioxanone, a mono filament.

Answer 11

Polydioxanone

Question 12

• also a mono filament, co-polymer of glycolic acid and trimethylene carbonate.

Answer 12

Polyglyconate

Question 13

:
-these materials maintain their strength for longer than 60 days. They are used where prolonged mechanical support is required e.g skin closure, and within slow healing tissues.

Answer 13

Non-absorbable sutures

Question 14

Non-absorbable sutures:

Answer 14

Natural non-absorbable
Metallic sutures
Synthetic sutures

Question 15

Natural non-absorbable:

Answer 15

Silk and cotton

Question 16

– available in braided multi filament or twisted strands. Obtained from threads spun by the silk worm larvae and coated with silicon or wax to minimize capillarity w/c may promote infection.

Answer 16

Silk

Question 17

Cotton – was introduce in _____ to replace silk.

Answer 17

1939

Question 18

Metallic sutures:

Answer 18

Stainless steel
Other metallic sutures

Question 19

• it is biologically inert, non-capillarity and easily sterilized by autoclaving. It has the highest tensile strength and greatest knot security of all the suture materials. But it has the tendency to cut tissues, w/ poor handling characteristics and inability to withstand repeated bending w/o breaking.

Answer 19

Stainless steel

Question 20

– tantalum, aluminum & silver, they are not commonly used

Answer 20

Other metallic sutures

Question 21

Synthetic sutures:

Answer 21

Polyamide
Polyester fibers
Polybutester

Question 22

Polyamide- __________and ________ commonly used in vet. surgery.

Answer 22

(a) nylon and (b) polymerized caprolactam (vetafil, supramid)

Question 23

• a braided multifilament available in plain and coated forms.

Answer 23

Polyester fibers

Question 24

• almost twice as flexible as polypropylene or nylon.

Answer 24

Polybutester

Question 25

Polyolefin plastics:

Answer 25

Polypropylene Polyethylene Polytetraflouroehtylene

Question 26

a monofilament, its advantages include its strength, inertness, retention of strength after implantation, minimal tissue reactivity, and resistance to bacterial contamination. The only disadvantages are its slippery in handling and tying characteristics.

Answer 26

Polypropylene

Question 27

a monofilament w/ excellent tensile strength but very poor knot security

Answer 27

Polyethylene-

Question 28

- a new non-absorbable monofilament sutures that has low surface friction, chemical inertness, and enhanced flexibility. Its disadvantage is its high cost.

Answer 28

Polytetraflouroehtylene

Question 29

Alternative to sutures:

Answer 29

Staples Tissue glue Adhesive tapes-

Question 30

metal clips or staples for use in skin and other tissues have gained popularity in vet. surgery. The main advantage is speed of insertion, they are inert and well tolerated. Their major disadvantage is cost, but their ease of use and the shortened surgery time have much to recommend them.

Answer 30

Staples-

Question 31

- there are cyanoacrylic monomers w/c polymerize on contact with moisture in the wound.

Answer 31

Tissue glue

Question 32

designed for use in humans, limited use in animals as they do not adhere well to moist skin.

Answer 32

Adhesive tapes

Question 33

Selection of Suture Materials Principles in the selection:

Answer 33

1.Sutures should be at least as strong as the tissue through w/c they are placed. 2. The relative rates of w/c suture losses strength and the wound gains strength should be compatible. 3.If the suture biologically alters the healing process, these changes must be considered when selecting a suture. 4. The mechanical properties of the suture should closely match those of the tissue to be closed.

Question 34

Skin – _____and ______ are the preferred sutures for skin. Sutures that are capillary or reactive should be avoided.

Answer 34

monofilament nylon and polypropylene

Question 35

Subcutis- are preferred because of their low tissue reactivity.

Answer 35

synthetic absorbable

Question 36

Fascia-

Answer 36

synthetic non-absorbable, surgical gut, and synthetic absorbable.

Question 37

Muscle- __________ are recommended for cardiac muscle.

Answer 37

synthetic absorbable or non-absorbable. Nylon and polypropylene

Question 38

Hollow viscus- ____________(multi-filament non-absorbable is avoided)

Answer 38

surgical gut, synthetic absorbable, monofilament non-absorbable

Question 39

Tendon- ________ and _______ are usually recommended. PDS and polyglyconate may also be effective.

Answer 39

nylon, and stainless steel

Question 40

Blood vessels- ___________ is the material of choice in vascular repair. Polyteraflouroethylene, nylon, coated polyester, and PDS have also been used effectively.

Answer 40

polypropylene

Question 41

Nerve- ________________ are recommended. Low reactivity is the most important consideration in peripheral nerve repair.

Answer 41

nylon, polypropylene

Question 42

Suture Size Skin and subcutis :

Answer 42

4-O to 3-O

Question 43

Muscle , Fascia and Tendon

Answer 43

3-O to O

Question 44

Hollow Viscus

Answer 44

5-0 and 2-0

Question 45

Vessels (ligature)

Answer 45

4-O to 2-O

Question 46

Vessels (sutures)

Answer 46

6-O to 5-O

Question 47

Nerve

Answer 47

6-O to 5-O

Question 48

Suture Patterns: A vast number of suture patterns have been described for use in animals. They have benn categorized according to the following:

Answer 48

Anatomical areas in w/c they are placed; Tendency to promote apposition, inversion, or eversion of tissues; Ability to overcome tension forces that may disrupt accurate approximation of tissues; Whether they are placed in a continuous or an interrupted pattern.

Question 49

Categorization of Suture Patterns: According to type:

Answer 49

Interrupted sutures Continuous sutures-

Question 50

Interrupted sutures- each suture is individually tied and cut distal to the knot. Advantage:

Answer 50

Ability to maintain strength and tissue apposition if part of the suture line fails.

Question 51

Interrupted sutures- each suture is individually tied and cut distal to the knot. Disadvantages:

Answer 51

1. Increased time needed to tie multiple knots. 2. Increased volume of foreign materials left in the wound. 3. Poor suture recovery.

Question 52

- these are neither knotted nor cut, except at each end of the suture lines.

Answer 52

Continuous sutures

Question 53

Continuous sutures- these are neither knotted nor cut, except at each end of the suture lines. Advantages:

Answer 53

1. Ease of application or suture speed. 2. Use of minimal amount of suture material. 3. Ease of removal.

Question 54

Continuous sutures- these are neither knotted nor cut, except at each end of the suture lines. Disadvantages:

Answer 54

1. Less precise control of suture tension and wound approximation. 2. Potentially disastrous effects of suture breakage.

Question 55

Suture patterns According to location:

Answer 55

1.Skin sutures 2. Muscle & fascia sutures 3.Hollow organs sutures 4. Nerve & tendons sutures

Question 56

Common Suture Patterns: Skin – skin suture should be placed at least 5mm from the skin edge and be placed squarely across the wound. The skin should be handled gently with fine rat-toothed forceps. Observed proper apposition of alignment of wound edges.

Question 57

Common Suture Patterns: Skin – skin suture should be placed at least 5mm from the skin edge and be placed squarely across the wound. The skin should be handled gently with fine rat-toothed forceps. Observed proper apposition of alignment of wound edges.

Question 58

Common suture patterns in the skin:

Answer 58

Simple interrupted Simple continuous Ford interlocking Interrupted vertical mattress Interrupted horizontal mattress Cruciate mattress

Question 59

Suture patterns for muscle & fascia:

Answer 59

Simple interrupted Simple continuous Ford interlocking Horizontal mattress Vertical mattress Cruciate mattress

Question 60

Suture patterns for hollow organs:

Answer 60

Simple interrupted Parker kerr Purse string Connell Cushing Lembert Gambee Halstead

Question 61

Suture patterns for nerve & tendons:

Answer 61

Intraneural (nerve) Locking loop or modified Kessler (tendons) Interrupted horizontal mattress (tendons)

Question 62

Sutures patterns

Answer 62

According to function: Appositional sutures: simple interrupted, gambee, interrupted intradermal/subcuticular, interrupted cruciate mattress, simple contimuous, continuous intradermal/sucuticular, ford interlocking. Inverting sutures: lembert, halstead, cushing, connell, parker kerr, purse string. Tension sutures: simple interrupted, vertical & horizontal mattress, far-far-near-near, far-near-near-far. Everting sutures: vertical and horizontal mattress etc.

Question 63

Knot tying Technique- Square knot:

Answer 63

Go to ppt