Properties and Selection of Suture Material Flashcards
Which is smaller- 3-0 or 2-0?
3-0
What are the main disadvantages of using natural suture?
Unpredictable loss of tensile strength, diameter/size, strength
What is the main disadvantage to synthetic suture?
Decreased handling due to increased memory
Describe the pros and cons of monofilament suture
Pros:
- lower tissue drag
-decreased capillarity
-decreased risk of nidus
Cons:
-less pliable
-increased memory
-more susceptible to damage
Describe the pros and cons of multifilament suture
Pros:
-increased strength
-increased pliability
Cons:
-increased tissue drag/fraction
-increased capillarity
-increased tendency for bacterial colonization
What is the definition of absorbable suture?
Suture that loses tensile strength within 60-90 days in living mammalian tissue
-may be present >60 days but with negligible tensile strength
What are the mechanisms by which natural suture gets broken down?
Phagocytosis by macrophages, enzymatic breakdown or via hydrolysis
What are some examples of natural and synthetic suture that is absorbable?
Natural: catgut, chromic gut
Synthetic: vicryl, monocryl, PDS
What are examples of non-absorbable suture in natural and synthetic forms?
Natural- silk
Synthetic: prolene, nylon, stainless steel
What is catgut/chromic gut made out of?
Porcine small intestinal mucosa
What are the pros and cons of using gut?
Pros: works well in rapidly healing tissues, completely absorbed in 2-3 weeks, good handling, minimal capillarity, good knot security when dry, cheap
Cons: high tissue reactivity, poor knot security when wet, cannot be autoclaved, disappears quickly in infected wounds
Describe the characteristics of Monocryl
Absorbed via hydrolysis, loses 50% of tensile strength at one week, 70-80% in 2 weeks
Monocryl pros and cons
Pros: good handling, very pliable, good strength, absorbed predictably, minimally reactive, can be used in contaminated wounds, fair knot security
Cons: expensive
Describe the characteristics of Vicryl
Braided soft multifilament, absorbed via hydrolysis (50% strength lost at 2-3 weeks though vicryl rapide lost at 5 days)
-good handling and knot security, soft, minimally reactive but increased tissue drag and capillary action
What are the properties of PDS?
Monofilament, absorbed via hydrolysis, 50% tensile strength lost at 5-6 weeks
PDS pros and cons
Pros: minimally reactive, no capillarity or tissue drag, good handling and knot security, absorbed predictably, can be used in contaminated wounds
Cons: Expensive
Of the absorbable synthetic sutures, which is the quickest to be absorbed?
Vicryl
Describe the properties of silk
Natural, braided, multifilament, high tissue reactivity, absorbed via phagocytosis, retains 56% tensile strength at 12 weeks
Describe the properties of prolene
Monofilament, resistant to degradation due to lack of hydrolysable bonds, lack of tissue reactivity so can be used anywhere
Pros and cons of prolene
Pros: minimally reactive, can be used in contaminated wounds
Cons: poor handling (slippery, memory), poor knot security
Describe the characteristics of nylon
Monofilament, absorbed via hydration, retains 50% tensile strength in 12 weeks in acidic environment
Pros and cons of nylon
Pros: minimal reactivity, biologically inert, no capillarity, antibacterial end products, inexpensive
Cons: Lots of memory, poor knot security, irritation can occur from suture ends
When should you use staples?
Linear incisions, thicker skin
When should you use reverse cutting vs taper point needles?
Reverse cutting with the skin and very tough tissues, taper point with basically everything else (soft tissues and luminal organs)
