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Surgery Exam 2 > Suture Materials and Needles > Flashcards

Suture Materials and Needles Flashcards

(102 cards)

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1
Q

what does suturing do

A

provide homeostasis
supports wound healing

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2
Q

ideal suture

A

easy to handle
minimally react in tissue
inhibit bacteria growth
secure hold when knotted
resist shrinking in tissue
absorb with minimal reaction

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3
Q

tensile strength

A

time it takes suture material to lose 70-80% of initial strength
measures ability of material to resist breakage or deformation
exponentially proportional to size

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4
Q

pliability and flexibility

A

depends on material and size of suture
ease when the suture material is handled
more flexibility good for vessel ligation

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5
Q

memory

A

tendency of suture material to return to original shape
monofilament has mor memory than multifilament

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6
Q

surface friction

A

relates to roughness of outer surface
rough sutures cause more injury than smooth sutures

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7
Q

tissue drag

A

part of surface friction
ease when the suture is pulled through tissue
braided suture has more drag than monofilament suture

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8
Q

knot security

A

ability of suture to hold a knot
inversely proportional to suture size

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9
Q

capillarity

A

process by which fluid and bacteria are carried into interstices of multifilament fibers
monofilament are non capillary
braided sutures have capillarity
do not use multifilament suture in infected/contaminated tissues

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10
Q

tissue reactivity

A

degree to which body reacts to presence of suture material
natural fibers much more reactive than synthetic suture
multifilament more reactive than monofilament

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11
Q

fiber origin– natural vs synthetic

A

natural – biological sources (ex silk)
synthetic – man made (ex nylon)

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12
Q

structure – monofilament vs multifilament

A

monofilament – harder to handle, more memory
multifilament – more tissue drag, harbor bacteria

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13
Q

behavior in tissues

A

absorbable vs non absorbable

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14
Q

what are “plus” sutures

A

antimicrobial

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15
Q

non absorbable multifilament

A

silk
polyester

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16
Q

absorbable multifilament

A

polyglactin 910
catgut

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17
Q

non absorbable monofilament

A

polypropylene
nylon

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18
Q

absorbable monofilament

A

poliglecaprone 25

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19
Q

does loss of tensile strength determine rate of absorption

A

no

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20
Q

nonabsorbable suture and tensile strength

A

maintains >50% of tensile strength for greater than 60 days

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21
Q

absorbable suture and tensile strength

A

loses >50% of tensile strength in less than 60 days

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22
Q

absorption of natural fibers

A

causes more reaction
enzymatic digestion
rate of absorption increases with presence of infection and inflammation

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23
Q

absorption of syntehtic fibers

A

hydrolysis
water molecuels penetrate suture material casuing breakdown of polymer chain
less tissue reaction than enzymatic digestion

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24
Q

what does suture duration include

A

loss of tensile strength (loss of suture strength)
absorption

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25
surgical gut (chromic gut, cat gut)
absorbable natural absorbed by enzymatic digestion, phagocytosis multifilament not frequently used in practices sheep intestine submucosa, bovine serosa marked inflammatory reaction
26
uses of surgical gut
vascular pedicle ligation
27
what is the most reactive suture material what has the most severe reaction in cats
surgical gut
28
polyglactin 910 -- vicryl
absorbable syntehtic braided, multifilament more drag, less memory can get monofilament in 9-0 and 10-0 minimal tissue reactivity 25% sterngth lost by day 14 completely absorbed by 60-70 days
29
uses of polyglactin 910 -- vicryl
soft tissue approximation hollow organs ophthalmic procedures subcutaneous tissues
30
polyglactin -- vicryl rapide
absorbable synthetic braided, multifilament minimal tissue reactivity 50% strength lost by day 5-6, almost 100% by day 14 completely absorbed by 42 days
31
uses of polyglactin -- vicryl rapide
skin and mucosa perineal repair lacerations mucosa in oral cavity periocular skin skin repairs where rapid absorption beneficial
32
polyglactin -- vicryl rapide -- why is it absorbed faster
exposed to radiation (cobalt 60) to increase rate of absorption
33
polyglactin -- vicryl plus
absorbable syntehtic braided, multifilament minimal tissue reactivity completely absorbed by 56-70 days
34
uses of polyglactin -- vicryl plus
contaminated and infected sites reproductive tract ligation general closure bowel orthopedic proceedures
35
polyglactin -- vicryl plus -- what makes it plus
coated with triclosan (broad spectrum antibacterial agent) to reduce bacterial growth at suture line
36
polydioxanone
absorbable PDS II vs PDS plus syntehtic monofilament minimal tissue reactivity completely absorbed at 180 days
37
uses of polydioxanone
soft tissue approximation fascia closure blood vessel anastomosis orthopedics tissues that require longer term strength (linea alba, bladder)
38
poliglecaprone 25
absorbable monocryl vs monocryl plus synthetic monofilament minimal tissue reactivity high tensile strength 70-80% strength lost at 14 days complete absorption at 100 days
39
uses of poliglecaprone 25
soft tissue approximation ligations skin repairs bowel peritoneum uterus vaginal cuff subcutaneous
40
silk
nonabsorbable natural braided, multifilament harvested from cocoon of silkworm moderate tissue inflammatory reaction
41
reactivity of silk
most reactive of nonabsorbable material potential nidus for calculus formation (bladder or gallbladder stone formation) nidus -- spot that bacteria can multiply or that stones can stay and form
42
uses of silk
vessel ligation cardiovascular procedures ophthalmic procedures neurological procedures amputations (wouldn't use for amputations though)
43
nylon (polyaminde)
non absorbable ethilon synthetic monofilament minimal tissue reaction minimal break down
44
uses on nylon (polyamide)
soft tissue approximation ophthalmic procedures ligation
45
polyester
non absorbable mersilene synthetic multifilament +/- coating (to decrease drag) monofilament in 10-0 and 11-0 strongest non metallic suture material intermediate reaction (most reactive on syntehtics)
46
uses of polyester
stabilizing unstable joints
47
polypropylene
non absorbable prolene synthetic monofilament high memory least reactive nonabsorbable
48
uses of polypropylene
vascular surgeries neurological procedures tendon repairs
49
stainless steel
non absorbable metallic monofilament or multifilament monofilament most common high tensile strength hard to handle
50
uses of stainless steel
orthopedics sternotomy repair hernia repair
51
sizing of needles
12-0 -- smallest 7 -- largest
52
why do you need to choose correct size
prevent wound dehiscence promote wound healing
53
which size causes more tissue reaction and delayed healing
larger sizes
54
suture sizes and throws
larger sizes require more throws
55
what can cause suture site infection
suture reaction multifilamnet > coated multifilament > monofilament
56
what is wicking
fluid and bacteria carried into interstices of multifilament fibers -- can lead to infection capillarity
57
what is dehiscence
failure of sutures to hold incision closed
58
causes of dehisence
too small suture used apposition of unlike tissues sutures too tight too much tension on sutures poor suture technique
59
seroma
increased dead space
60
description of suture needles
stainless steel wire swaged onto suture varying parts of a circle
61
with suture neeldes what in trauma proportional to
diameter
62
tapered needles
minimal trauma must curve wrist to follow needle
63
cutting needles
facilitates tough tissue penetration cutting edge on concave surface reverse cutting edge on convex surface
64
what to think of when selecting needle
diameter depth of wound
65
1/4 circle
ophthalmic surgery
66
1/2 circle
many tissue types and procedures
67
3/8 circle
skin and superficial tissue
68
5/8 circle
confined locations or deep tissues
69
1/2 curve
rarely used
70
straight
typically hand held used in easily accessible areas
71
closed vs french
72
taperpoint
sharp tip pierces and spreads tissue without cutting intestine, submucosa, fascia
73
tapercut
combination of reverse cutting and taperpoint heavy thick fascia, tendons
74
cutting
cutting edge on concave portion of needle tends to cut out of tissue
75
reverse cutting
cutting on convex edge surface reduces risk of tissue being cut out skin
76
spatula point
flat on top and bottom ophthalmic procedures
77
blunt point
dissects through friable tissues without cutting soft parenchymal organs like liver and kidneys
78
tissue glue
cyanoacrylates
79
tissue glue
cyanoacrylates sets in < 1 minute -- delayed if area wet close short skin incisions and lacerations (< 5cm)
80
disadvantages of tissue glue
can delay healing cause tissue reaction granuloma formation may promote wound infection
81
what do you never use tissue glue on
bite wounds or other heavily contaminated wounds puncture or deep wounds lacerations > 5cm mucous membranes near the eye in subcutaneous tissues
82
skin staplers
rectangular shaped staples skin apposition apply skin staples perpendicular to incision first align and apposition edges with thumb forceps moderate pressure needed staples should be 5-6 mm apart
83
advantages of skin staples
rapid application (can take time to figure out correct pressure)
84
disadvantages of skin staples
cost eversion -- if placed incorrectly rotation -- if placed incorrectly single use time saved in placement is lost in removal
85
thoracoabdominal (TA) stapler
2-3 parallel rows of B shaped staples lung or liver lobe resection partial splenectomy partial gastrectomy
86
gastrointestinal anastomosis (GA) stapler
4-6 rows of B shaped staples and cuts in the middle creates side to side anastomosis
87
end to end anastomosis (EEA) stapler
creates circular end to end anastomosis intestinal anastomosis
88
skin surgical closure
use non absorbable (unless doing intradermal, then use absorbable) minimal tissue reactivity suture -- nylon, polyrpopylene, monocryl (absorbable) size -- 4-0 to 2-0 depending on patient tension patterns -- horizontal mattress, vertical mattress, cruciate, near far patterns no tension patterns -- simple interrupted, simple continuous, +/- cruciate, intradermal, ford interlocking
89
subcutaneous surgical closure
rapidly absorbable suture -- minimal tissue reactivity suture -- monocryl, vicryl, PDS size -- 4-0, 3-0, +/- 2-0 simple continuous, simple interrupted
90
body wall and fascia surgical closure
slowly absorbable - high tensile strength external rectus sheath is holding layer don't want to go through entire muscle, just external rectus sheath (difficult in cats) good knot security suture -- PDS size -- 3-0 to 0 simple interrupted, simple continuous, cruciate
91
stomach surgical closure
slowly absorbable low tissue reactivity good tensile strength good knot security suture -- PDS, monocryl size -- 4-0 to 3-0, +/- 2-0 simple continuous, lambert, halstead, connell, cushing
92
small intestine surgical closure
slowly absorbable low tissue reactivity good knot security suture -- PDS, monocryl size -- 4-0 +/- 3-0 simple interrupted, simple continuous, gambee
93
urinary bladder surgical closure
rapidly absorbable low tissue reactivity good tensile strength good knot security suture -- monocryl, PDS size -- 4-0 and 3-0 simple continuous, cushing
94
colon surgical closure
slowly absorbable low tissue reactivity good knot security suture -- PDS size -- 4-0 +/- 3-0 simple interrupted, simple continuous sometimes used
95
vessel and pedicle ligations
slowly absorbable good knot security good tensile strength suture -- PDS size -- 3-0 to 0 for pedicle, 4-0 to 3-0 for vessel knots -- square, modified millers, surgeons friction knots stay tighter (millers, modified millers)
96
tendons and ligaments surgical closure
nonabsorbable good tensile strength good knot security suture -- nylon size -- 3-0 to 1
97
bird and reptile skin
tend to invert -- everting patterns recommended
98
oral mucosa in dogs and cats
tend to invert -- everting patterns recommended
99
larger hollow organs with aggressive eversion of mucosa (stomach, uterus)
inverting or modified gambee patterns recommended
100
one layer or two layer closure?
one layer preferred two layer acceptable for hollow organ repair
101
one layer or two layer closure -- bladder and stomach
double layer commonly seen two layer closure have disadvantage of compromising lumen, large cuff (source for bleeding and irritation)
102
one layer or two layer -- small lumen organs
one layer closure

Surgery Exam 2 (6 decks)

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