Chapter 16: Suture Material, Tissue Staplers, Ligation Devices, and Closure Methods Flashcards
What are types of barbed suture?
VLOC - loop at end
Stratafix - tab end
Quill - bidirectional, two needles
In GIT surgery, results in faster repair with equivalent or better bursting strength and leakage
- 2-0 barbed break strength is like 3-0 monofilament
What are the 2 major methods of suture absorption?
- Enzymatic (predominates in natural materials)
- Hydrolytic (Predominates in synthetic sutures)
List the (5) disadvantages of Catgut (twisted material from SI submucosa of cattle/sheep):
- Relatively weak
- Not uniform (has weak areas)
- High tissue reaction
- Absorption is extremely variable and unpredictable
- very rapid absorption in gastric or intestinal surgery (<24hr)
What species of worms produce silk?
What are features of silk suture?
Bombyx mori
Anaphe pernyi
- Excellent handling and knot security
- Significant tissue reactivity (good for progressive occlusion)
What are the disadvantages of Nylon Leader Line for CCL repair?
It was not designed as an implantable biomaterial. It will elongate under constant loads and its physical properties are significantly influenced by steam sterilization
Steam sterilization resulted in a 204x increase in elongation
What is the strongest form of suture?
Polyester composite sutures eg FiberWire (multifilament UHMW polyethylene core surrounded by braided polyester and polyethylene exterior)
What is meant by the warp, weft, and bias of woven mesh?
Warp: lengthwise filaments, unidirectional
Weft: weaves in and out of warp
Bias: 45 degree angle, more stretchy
Tend to be more elastic and fluid in the bias direction
What is meant by the course and wale of a knitted mesh?
Course: row of distendable loops across fabric
Wale: Column of loops along the edge (this accounts for strength)
*anisotropic in different directions (can elongate more on course than wale)
They are anisotropic with more elongation along the course than the wale
What is meant by the pore size and porosity of mesh materials? How does this affect its properties?
- The ratio of material to air
- Polypropylene mesh - pore size 0.6-0.9mm with porosity 28-32%
- ePTFE pore size is 20-25nm
Very small pore size will prevent capillary ingrowth causing encapsulation rather than incorporation
What biologic materials have been used as mesh?
- Porcine SI submucosa
- Bovine pericardium
- Acellular dermal matrix
- Canine fascia lata
PSIS is gone/can’t be found on histo at 3 months after implantation
Fascia lata consistently has shown the best biological properties followed by polypropylene, then PSIS
What are the recommendations for implantation of mesh?
- Trimming with electrosurgery may seal edges and prevent fraying
- Create a hem
- Horizontal mattress sutures will engage more mesh
- If under tension, should overlay 1cm of tissue
- Little or no tension, 0.6cm overlap
What are the dimensions of regular and wide skin staples? Are skin staples appositional, inverting or everting?
Regular: 4.8-5.7mm
Wide: 6.5-6.9mm
Slightly everting
What are the principles of vascular clip application?
- Vessel is skeletonised prior to application
- Diameter of the vessel should be no more than 2/3 and no less than 1/3 the length of the clip
- Clip applied several mm from the cut edge
- Arteries and veins clipped separately
What height are the staples in each colored cartridges for TA devices? What do they reduce to when fired?
Green - 4.8mm reduces to 2.0mm
Blue - 3.5mm reduces to 1.5mm
White - 2.5mm reduces to 1mm
What can linear staplers be used for?
- Pulmonary
- Cardiac
- GI
- hepatobiliary
- reproductive
