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Phase 1 > Ch. 16 Suture, Staplers, Ligation > Flashcards

Ch. 16 Suture, Staplers, Ligation Flashcards

1
Q

What side of the curved needing is the cutting surface for a reverse cutting point

A

the cutting surface is on the conVEX surface, resulting in a triangular needle hole with a flat edge parallel to the incision

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2
Q

Breaking strength definition (suture)

A

The stress value on the stress-strain curve at which suture acutely fails

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3
Q

Capillarity definition (suture)

A

the degree to which absorbed fluid is transferred along a suture
multifilament sutures tend to have greater capillarity compared to monofilament

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4
Q

Creep definition (suture)

A

The tendency of a suture to slowly and permanently deform under constant stress

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5
Q

Elasticity definition (suture)

A

The degree to which suture will deform under stress or load and return to its original form when the load is removed

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6
Q

Fluid absorption definition (suture)

A

The degree to which a suture will absorb fluid following immersion

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7
Q

Knot pull out strength definition (suture)

A

The load required to break a suture deformed by a knot.

Deformation caused by knot placement generally results in 10-40% loss of strength

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8
Q

Knot strength definition (suture)

A

the force necessary to cause a knot to slip

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9
Q

Memory definition (suture)

A

the tendency for a suture to return to its original shape after deformation

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10
Q

Plasticity definition (suture)

A

The degree to which a suture will deform without breaking and will maintain its shape after removal of the deforming force

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11
Q

stress relaxation definition (suture)

A

the ability of suture to reduce stress under constant strain

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12
Q

Suture pull out value definition (suture)

A

the weight required to pull a suture loop from tissue
the measured value relates to tissue strength
fat: 0.2 kg
muscle: 1.27 kg
skin: 1.82 kg
fascia: 3.77 kg

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13
Q

Tensile strength definition (suture)

A

similar to ultimate strength, breaking strength, or yield strength
a measure of a suture’s ability to resist deformation and breakage and the stress at which deformation (yield strength) or rupture (breaking or ultimate strength) occurs

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14
Q

What is polyglactin 910 (Vicryl) coated in?

A

a water insoluble 50-50 mix of polyglactin 370 and calcium stearate which increases pliability, reduces tissue drag, and improves tying characteristics

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15
Q

What is polyglycolic acid suture (Dexon II) coated with?

A

water soluble copolymer of glycolide and E-caprolactone to help with knot formation

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16
Q

What is Ticron polyester suture coated with?

A

proprietary silicon to aid in knot formation

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17
Q

How are natural absorbable sutures like gut absorbed through the body?

A

Enzymatic breakdown uses cellular proteases and collagenases
specifically, acid phosphatase and leucine aminopeptidase

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18
Q

How are synthetic absorbable sutures broken down?

A

Hydrolysis: random main chain scission of ester linkages

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19
Q

How does pH affect suture absorption?

A

Sutures with glycolide components such as poliglecaprone 25, polyglyconate, or glycomer 631 will degraded more rapidly in an alkaline environment
Sutures with a dioxanone component such as polydioxanone will lose tensile strength rapidly in an acid environment

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20
Q

Characteristics of catgut

A

twisted suture
actually from small intestinal submucosa of sheep or intestinal serosa of cattle
chromic catgut has additional curing with chromium trioxide salts, which increases collage cross linkages, delays suture absorption, and reduces tissue inflammation
may see complete loss of strength within 12 or 24 hours
completely absorbed within 2-3 weeks

21
Q

Characteristics of polyglycolic acid (Dexon)

A

braided homopolymer of glycolic acid in coated or uncoated forms
minimal absorption for first 14 days then rapid hydrolysis
loses 50% of strength at 2-3 weeks

22
Q

Characteristics of polyglactin 910 (vicryl)

A

90% glycolide and 10% L lactide
coated with calcium stearate and polyglactic acid
similar to polyclycolic acid (dexon) properties
loses 50% of strength at 2-3 weeks

23
Q

Characteristics of Poliglecaprone 25 (Monocryl)

A

copolymer of E-caprolactone and glycolide
high initial breaking strength
lose 50% of strength at 1-2 weeks
completely absorbed within 90-120 days with mild inflammation

24
Q

Characteristics of polyglytone 6211 (caprosyn)

A

rapidly absorbed
monofilament
after three weeks, no measurable strength

25
Q

characteristics polydioxanone (PDS II or PDS plus)

A

monofilament
50% of tensile strength at 5 to 6 weeks
intermediate knot security

26
Q

characteristics of polyglyconate (glycolic acid trimethylene carbonate or Maxon)

A

copolymer of glycolic acid and trimethylene carbonate
monofilament and relatively slowly absorbed
50% of its strength at 4-5 weeks
greater memory compared to polydioxanone

27
Q

Characteristics of glycomer 631 (Biosyn)

A

monofilament of glycolide, diaoxanone, trimethylene carbonate
rapidly absorbed with 50% loss of strength at 2-3 weeks and completely absorbed at 90-110 days

28
Q

characteristics of silk

A

considered a nonabsorbable sutures but the crystalline structure of silk is slowly degraded by hydration and completely deteriorates by two years with loss of strength 50% at 12 weeks
foreign protein will incite tissue reaction

29
Q

characteristics of polypropylene (suture)

A

monofilament polyolefin suture
strong and has highest energy to break point compared to silk, nylon, polyester, polyglycolic acid, and gut
a lot of memory
resistant to degradation because of a lack of hydrolyzable bonds

30
Q

characteristics of nylon suture

A

very strong
it is susceptible to degradation and in an acidic environment, 50% loss of strength seen at 12 weeks
nylon fishing or leader line is used - made to withstand high loads and is mostly used in saltwater fly fishing
steam sterilization of nylon line resulted in a two to fourfold increase in elongation but no affect on ultrimate strength

31
Q

characteristics of polymerized caprolactam (Vetafil)

A

not recommended for inside tissues because it makes sinus formations
use only in the skin
twisted, coated, nylon based multifilament suture

32
Q

Characterstics of polyester (polyethylene, polybutester, and composites)

A

strong and relatively resistant to degradation
polybutester (Novafil) has high elasticity
may be useful for closing wounds that you expect to swell
polyester composites are used for ortho surgery like FiberWire (a multifilament ultra high molecular weight polyethylene core surrounded by a braided polyester and polyethylene exterior)
orthocord and Hi-Fi are other similar options
of all the polyblend sutures, Fiberwire has the highest maximal failure load

33
Q

characteristics of stainless steel suture

A

304, 316, or 316L stainless steel
L denotes a low concentration of carbon, which increases corrosion resistance
mostly we just use them for median sternotomies now

34
Q

Define warp and weft directions in regards to woven mesh

A

the warp is a set of lengthwise filaments aligned in one direction
the weft are woven over and under the warp at a perpendicular angle
woven material will be most elestic in the bias direction, which is 45 degrees from the warp and weft (aka, the cross grain direction)
woven fabrics tend to be stronger, stiffer, and less porous compared with knitted meshes because the filaments are so tightly packed

35
Q

Define the course and wale of a knitted mesh

A

the course is the row of distensible loops across a fabric
the wale is the column of loops along the length of the fabric
the wale accounts for the strength of knitted mesh
elongation along the course is greater than elongation along the wale = this is called anisotropy
knitted meshes are more porous and flexible but less strong than woven meshes

36
Q

Porosity of mesh

A

knitted polypropylene mesh like Prolene or Marlex have pores of 0.6 to 0.9 mm
expanded polytetrafluoroethylene (ePTFE) is not woven or knitted and has a pore size of 20 to 25 um
a very small pore size will prevent ingrowth of capillaries and fibroblasts which causes encapsulation instead of incorporation

37
Q

Properties of porcine small intestinal submucosa as a bioscaffold mesh

A
  • three months after implantation, not histologically apparent
  • initial degradation in bursting strength at 10 days, followed by a progressive increase in bursting strength to levels above native tissue
  • may have modulatory effect on local cytokines involved in wound healing such as vascular endothelial growth factor, fibroblast growth factor, and transforming growth factor like substance
  • evokes a more intense leukocyte infiltration compared to polypropylene mesh -
38
Q

Diameter, width, and depth of regular skin staples

A

Diameter: 0.53 mm
Width: 4.8-5.7 mm
Depth: 3.4-3.9 mm

39
Q

Diameter, width, and depth of wide skin staples

A

Diameter: 0.58 mm
Width: 6.5-6.9 mm
Depth: 3.9-4.1 mm

40
Q

Sizes of a ligate-divide-staple (LDS)

A

regular (5.79 mm wide x 5.23 mm tall, closed width 5.33 mm)

wide (8 mm wide x 7.2 mm tall, closed width 7.3 mm)

41
Q

Guidelines for use of vascular clips

A
  1. remove as much of surrounding tissue as possible around the vessel
  2. the diameter of the vessel to be occluded should be no more than two thirds and no less than one third the length of the clip
  3. the clip should be applied several mm from the cut edge
  4. arteries and veins should be clipped separately
42
Q

Ethicon TA 30V: rows/closed staple height in mm/open staple height in mm

A

3 rows

  1. 0 mm closed
  2. 5 mm open
43
Q

Ethicon TA 30B: rows/closed staple height in mm/open staple height in mm

A

2 rows

  1. 5 mm closed
  2. 5 mm open
44
Q

Ethicon TA 30G: rows/closed staple height in mm/open staple height in mm

A

2 rows

  1. 0 mm closed
  2. 8 mm open
45
Q

White linear staples have —- rows, —- closed staple height, and —- open staple height

A

3 rows

  1. 0 mm closed staples
  2. 5 mm open staples
46
Q

Blue linear staples have —- rows, —- closed staple height, and —- open staple height

A

2 rows

  1. 5 mm closed staples
  2. 5 mm open staples
47
Q

Green linear staples have —- rows, —- closed staple height, and —- open staple height

A

2 rows

  1. 0 mm closed staples
  2. 8 mm open staples
48
Q

What size tissue should be used with circular anastomoses? What kind of anastomosis can be performed?

A

use with tissue >1 mm and <2.5 mm

end to end, end to side, or side to side

49
Q

Triclosan

A

An antibiotic coating for suture (like what makes PDS II go to PDS plus)
works by inhibiting bacterial fatty acid synthesis

Phase 1 (35 decks)

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