Flashcards in Suture materials Deck (59)
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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
