Surgery Flashcards
What are properties of the “ideal” suture (which doesnt exist)?
- maintain tensile strength
- absorbed predictably
- Bio-inert
- Sterilized
- monofilament
- economical
Absorbable suture loses tensile strength in _____ days due to phagocytosis by macrophages or enzymatic hydrolysis.
60
Non-absorbable suture retains tensile strength for greater than _______ days.
60
________ suture has the most unpredictable tensile strength loss
natural
__________ suture has better predictability of tensile strength loss, however the downside is that it has a lot of memory.
synthetic
Multifilament suture is created by twisting or braiding multiple strands together to make a single strand. It is coated which improves its handling properties, however the biggest downside to multifilament suture is …
the filaments create a nidus for infection
A suture that is ________ absorbs fluid and transports bacteria. This is a common property of multifilament suture.
capillary
If you are suturing skin, what is the best suture property to have – capillary or non-capillary?
non-capillary – because this suture will not absorb water and transport bacteria. the skin has normal flora or even pathogenic flora if wounded. if you pass a capillary suture through the skin into inner tissues, you can transfer bacteria from the outside into clean tissues and create infection.
Name this suture:
Natural, multifilament, absorbable suture
absorbed by macrophages. Major downside to this suture is that is causes a severe foreign body reaction
Surgical Gut (catgut)
Surgical gut suture causes major foreign body reaction, so __________ was developed. This suture decreases tissue reaction, increases tensile strength and has increases resistance to being degraded.
chromic gut
Chromic gut has good handling, minimal capillary action, good knot security when its dry, and is relatively inexpensive. What are the downsides to this suture type?
its still reactive and its packaged in alcohol-based liquids that are irritating.
the knot security will be poor when its wet
it is NOT autoclavable
if the wound is infected, the suture will lose tensile strength
why does chromic gut suture lose tensile strength when it is used in infected wounds?
macrophages absorb this suture. In a state of infection, more macrophages will be present, therefore the suture is more vulnerable to absorption
___________ is a synthetic, multifilament, absorbable suture that is degraded by hydrolysis. Half of its tensile strength is lost within 14 days. This suture is coated which decreases wicking and tissue drag.
Vicryl (polyglactin-910)
Vicryl has tissue drag and is multifilament so it can serve as a nidus for urinary calculi.
Advantages of vicryl include…
minimal reactivity
good handling and knot security
stable in contaminated wounds
predictable absorption
soft and easy to bury
A patient presents to your clinic after being hit by a car what looks like 3-4 days ago. A large laceration on the hind limb appears to be infected but needs to be cleaned and sutured. What are the best suture types to use that will be minimally reactive, stable in contaminated wounds, and wont stick around for too long?
Vicryl or monocryl
vicryl is cheaper ($5), monocryl is ~$15 per pack.
However, monocryl has more suture within an individual pack, so if the laceration is large, then that may be a better option.
___________ is a synthetic, monofilament, absorbable suture. It has high initial tensile strength, but loses 40-50% by 7 days, and has no tensile strength by 21 days. It gets absorbed within 90-120 days by hydrolysis.
Monocryl (poliglecaprine 25)
Monocryl suture is monofilament, has good handling (considered the most pliable monofilament suture), good strength, and absorbs predictably. Since it is degraded by hydrolysis and has all of the advantages listed above, this suture is commonly used for what procedures?
Dentals
it is minimally reactive and is able to be used in contaminated wounds.
________ is a monofilament, synthetic, absorbable suture degraded by hydrolysis. It loses almost half of its tensile strength within 4 weeks, but then absorption completes within ~ 6 months.
PDS (polydioxanone)
PDS suture is commonly used in closure of ___________ because it is minimally reactive, has no capillarity or drag, has good handling and knot security, predictable absorption, and can be used in contaminated sites.
linea alba during a spay
Why would you not use monocryl in a spay linea closure?
monocryl loses half of tensile strength in 7 days. The linea alba takes at least 2 weeks to gain only 50% of its original strength back. You need to choose a suture that will uphold tensile strength past that 2 week mark at least, but longer is more ideal to cover for any potential delays in the healing process.
What are the 3 disadvantages of PDS?
its expensive, tends to kink, and can be more reactive if used intradermally.
You perform a spay and used PDS to do the closure. The dog presents 1 month post-op because there is a inflammed, elevated red bump that resembles a pimple on top of the incision site. How do you explain this to the owner and what do you do to treat it?
This is a PDS reaction. PDS suture caused a tissue reaction at the end of the suture where the knot was buried. This is not a serious complication. It can be popped and will heal!
_______ is a multifilament, natural, non-absorbable suture that has good initial tensile strength. It loses 50% by 1 year and 100% by 2 years. It is degraded by phagocytosis
silk
Silk suture is inexpensive and beneficial because of what property?
excellent handling
Silk does cause a moderate tissue reaction and has capillarity so it can lead to infection. This suture also can lose tensile strength if it gets wet. What is the knot security of this suture?
poor to fair
__________ is a monofilament, synthetic, non-absorbable suture that has LOTS of memory and poor knot security.
Nylon
