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ICMS > Suture Materials > Flashcards

Suture Materials Flashcards

1
Q

Sutures hold a wound in apposition until…

A

the natural healing process is established enough to make support from the suture material unnecessary.

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2
Q

What is the adequate duration on average for sutures being left in the body?

A

14-21 days on avg, except tendon

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3
Q

In the early stages of wound healing, wound strength is due to…

A
  • fibrin from inflammatory reaction
  • vascular endothelial ingrowth
  • epithelial migration into wound
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4
Q

What factors are likely to influence wound healing?

A

infection
tension
severe protein depletion
poor vascularisation

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5
Q

What biological properties of suture material have to be considered?

A
  • the likelihood of the material to potentiate infection
  • calculogenic?
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6
Q

suture strength should match…

A

tissue strength

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7
Q

The rate of loss of suture strength must be compatible w/ the…

A

the rate of gain of wound strength

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8
Q

Define: ‘Straight pull’ tensile strength

A

Represents the maximum longitudinal force a strand can bear before breaking

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9
Q

Define: ‘Knot-pull’ tensile strength

A

The force which a suture strand can resist before it breaks when a knot exists

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10
Q

Define: ‘Out of packet’ tensile strength

A

This is the ‘straight pull’ tensile strength
AKA the original tensile strength

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11
Q

Define: Tensile strength

A

Time suture will mechanically support the wound, usually measured in days

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12
Q

Define: Mass absorption

A

Time in days for suture to be totally absorbed by the body

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13
Q

What is the Critical wound healing period (CWHP)?

A

The time in days a wound requires mechanical support

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14
Q

What is the metric number used in the metric system of suture size?

A

Metric number = the thread in diameter in tenths of a mm

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15
Q

Explain the USP system of suture size.

A

System has a standard range in diameter for each size or grade
Denoted in zeros with the finest is (14-0) and a max diameter is at 7.

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16
Q

What are the ideal properties of suture material?

A
  • low cost
  • easily sterilised
  • pliable
  • high tensile strength
  • non-capillary
  • secure knots
  • no tissue rxn
  • absorbed/encapsulated
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17
Q

What are the 3 classifications of suture?

A
  • Absorbable or non-absorbable
  • Multifilament or monofilament
  • Natural or synthetic
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18
Q

What are the different types of absorbable suture that are commonly found?

A

Catgut, Chromic catgut, Polyglycolic acid (Dexon), Polyglactin 910 (Vicryl/Vicryl RAPIDE), Polydioxanone (PDS), Polyglyconate (Maxon), Poliglecaprone 25 (Monocryl), Glycomer 631 (Biosyn), Polyglytone 6211 (Caprosyn)

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19
Q

Catgut is …

A

natural, absorbable, monofilament

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20
Q

Catgut is made from the submucosa of…

A

sheep/cattle

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21
Q

Plain gut (catgut) evokes…

A

severe sterile pyogenic reaction

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22
Q

Catgut loses tensile strength…

A

rapidly

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23
Q

How long does it take the body to absorb catgut?

A

about 7 days

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24
Q

What is important to remember about plain gut (catgut)?

A

Plain gut should not be used in Surgery

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25
Q

Chromic catgut is…

A

natural, absorbable, monofilament suture

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26
Q

What differs chromic catgut from plain gut?

A

Chromic catgut has a chromic oxide treatment to reduce inflammatory reactions in the body. It has a higher tensile strength for longer and a more even absorption pattern

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27
Q

What are some advantages of chromic catgut?

A
  • relatively cheap if purchased in cassettes
  • easy to handle
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28
Q

What are some disadvantages of chromic catgut?

A
  • severe inflammatory rxn
  • poor knot security
  • questionable sterility in cassettes
  • variability in strength & loss of strength
  • swells & weakens when wet
  • weakens when knotted
  • capillary action
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29
Q

Polyglycolic acid (aka Dexon)

A

Synthetic, multifilament, absorbable

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30
Q

How is Polyglycolic acid broken down? What does this do to the body?

A

It is broken down by hydrolysis thus making it less reactive to the body than catgut.

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31
Q

Polyglycolic acid has better… than catgut.

A

knot security

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32
Q

The strength of polyglycolic acid is … by knotting than catgut

A

less affected

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33
Q

polyglycolic acid has some …. due to the ….

A

tissue drag
multifilament synthetic braided suture

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34
Q

What suture is the main competitor to polyglycolic acid?

A

Polyglactin 910

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35
Q

Polyglactin 910 (Vicryl) is a

A

synthetic, multifilament, absorbable suture

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36
Q

Why is polyglactin 910 a competitor for Polyglycolic acid?

A

it is marginally stronger than the polyglycolic acid

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37
Q

When is it ideal to use Vicryl rapide?

A

Superficial soft tissue (skin & mucosa) where only short-term wound support is required.

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38
Q

How long does vicryl rapide last?

A

about 7-10 days

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39
Q

Vicryl rapide should not be used for…

A

ligation, cardiovascular, GIT, etc

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40
Q

Polydioxanone is also known as

A

PDS

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41
Q

polydioxanone is a

A

synthetic, absorbable, monofilament

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42
Q

how is polydioxanone absorbed?

A

by hydrolysis

43
Q

Polydioxanone is stronger than…

A

polypropylene or nylon

44
Q

At 4 weeks, polydioxanone has what percent of strength remaining?

A

50-70%

45
Q

At 6 weeks, polydioxanone has what percent of strength remaining?

A

25%

46
Q

What type of filament suture is best for infected tissues? why?

A

Monofilament because it is made of only 1 strand and isn’t braided like polyfilament. The braiding allows bacterial to get into the suture material and harbor there.

47
Q

Another name for polyglyconate suture is…

A

Maxon

48
Q

Polyglyconate suture is

A

synthetic, absorbable, monofilament

49
Q

Polyglyconate differs from PDS how?

A
  • possibly a little stronger than PDS II
  • slightly better knot security
50
Q

Poliglecaprone 25 is also known as

A

monocryl

51
Q

Poliglecaprone 25 is

A

synthetic, absorbable, monofilament

52
Q

poliglecaprone 25 is rapidly…

A

absorbed

53
Q

How long does it take poliglecaprone 25 to lose most or all of its significant strength?

A

14 days

54
Q

When should you use poliglecaprone 25?

A

in rapidly healing tissues or when you don’t want suture material present for long

55
Q

Glycomer 631 is also known as

A

biosyn

56
Q

Glycomer 631 is

A

monofilament, synthetic, absorbable suture

57
Q

What is glycomer 631 excellent in?

A

initial strength and in vivo strength over the CWHP

58
Q

Glycomer 631 has minimal

A

memory

59
Q

glycomer 631 is used for

A

general soft tissue approximation

60
Q

Polyglytone 6211 is also known as

A

caprosyn

61
Q

Polyglytone 6211 is

A

absorbable monofilament suture

62
Q

How long does complete absorption take in Polyglytone 6211?

A

56 days

63
Q

polyglytone 6211 has what good characteristics?

A
  • excellent handling
  • retains up to 30% knot strength, even at 10 days post-implantation
64
Q

rapid absorption limits application in which absorbable suture?

A

polyglytone 6211 (caprosyn)

65
Q

Any suture degraded by hydrolysis may be at risk of…

A

premature degradation when used in a bladder infected w/ Proteus spp.

66
Q

What are the types of non-absorbable sutures?

A

silk, polyamide (nylon), polypropylene (prolene), stainless steel, coated caprolactum (supramid)

67
Q

Silk is…

A

natural multifilament non-absorbable suture

68
Q

what are advantages with silk suture?

A
  • cheap & easy to handle
  • tensile strength lost after 6 mos
  • good knot security
69
Q

When is silk used?

A

cardiovascular surgery

70
Q

What are the problems with silk suture?

A
  • causes ulceration in the GIT
  • unsuited in contaminated sites
  • predisposes to calculi in the bladder
71
Q

polyamide is also known as

A

nylon

72
Q

polyamide is

A

synthetic mono or multifilament non-absorbable suture

73
Q

The half life of polyamide

A

exceeds 6 months

74
Q

what are some key characteristics of polyamide suture?

A
  • minimal tissue reaction
  • moderate strength
  • moderate security
  • little discomfort on removal
  • commonly used for skin
75
Q

Polypropylene is also known as

A

prolene

76
Q

polypropylene is

A

synthetic monofilament non-absorbable suture

77
Q

What are some key characteristics of polypropylene suture?

A
  • minimal tissue drag
  • moderate knot security
  • moderate strength
  • good for skin
  • least thrombogenic, so great for cardiovascular surgery
78
Q

What is the memory like in polypropylene suture?

A

slightly difficult to handle

79
Q

What are some key characteristics for stainless steel suture?

A
  • very strong & retains strength
  • non-capillary & inert
  • difficult to handle
  • can be used for skin suture
80
Q

What is another name for coated caprolactum?

A

Supramid

81
Q

Coated caprolactum is

A

synthetic, multifilament, non-absorbable suture

82
Q

What are some key characteristics of coated caprolactum?

A
  • twisted multifilament of the nylon family
  • coated in a proteinaceous material
  • common for skin closure
  • chemical disinfection does not sterilise so cannot be used for anyone other than skin closure
  • intermediate tissue reactivity
  • superior tensile strength to nylon
83
Q

What are the main problems w/ multifilaments?

A
  • capillary properties
  • tissue drag/friction
  • premature locking of knots, especially ligatures
84
Q

How were multi-filaments fixed?

A

they were coated to solve tissue drag & premature locking

85
Q

When are multi-filament sutures unsuitable?

A
  • slow healing tissues like tendon
  • delayed healing situations (infections)
86
Q

What are the two types of needles used in suture?

A

Swaged needles
Eyed needles

87
Q

What are some advantages to swaged needles?

A
  • less traumatic
  • immediately available
  • always sharp
  • guaranteed sterile
  • slim as possible without compromising strength
  • stable in needle holder
  • coated w/ silicone to improve sensation of sharpness
88
Q

What are some advantages to eyed needles?

A
  • less expensive
  • reusable
89
Q

What are some disadvantages to eyed needle suture?

A
  • soft steel, easily bent
  • larger than swaged due to the eyelet
  • edge is lost with autoclaving/chemical sterilization
90
Q

Needle bodies can be either…

A

straight or curved

91
Q

Needle choice depends on the

A

depth and size of the wound

92
Q

What fraction of a circle in needle curvature is available?

A

1/4 circle
3/8 circle
1/2 circle
5/8 circle

93
Q

Cutting needles come in what types?

A

Taper point, reverse cutting, conventional cutting, taper cutting

94
Q

Round-bodied needles have

A

no sharp edges

95
Q

What are some tissues that taper point needles are used on?

A

biliary tract
nerve
vessels
dura
peritoneum
pleura
GIT
SQ fat
muscles
myocardium

96
Q

What are some tissues that reverse cutting needles are used on?

A

fascia
ligaments
skin
tendons

97
Q

What are some tissues that conventional cutting needles are used on?

A

skin, ligaments, tendons

98
Q

When is a taper cutting needle used?

A

bronchus, tendons, calcified tissue, trachea, fascia, uterus, ligaments, vessels, ovary

99
Q

When are round-bodied needles used?

A

parenchyma, fat, muscles

100
Q

straight needles are used…

A

in open access areas
skin, GI

101
Q

1/4 circle needles are used in

A

ophthalmic or microsurgeries

102
Q

3/8 circle needles are used…

A

most of the time
skin, muscle, GIT, cardiovascular, vascular, tendon, etc.

103
Q

1/2 circle needles are used…

A

in deeper tissues usually
GI, CV, vascular, muscle, oral cavity, etc

104
Q

5/8 circle needles are used

A
  • in tight access areas
  • urology, pelvic cavity
  • prostatectomy, pelvic cavity

ICMS (22 decks)

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