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Surgery I > Suture Materials & Patterns (6) > Flashcards

Suture Materials & Patterns (6) Flashcards

Dr. Thompson

1
Q

What are sutures’ roles in wound repair?

A
  • provides hemostasis
  • supports healing tissue by apposing and supporting tissue layers
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2
Q

What is the ideal suture?

A
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3
Q

What is the most commonly used standard for suture size?

A

United States Pharmacopeia

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4
Q

What are the largest and smallest suture sizes?

A

largest: 7
smallest: 12-0

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5
Q

T/F: 3-0 is smaller than 0

A

TRUE

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6
Q

What suture should be used to minimize trauma and reduce the amount of foreign material left in the wound?

A

the smallest diameter suture

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7
Q

When are flexible sutures indicated?

A

indicated for ligating vessels or performing continuous suture patterns

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8
Q

List the suture types from stiff to flexible

A

stiff: nylon and surgical gut

intermediate: braided polyester

flexible: silk

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9
Q

T/F: Smooth sutures cause more injury than rough sutures

A

FALSE - rough sutures do

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10
Q

What are the caveats to sutures with smooth surfaces?

A

requires greater tension to ensure good apposition of tissues

have less knot security

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11
Q

Which suture material has more drag than monofilament sutures?

A

braided materials

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12
Q

What is capillarity?

A

the process by which fluid and bacteria are carried into the interstices of multifilament fibers

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13
Q

Which suture material is more likely to harbor infection?

A

non-absorbable sutures

braided materials (PGA, silk) - some degrees

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14
Q

Which suture material is considered noncapillary?

A

monofilament

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15
Q

How is knot tensile strength measured?

A

by the force in pounds that the suture strand can withstand before it breaks when knotted

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16
Q

Tensile strength of the suture should not greatly exceed _______

A

the tensile strength of the tissue

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17
Q

What is relative knot security?

A

the holding capacity (how much force a knot can resist before slipping or failing) of a suture expressed as a percentage of its tensile strength

It shows how much of the suture’s full strength is retained after tying a knot.

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18
Q

What is knot-holding capacity?

A

the strength required to untie or break a defined knot by loading the part of the suture that forms the loop

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19
Q

What is tensile strength?

A

the strength required to break an untied fiber with a force applied to the direction of its length

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20
Q

How are suture materials classified?

A
  1. structure: monofilament, multifilament
  2. behavior in tissue: absorbable, nonabsorbable
  3. origin: synthetic, organic, metallic
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21
Q

What are the features of monofilament?

A
  • less tissue drag
  • do not have interstices
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22
Q

What should you be cautious of with monofilament suture?

A

nicking or damaging the material with forceps or needle holders may weaken the suture and predispose it to breakage

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23
Q

What are the characteristics of multifilament suture?

A
  • may be coated to reduce tissue drag and enhance handling characteristics
  • more pliable and flexible
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24
Q

How are sutures from organic origin broken down?

A

gradually digested by tissue enzymes and phagocytized

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25
How are sutures manufactured from synthetic polymers broken down?
hydrolysis
26
How are **nonabsorbable** sutures broken down?
ultimately **encapsulated or walled off** by fibrous tissue
27
What are the absorbable suture materials?
- surgical gut - chromic gut - multifilament - monofilament
28
PGA is a [mono/multi]filament
multifilament
29
Vicryl is a [mono/multi]filament
multifilament
30
PDSII is a [mono/multi]filament
monofilament
31
When do most absorbable suture materials lose their tensile strength?
60 days
32
What are the characteristics of catgut?
- most common **nonsynthetic absorbable suture material** - elicits a **notable inflammatory reaction** - rapidly removed when exposed to digestive enzymes - knots may loosen when wet
33
What are the characteristics of synthetic absorbable suture?
- broken down by hydrolysis - minimal tissue reaction - not affected by digestion - hydrolyzed in **alkaline environments** - **rapidly degraded in infected urine**
34
When are synthetic absorbable suture **rapidly degraded**?
infected urine
35
Review flowchart
36
List the types of nonabsorbable suture materials
- organic - synthetic - metallic
37
What is the most common organic nonabsorbable suture?
silk
38
When should you **not** use organic nonabsorbable suture (silk)?
loses tensile strength after 6 months - do not use for vascular grafts **should be avoided in contaminated sites**
39
What are the synthetic nonabsorbable suture marketed as?
- braided multifilament threads - monofilament threads
40
What are the benefits of synthetic nonabsorbable suture?
typically **strong** induce **minimal tissue reaction**
41
T/F: You can use cable ties in the body
FALSE
42
What are the characteristics of metallic sutures?
- stainless steel - minimal tissue reaction, though knot ends evoke inflammatory reaction - tendency to cut tissue - may fragment and migrate
43
What are the caveats of using absorbable sutures in the skin?
may be used, but should ultimately be removed because **absorption requires contact with body fluids**
44
What do you use for subcutaneous sutures?
multi- or monofilament absorbable suture
45
Which suture do you select for an abdominal closure?
nonabsorbable or standard absorbable monofilament suture with good knot security - usually standard absorbable normally simple continuous pattern (one size larger suture)
46
How many knots in an abdominal closure?
3 or 4 square knots (6 or 8 throws)
47
How should you suture muscle? Which suture material?
NOT parallel absorbable or non absorbable
48
What type of suture material and needle should you use when suturing a tendon?
strong, nonabsorbable, and minimally reactive taper or taper-cut needle
49
How should you suture parenchymal organs?
absorbable monofilament suture
50
What type of suture material for hollow viscus organs?
absorbable monofilament
51
What suture material should you select for infected or contaminated wounds?
monofilament, absorbable
52
Which suture material for ligating vessels? Anastomoses?
absorbable anastomoses: monofilament, nonabsorbable suture
53
Most surgical needles are made from _____
stainless steel wire
54
What is surgical yield?
the amount of angular deformation a needle can withstand before becoming permanently deformed
55
What is ductility?
the needle's resistance to breaking under a specified amount of bending
56
What is sharpness?
related to the angle of the point and the taper ratio of the needle
57
What are the most commonly used surgical needles in veterinary medicine?
- 3/8ths - 1/2
58
What needle is easier to use in confined locations?
**1/2 or 5/8**, as opposed to a 3/8 curved needle
59
What type of needle?
taperpoint
60
What type of needle?
tapercut
61
What type of needle?
reverse cutting
62
What type of needle?
regular cutting
63
Suture patterns can be classified as _______
- interrupted or continuous - by the way they appose tissue - by which tissues they primarily appose
64
What does everting mean?
turn the tissue edges outward, away from the patient and toward the surgeon
65
What does inverting mean?
turn tissue away from the surgeon, or toward the lumen of a hollow viscus organ
66
What are the purpose of subcutaneous sutures? Which pattern?
- eliminate dead space - provide some apposition of skin so less tension simple continuous
67
Where is suture advanced in subcuticular sutures?
dermal tissue
68
How are bites placed in subcuticular sutures?
parallel to the long axis of the incision
69
Suture pattern?
subcuticular
70
Suture pattern?
subcutaneous
71
How is the knot placed in a simple interrupted?
knot is **offset**
72
In simple interrupted, sutures should be placed approximately _____ away from the skin edge
2-3 mm away from the skin edge
73
When are horizontal mattress sutures used?
primarily in areas of tension often cause tissue eversion - appose, not evert
74
What do cruciate sutures do?
can relieve low to moderate tension
75
Suture pattern?
simple interrupted
76
Suture pattern?
horizontal mattress
77
Suture pattern?
cruciate
78
[Vertical/Horizontal] mattress sutures are stronger
vertical - also less disruption to blood supply
79
What do stents do?
relieve more tension
80
What is a Halsted pattern?
an interrupted mattress pattern that is a modification of a continuous Lembert pattern
81
What is a Gambee pattern? Used for?
interrupted pattern used in intestinal surgery to **reduce mucosal eversion**
82
Suture type?
vertical mattress
83
Suture type?
halsted
84
Suture type?
Gambee
85
What are the characteristics of simple continuous?
- series of simple interrupted sutures with a knot on either end - provides maximum tissue apposition - relatively air and fluid tight - frequently used to close the lines alba and SQ tissue
86
Suture pattern?
simple continuous
87
Suture pattern?
running
88
What is the difference between simple continuous and running?
simple continuous: needle passed **perpendicular to the incision** and **advanced above the incision line as diagonal** running: suture is advanced **above and below incision line**
89
Running or simple continuous?
running
90
What are the characteristics of a ford interlocking pattern?
91
What is a Lembert pattern?
a variation of a vertical mattress pattern applied in a continuous fashion often used to close hollow viscera
92
What is the difference between a Cushing and Connell pattern?
cone**LL**: enters the **L**umen Cushing: extends only to the submucosal layer both are inverting patterns
93
Suture pattern?
lembert
94
Suture pattern?
Connell
95
Suture pattern?
cushing
96
What is the Parker-Kerr oversew?
two-layer closure for inverted closure of a transected, clamped, stump of hollow viscera
97
How are tendon sutures used?
used to approximate severed ends of a tendon or to secure one end of a tendon to bone or muscle
98
What is an Aberdeen knot?
alternative to the square knot at the end of a continuous line larger knot volume, larger holding capacity
99
What is this?
Aberdeen knot

Surgery I (30 decks)

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