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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

What material for tendon?

non-abs, mono - prolene, nylon

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