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Flashcards in Suture material Deck (50):
1

functions of suture material

Wound closure
Attachment of tubes
Ligation
Stay sutures

2

ideal interaction with the tissue

Maintains strength until wound strength develops
Rapid resorption when no longer required
Encapsulated without post-operative complications
Easily removed
Minimal tissue reaction
Does not favour bacterial growth
Minimal drag through tissues
Suitable for all wounds

3

ideal interaction with the surgeon

easy to handle
good knot security

4

ideal material properties

Easy to sterilise
Non-capillary (fluid doesn't stick to them)
Non-electrolytic
Non-corrosive
Non-allergenic
Non-carcinogenic

5

classification of suture material

natural vs synthetic
absorbable vs non
multi vs monofilament

6

Natural fibre - properties

Tissue inflammatory reaction
Variable absorption

7

Synthetic fibre - properties

Less reaction
Predictable absorption

8

Multifilament - properties

Easier to handle
Better knot security
 Capillarity

9

Monofilament - properties

Less tissue drag
Can weaken when crushed

10

coating effects

improves handling
reduces tissue drag

11

Synthetic Absorbable Multifilament - materials

Vicryl - Polyglactin 910
Dexon - Polyglycolic acid
Polysorb - Lactomer 9-1
Panacryl - Poly(L-lactide/glycolide)

12

Synthetic Absorbable Multifilament - Interaction with tissue

Absorption complete at 60-90d
Speed: Polysorb>Vicryl>Dexon

13

Synthetic Absorbable Multifilament - Tensile strength & loss

Loss 33% (7d), 80% (14d), 100% (21d)
Strength: Polysorb>Vicryl>Dexon

14

Synthetic Absorbable Multifilament - Handling & knotting

Good handling/knotting
Tissue drag - improved by coating

15

Synthetic Absorbable Multifilament - use

Vessel ligation
General soft tissue closure (skin, mouth)

16

Synthetic Absorbable Monofilament - short duration - Materials

Monocryl - Polyglecaprone
Caprosyn – Polyglytone

17

Synthetic Absorbable Monofilament - short duration - Interaction with tissue

Absorption complete @ 90-120d
Speed: Caprosyn>Monocryl

18

Synthetic Absorbable Monofilament - short duration - Tensile strength & loss

High tensile strength
Loss: 50%(7d),60%(14d), 100%(21d)

19

Synthetic Absorbable Monofilament - short duration - Handling & knotting

Monocryl - soft & pliable, low memory
Caprosyn - more sticky

20

Synthetic Absorbable Monofilament - short duration - use

General soft tissue closure
Visceral closure - Monocryl

21

Synthetic Absorbable Monofilament - long duration - Materials

PDS II - Polydioxanone
Maxon - Polyglyconate
Biosyn - Glycomer 631

22

Synthetic Absorbable Monofilament - long duration - Interaction with tissue

Absorption complete @ 110-210d

23

Synthetic Absorbable Monofilament - long duration - Tensile strength & loss

Strong materials (>Nylon, Prolene)
Loss: 26% (14d), 40% (28d), 75% (42d)
Strength: PDS II>Maxon>Biosyn

24

Synthetic Absorbable Monofilament - long duration - Handling & knotting

PDS - memory, tendency to coil, 7 knots

25

Synthetic Absorbable Monofilament - long duration - use

Soft tissues needing long support
Muscle, fascia, linea alba, viscera

26

Synthetic Non-absorbable Monofilament - Materials

Prolene/SurgiPro - Polypropylene
Ethilon/Monosof – Polyamide
Flexon – Steel

27

Synthetic Non-absorbable Monofilament - Interaction with tissue

Minimal reaction – inert

28

Synthetic Non-absorbable Monofilament - Tensile strength

Strong
25% loss at 2 years - nylon

29

Synthetic Non-absorbable Monofilament - Handling & knotting

Memory - Prolene>Nylon
Knot security - Prolene>Nylon

30

Synthetic Non-absorbable Monofilament - Use

Inert - skin, stoma, vessels
Prolonged support-hernia, tendon

31

Synthetic Non-absorbable Multifilament - Materials

Mersilene, Ethibond - Polyester
Novafil - Polybutester
Supramid - Caprolactam

32

Synthetic Non-absorbable Multifilament - Interaction with tissue

Moderate inflammation

33

Synthetic Non-absorbable Multifilament - Tensile strength

stronger than nylon
Very little loss of strength

34

Synthetic Non-absorbable Multifilament - Handling & knotting

Fair handling, slight elasticity
Sheath cracks on knotting

35

Synthetic Non-absorbable Multifilament - Use

Ligament prosthesis
? Skin closure

36

Natural Absorbable Multifilament - Materials

Catgut – plain or chromic
Collagen – ophthalmic surgery

37

Natural Absorbable Multifilament - Interaction with tissue

Absorption complete @ 60-70d
Tissue reaction marked
Faster in infected, vascular or acidic wounds
UNPREDICTABLE: absorption via phagocytosis cf hydrolysis

38

Natural Absorbable Multifilament - Tensile strength & loss

33% loss (7d), 67% loss (14d)

39

Natural Absorbable Multifilament - Handling & knotting

Knots weaker when wet
Poor knot security so leave ends long
Good handling

40

Natural Absorbable Multifilament - Use

Vessel ligation, ophthalmic surgery

41

Natural Non-absorbable Multifilament - Materials

Mersilk, PermaHand – Silk

42

Natural Non-absorbable Multifilament - Tissue interaction

Moderate-marked inflammation
Encapsulated in fibrous tissue

43

Natural Non-absorbable Multifilament - Tensile strength

Weak - will break
Very slow absorption - 2yr

44

Natural Non-absorbable Multifilament - Handling & knotting

Handling good (silk)

45

Natural Non-absorbable Multifilament - use

Large vessel ligation
NOT in viscera – ulcers and calculi

46

General rules to avoid complications

Avoid multifilament material in contaminated wounds
Avoid non-absorbable sutures in hollow organs
Use inert material in the skin
Avoid reactive material for stoma creation
Use slowly/non-absorbable material in fascia/tendons
Avoid burying any suture from a multi-use cassette
Avoid catgut in inflamed, infected or acidic wounds

47

Choice of suture size

Use the smallest size possible
Less tissue trauma – tissue tract
Smaller knots – reduced bulk

48

Advantages of swaged-on needles

Available for use immediately
Unlikely to detach suture material
Less handling of suture material
Less fraying of suture material
Less tissue trauma
Likely to be sharper
Guaranteed sterile
Greater range of needles available

49

advantages of reverse cutting needles

stronger
Danger of tissue cutout is greatly reduced
Hole left by the needle leaves a wide wall of tissue against which the suture is to be tied

50

needle requirements

Sharp enough to pass through tissue
No change to tissue architecture
Needle resists bending/breakage
Needle hole just big enough for suture