Basics Of Sutures

Question 1

What three outcomes do doctors look for when using sutures?

Answer 1

Appropriate and predictable strength for tissue layer.

Minimum tissue trauma and reactivity. (Passes smoothly through tissue)

Antibacterial protection. (Minimize bacterial colonization)

Question 2

What suture is recommended for closure of the surface of the skin?

Answer 2

None.

Topical skin adhesives are recommended.

Question 3

Surgeons may sometimes suture the peritoneum. Why?

Answer 3

To avoid adhesions with the intestines.

Question 4

Ethicon suture sizing ranges from ___ to ___ with ___ being the largest and ___ being the smallest.

Answer 4

Range from 7 to 11-0

7 is the largest.

11-0 is the smallest.

7-0 approximately corresponds to the thickness of human hair.

Question 5

What Ethicon suture is recommended for the Subticular layer?

Answer 5

MONOCRYL PLUS Antibacterial.

Poliglecaprone 25

Question 6

What Ethicon suture is recommended for the Subcutaneous/Fat layer?

Answer 6

MONOCRYL PLUS Antibacterial (poliglecaprone 25)

Coated VICRYL PLUS Antibacterial (polyglactin 910)

Question 7

What Ethicon suture is recommended for the Fascia layer?

Answer 7

PDS PLUS Antibacterial (polydioxanone)

Question 8

What Ethicon suture is recommended for the Organ/Space layer?

Answer 8

Prolene (polypropylene)

Ethibond Excel (polyester suture)

Coated VICRYL PLUS Antibacterial (polyglactin 910)

PDS PLUS Antibacterial (polydioxanone)

Question 9

Triclosan used in PLUS sutures is proven in vitro to inhibit bacterial colonization of the suture for how long?

Answer 9

7 days or more

Question 10

Suture materials are classified as __________ and _________.

Answer 10

Synthetic (polyester, nylon, other polymers)

Natural (gut, silk, stainless steel)

Question 11

What are some of the other polymers in the synthetic category?

Answer 11

Prolene (polypropylene)

Pronova poly (Hexafluoropropylene-VDF)

Monocryl (poliglecaprone 25)

PDS (polydioxanone)

Coated Vicryl (polyglactin 910)

Question 12

Gut and silk sutures are derived from:

Answer 12

Gut: submucosa of sheep intestine or serosa of cow intestine

Silk: filament of silkworm cocoon

Question 13

Stainless steel sutures are used for what type of closure?

Answer 13

Sternal closures.

Question 14

What are the advantages of synthetic sutures?

Answer 14

Low inflammatory response.

Not significantly affected by body responses (temperature, infection, etc.)

Can be antibacterial.

Greater predictability that Natural sutures.

Optimizes strength, strength retention, absorption, and pliability.

Question 15

What are the advantages of natural sutures?

Answer 15

Silk has good handling.

Stainless steel can create a high tension closure.

Surgeons are often trained with natural.

It is perceived as less expensive.

Question 16

All PLUS sutures are which:

 Synthetic and Absorbable

 Synthetic and Non-Absorbable

 Natural and Absorbable

 Natural and Non-Absorbable

Answer 16

Synthetic and Absorbable

Question 17

Absorbable sutures lose _________ and ________ over time.

Answer 17

Strength and mass.

*note: Non-absorbable sutures generally retain strength and mass.

Question 18

Absorbable sutures last for ________ to ________, where Non-absorbable sutures last for _________ to _________.

Answer 18

Absorbable: days to weeks

Non-absorbable: months to years

Question 19

TSR profile stands for?

Answer 19

Tensile Strength Retention.

 The sutures ability to retain strength over time within the body.

 Suture strength needs to last long enough for the wound to support itself.

Note: Tensile strength and mass aren’t always linear. Mass may remain even when strength is diminished.

Question 20

Absorption refers to the loss of _______?

Answer 20

Mass

Question 21

How do synthetic sutures absorb?

Answer 21

Process of hydrolysis.

 Water breaks up the chemical bonds of the polymer. 

 This process results in predictable degeneration of the material.

Question 22

How do natural sutures absorb?

Answer 22

Immune response.

 White blood cells attack and remove the material.

 Degeneration can be unpredictable based on patient factors (age, nutrition status, disease process, etc.)

Question 23

When should non-absorbable sutures be used?

Answer 23

When permanent support is needed.
(Cardiac valve replacement, sternotony closure, vessel anastomoses, prosthetic vascular graft implantation)

Bone and tendons (they have a longer healing period than absorbable sutures can support)

Also when suture removal is intended
(Skin sutures that will be removed in 7 days, sutures securing drain that will be removed when drain is no longer needed)

Question 24

Monofilament suture has ______ surface area than a braided suture and causes less tissue ______ because of smoother passage. It is also has ______ reactivity and a ______ infection risk.

Answer 24

Monofilament: Less surface area. Less tissue trauma. Less reactivity. Less infection risk.

Question 25

Why does a braided suture have a higher risk for infection? Cause more tissue trauma? Cause more reactivity?

Answer 25

The rough texture creates increased surface area and is more likely to harbor bacteria. It is also more likely to spread bacteria and fluid via wicking. (Capillarity- the spread of bacteria and fluid along the suture strand) Rough texture can also cause tissue sawing. (Damage) Larger surface area also increases risk for tissue reaction.

Question 26

Tissue trauma depends on ________ and ________.

Answer 26

Tissue factors and suture size.

Question 27

Braided sutures naturally have crevices called interstices. When does a monofilament suture have interstices?

Answer 27

When it is tied into a knot. The knot then has interstices.

Question 28

Which type of suture tends to retain package shape? Monofilament or braided?

Answer 28

Monofilament.

Question 29

_____________ sutures have a larger knot tower and MORE knot slippage.

Answer 29

Monofilament.

Question 30

Braided sutures have a flatter knot and their _______ _________ helps reduce knot slippage.

Answer 30

Rough surface.

Question 31

What are two techniques for wound closure suturing?

Answer 31

Continuous: multiple passes with one suture. Knots on both ends. Interrupted: series of individual loops and knots.

Question 32

Advantages of the interrupted suturing technique are?

Answer 32

Stronger if another pass breaks. Less risk of capillarity. Note: Braided is best suited because of the increased number of knots (more secure)

Question 33

What are the advantages of the continuous suturing technique?

Answer 33

More even tension throughout. Faster with fewer knots. Note: Monofilament is best suited because of smoother passage, less capillarity/harboring of bacteria.