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Flashcards in Suture materials Deck (59):
1

What are the functions of suture material?

Wound closure
Ligation
Attachment of tubes
Stay sutures

2

What are features of the ideal suture material?

INTERACTION WITH TISSUES - maintains strength until wound strength develops, rapid resorption when no longer required, encapsulated without post-op complications, easily removed, minimal tissue reaction, doesn't favour bacterial growth, minimal drag through tissues, suitable for all wounds
INTERACTION WITH SURGEON - easy to handle (pliable, low memory), good knot security
MATERIAL PROPERTIES - easy to sterilise, non-capillary, non-electrolytic, non-corrosive, non-allergenic, non-carcinogenic
PRACTICAL CONSIDERATIONS- cheap, readily available, range of sizes

3

How is suture material classified?

ORIGIN: Natural vs synthetic
PERSISTENCE: absorbable/non-absorbable
STRUCTURE: multifilament/monofilament

4

Describe the tissue reaction and absorption of natural and synthetic fibres.

NATURAL: tissue inflammatory reaction, variable absorption
SYNTHETIC: less reaction, predictable absorption

5

Describe the persistence of absorbable and non-absorbable fibres.

ABSORBABLE: temporary wound support, loss of strength (21d)
NON-ABSORBABLE: elicits tissue reaction --> encapsulation, strength persists >60d

6

Contrast multifilaments and monofilaments

MULTIFILAMENT: easier to handle, better knot security, capillarity
MONOFILAMENT: less tissue drag, can weaken when crushed, prone to kinking

7

How can 'other items' affect suture classification? 3

COATING - coated vs uncoated. Coating improves handling and reduces tissue drag.
COLOUR (dyed/undyed) - improves visibility
PACKAGING - cassette, individual packet

8

What does FACTS stand for in the context of suture material?

Interaction with tissue:
Absorption Completion
Tensile Strength and loss.

9

List some examples of SYNTHETIC ABSORBABLE MULTIFILAMENT 4

Important to know!!!!

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

10

Describe for SYNTHETIC ABSORBABLE MUTLIFILAMENT, the:

tissue interaction
tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete at 60-90d.
Speed: Polysorb>Vicryl>Dexon

TENSILE STRENGTH AND LOSS: loss 33% (7d), 80% (14d), 100% (21d). Strength: Polysorb>Vicryl>Dexon

HANDLING AND KNOTTING: good handling/knotting, tissue drag - improved by coating

USE: vessel ligation, general soft tissue closure (skin, mouth)

11

List examples of SYNTHETIC ABSORBABLE MONOFILAMENT - SHORT DURATION - 2

Monocryl - Polyglecaprone
Caprosyn - Polyglytone

12

Describe for SYNTHETIC ABSORBABLE MONOFILAMENT - SHORT DURATION, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete @90-120d, speed Caprosyn>Monocryl

TENSILE STRENGTH AND LOSS: high tensile strength, loss 50% (7d), 60% (14d), 100% (21d)

HANDLING AND KNOTTING: monocry - soft and pliable, low memory. Caprosyn - more sticky

USE: general soft tissue closure, visceral closure - monocryl

13

List examples of SYNTHETIC ABSORBABLE MONOFILAMENT - LONG DURATION - 3

PDS 2- Polydioxanone
Maxon - Polyglyconate
Biosyn - Glycomer 631

14

Describe for SYNTHETIC ABSORBABLE MONOFILAMENT - LONG DURATION, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete @110-210d

TENSILE STRENGTH AND LOSS: strong materials (>nylon, prolene), loss 26% (14d), 40% (28d), 75% (42d), Strength: PDS 2> Maxon>Biosyn

HANDLING AND KNOTTING: PDS - memory, tendency to coil, 7 knots

USE: soft tissues needing long support, muscle, fascia, linea alba, viscera.

15

List 3 Synthetic non-absorbable monofilament

Prolen/SurgiPro - Polypropylene
Ethilon/Monosof - Polyamide
Flexon - Steel

16

Describe for SYNTHETIC NON-ABSORBABLE MONOFILAMENT, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: minimal - inert

TENSILE STRENGTH: strong, 25% loss at 2 years -nylon

HANDLING AND KNOTTING: Memory Propylene>Nylon, knot security - prolene>nylon

USE: Inert - skin, stoma, vessels, prolonged support - hernia, tendon

17

List 3 Synthetic non-absorbable MULTIfilament

Mersilene, Ethibond - polyester
Novafil - Polybutester
Supramid - Caprolactam

18

Describe for SYNTHETIC NON-ABSORBABLE MONDOFILAMENT, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: moderate inflammation

TENSILE STRENGTH: stronger than nylon, very little loss of strength

HANDLING AND KNOTTING: fair handling, slight elasticity, sheath cracks on knotting

USE: ligament prosthesis, skin closure

19

List 2 NATURAL ABSORBABLE MULTIFILAMENTS

Catgut - plain or chromic
Collagen - ophthalmic surgery

20

Describe for SYNTHETIC NON-ABSORBABLE MULTIFILAMENT - LONG DURATION, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: absorption complete @60-70d, tissue reaction marked, faster in infected/vascular/acidic wounds, unpredictable - absorption via phagocytosis cf hydrolysis

TENSILE STRENGTH AND LOSS: 33% loss (7d), 67% loss (14d)

HANDLING AND KNOTTING: knots weaker when wet, poor knot security so leave ends long, good handling

USE: vessel ligation, ophthalmic surgery

21

Give an example of a suture material that is Natural, non-absorbable multifilament

Mersilk, PermaHand - Silk

22

Describe for NATURAL NON-ABSORBABLE MULTIFILAMENT, the:

Tissue interaction
Tensile strength and loss
Handling and knotting
Use

TISSUE INTERACTION: moderate-marked inflammation, encapsulation in fibrous tissue

TENSILE STRENGTH: weak - will break, very slow absorption - 2yr

HANDLING AND KNOTTING: handling good (silk)

USE: large vessel ligation, NOT in viscera - ulcers and calculi

23

What are general points to consider when doing a rational selection of suture material? 3

Tensile strength should match that of tissue which depends on collagen content (fascia/skin> viscera> muscle/fat)

Rate of loss of strength = gain in wound strength (rate of healing: viscera>skin>fascia)

Will suture alter healing biologically? (tissue reaction, potentiation of infection, sinus formation, potentiation of calculi, thrombi and ulcers

24

What are some general rules to avoid complications?

avoid multifilament 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

25

What materials might you use for skin?

non-abs, mono - nylon, prolene
abs, multi - vicryl

26

What material might you use for the subcutis?

abs, mono/multi - monocryl, vircryl, caprosyn

27

What material might you use for fascia?

abs/non-abs, mono - PDS, biosyn, prolene

28

What material might you use for muscle?

abs, mon - PDS, biosyn, maxon

29

What material might you use for viscera?

abs, mono - Monocryl, PDS

30

What material for tendon?

non-abs, mono - prolene, nylon

31

What material for nerve?

non-abs, mono - prolen, nylon

32

What material for vessel ligation?

abs , multi - vicryl, polysorb
OR
non-abs, mono - prolene, silk

33

What material for vessel repair?

non-abs, mono - prolene, surgiPro

34

How is suture material size categorised?

in 1/10smm
ascending scale
linear
no missing value
same for all sutures
Metric - UK, USP = USA
Metric guage 4/5/6 last longer. 0.2/0.3/0.4 less reaction, less discomfort

35

How should you choose a suture?

less tissue trauma - tissue tract
less suture material volume
smaller knots - reduced bulk
greater knot security
encourages gentle handling

36

Rounghy what size suture should you use for:
dogs
cats
delicate tissue
tough tissue

DOG = 3 metric
CAT = 2 metric
Delicate tissue - reduce by 1-2 metric
Tough tissue - increase by 0.5-1 metric

37

What suture size should you use for skin?

1.5-3 metric

38

What suture size should you use for s/c?

1.2-2 metric

39

What suture size should you use for fascia?

2-3.5 metric

40

What suture size should you use for muscle?

2-3 metric

41

What suture size should you use for viscera?

1-2 metric

42

What suture size should you use for tendon?

2-3.5 metric

43

What suture size should you use for vessel ligation - small?

1.5-2 metric

44

What suture size should you use for vessel ligation - large?

3-4 metric

45

What is a swaged needle?

a needle with no eye, having suture attached to a hollow end

46

What are the advantages of a swaged needle?

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.

47

How are surgical needles classified?

SIZE (length, diameter)
SHAPE (straight, curved, curved on straight, compound curve, j-shape)
CURVE SHAPE (3/8 circle, 1/2 circle, 5/8 circle)
POINT - NON-CUTTING (round bodied, taper point), CUTTING (taper cut, standard cutting, reverse cutting, side-cutting (spatula))

48

What are the features of a reverese cutting needle?

as sharp as cutting needle
the third cutting edge is located on the outer convex curvature of the needle.

49

What are the advantages of a cutting needle?

reverse cutting needles are stronger than cutting needle
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

What are the considerations for a rational choice of surgical needle?

sharp enough to pass through tissue
no change to tissue architecture
needle resists bending/breakageTrue
needle hole just big enough for suture
Tissue characteristics - strength and friability
Wound characteristics - depth and accessibility
Surgeon's preference - hand versus instruments

51

What is least important when deciding most appropriate material? (initial tensile strength, tissue characteristics, handling ease, rate of tissue healing)

Ease of handling

52

True/False: knot security is better for monofilament material

False

53

True/False: use non-absorbable material in the creation of a permanent stoma

True

54

Why is multi-filament better than monofilament for ligating blood vessels?

Less physically irritant to tissues

55

Out of these options, when would you use (Polyglytone = synthetic absorbable, multifilament)?

[closure of bladder/GIT/fascia/SC tissue}

closure of SC tissue

56

What is polyglecaprone (monocryl)?

synthetic absorbable monofilament (has high tensile strength)

57

What is the surgical advantage of having a suture material with a high tensile strength?

compared with weaker material, a smaller guage may be used.

58

Is polyglecaprone (monocryl) or polyamide (ethilon) easier to handle?

polyglecaprone (monocryl)

59

How long does it take visceral wounds to heal?

2-3 weeks

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