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Sx Skills- Suture material and surgical needles 1

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untimely's version from 2015-05-07 05:56

Suture material Intro

Question Answer
what are the 4 major suture material characteristics?(1) tensile strength (2) pliability and memory (3) surface friction and knot security (4) tissue reactivity
which gives better knot security- mono or multi filament?multi
what is tensile strength?Measure of the ability of a material to resist breakage
what is pliability?Related to the ease with which the suture material is handled
what is memory?Tendency of a suture material to return to its original shape
what is surface friction?Relates to “roughness” of outer surface, tissue “drag”; coating can be used to decrease surface friction
which types of fibers cause more tissue reactions than the other?NATURAL fibers cause way more tissue reactions than synthetic suture
surgical gut vs silk- which will cause a worse tissue reaction?the gut, bc it's made from tissue (even tho both are natural fibers!)
how do you say 2-0 and what size is it compared to size 0?it's said as "two-ought" and it's basically like saying double-zero
which is bigger... 3 or 3-0?3--- because 3-0 is like saying 000(tiny!)
what are the two ways to classify suture materal based on...structure?mono- versus multifilament
what are the two ways to classify suture materal based on...absorption?Absorbable vs Non-absorbable
what are the two ways to classify suture materal based on...fiber origin?natural vs synthetic
if a suture has antimicrobial properties, it will be called what?a "plus" suture
**what is the definition of a non-absorbable suture?maintains >50% of tensile strength for greater than 60 days
**what is the definition of an absorbable suture?loses >50% of tensile strength in less than 60 days
how does loss of tensile strength relate to rate of absorption?they do NOT equal each other.
what are the two methods of absorption, and which TYPE of suture material corresponds with the type of absorption?(1) ENZYMATIC DIGESTION-->Natural fibers (2) HYDROLYSIS-->Synthetic suture
which type of material will have an inc rate of absorption in the presence of infection/inflammation?NATURAL fibers, because this environment accelerates ENZYMATIC digestion which is what breaks down natural fibers
which method of absorption/corresponding suture material will cause less tissue reaction?synthetic fibers are broken down by HYDROLYSIS, where water molecules penetrate suture material causing breakdown of suture polymer chain. This involves no enzymes, so it causes less tissue reactions
(complications) what is Capillarity (wicking)?process whereby fluid and bacteria are carried into the interstices of multifilament fibers --> can lead to persistence of infection
(complications) which type of sutures are MORE likely to have capillarity (Wicking)? (least?)multifilament(most likely) > coated multifilament > monofilament
(complications) when should you NOT be using multifilament sutures, and why?NOT in contaminated environments, because they have capillarity/wicking where they can have bacteria living in them
(complications) what is Dehiscence?failure of sutures to hold incision closed
(complications) what are some common causes of dehiscence?apposition of unlike tissue, sutures too tight, too much tension on sutures, poor suturing technique
(complications) what is the most common result of failing to close the underlying dead space?a seroma
memorize

Suture material

Question Answer
is surgical gut aka cat gut a natural or synthetic fiber? is it mono or multifilament?natural, multi
what is surgical gut made of?made from submucosa of sheep intestine or serosa of bovine intestine (>90% collagen)
what are the two kinds of surgical gut?plain gut or chromic gut (treated with chromic acid)
what is strength loss like for surgical gut? (plain and chromic) (JUST KNOW RELATIVELY how quickly, not specific #s)Plain loses 100% by 10 days. Chromic 60% by 28 days, 80% by 60 days
how much tissue reaction is there to surgical gut? WHO is the reaction the most severe it?INTENSE reaction- it is the most reactive suture material (plain>chromic). cats have the most severe reaction (funny cause it can be called cat gut)
is surgical gut absorbable?yes
Polyglactin 910 aka?vicryl (yes it's glac, galc. vircryl's glac, glac... /tune of eminem/)
vicryl aka?polyglactin 910 (viking galaxy)
is polyglactin 910 (vicryl) natural or synthetic? is it mono or multi filament?It is a synthetic suture which can be multifilament OR braided (can also be coated or non-coated)
what is strength loss of polyglactin 910 (vicryl) like? (JUST KNOW RELATIVELY how quickly, not specific #s)30% by 14 days...complete absorption by 56-70 days
how much tissue reaction is there to polyglactin 910 (vicryl)?minimal (it's synthetic!)
what are the common uses fo vicryl (polyglactin 910)?tissues that heal with rapid increase in tensile strength (ie. ligatures, hollow organs, ophthalmic, subcutaneous tissue) (vikings can rapidly deal with a lot of tension)
*when is vicryl (polyglactin 910) most rapidly degraded?in INFECTED URINE
when would you not want to use vicryl (polyglactin 910)in repair of bladder with an INFECTION (makes material degrade really fast)
Vicryl Rapide (polyglactin 910) is different from regular vicryl how? (describe it's properties)Still synthetic, and can be braided or multifilament. HOWEVER, the suture is subjected to irradiation to increase rate of absorption (since rapide= fast= fast absorption)
what is the strength loss of vicryl rapide (polyglactin 910)? (JUST KNOW RELATIVELY how quickly, not specific #s)50% by day 5-6, almost 100% by 14 days....completely absorbed by 42 days
what is the tissue reaction of vicryl rapide like?minimal
what are common uses of vircyl rapide (polyglactin 910)?rapidly healing tissues ie) superficial mucosa, gingiva, periocular skin
Polyglactin 910 Antibacterial (AKA vircryl plus)---> how is this different from regular vircyl? what are the properities of it?it's still a synthetic braided or multifilament suture, but the "PLUS" is because it is coated with antibacterial (Triclosan –broad spectrum) to reduce risk of bacterial overgrowth at suture line; creating a zone of inhibition
what is the abx used in vircyl plus? (polyglactin 901 antibacterial)triclosan
what is strength loss like for vicryl plus? (JUST KNOW RELATIVELY how quickly, not specific #s)(as for coated vicryl)
what is the tissue reaction like for polyglactin 910 antibacterial (vircyl plus)?minimal
what are the common uses fr vicryl plus?ligatures, infected/contaminated sites, reproductive tract, oral mucosa, orthopedic, general tissue, cases at high risk surgical infection
Polydioxanone (AKA PDS/PDS plus) is it synthetic or natural? is it mono or multifilament?Synthetic, MONO filament ( PDS for single)
what is the strength like for PDS (Polydioxanone)? (JUST KNOW RELATIVELY how quickly, not specific #s)14% by 14 days, 31% by 42 days....takes ~6 months for complete absorption
what is tissue reaction like for PDS (polydioxanone)?minimal. HOWEVER, calcinosis circumscripta described in dogs (rare)
which type of suture can RARELY cause calcinosis circumscripta in dogs?PDS (polydioxanone)
when is PDS (polydioxanone) most commonly used?tissues where slightly longer-term strength is required ie) linea alba
which suture is really good for the linea alba?PDS (polydioxanone)
Polyglecaprone 25 is aka?Monocryl, Monocryl Plus (al caprone went MONO a MONO)
Monocryl, Monocryl Plus is aka?Polyglecaprone 25 (al caprone went MONO a MONO)
is monocryl (polyglecaprone) synthetic or natural? is it mono or multifilament?SYNTHETIC, MONOfilament (monocryl has monofilament!!)
what is monocryl's (polyglecaprone) strength like? (JUST KNOW RELATIVELY how quickly, not specific #s)strong initial strength...70-80% loss by day 14...complete absorption 90-120 days
what is monocryl's (polyglecaprone) tissue reaction like?minimal
what is monocryl (polyglecaprone) usually used for?tissues that heal with rapid increase in tensile strength (ie. ligatures, hollow organs, ophthalmic, subcutaneous tissue) (similar to vicryl, then)
*which sutures are NON-ABSORBABLE? (6)silk, nylon, polyester, Polypropylene, stainless steel, barbed suture material
what is silk suture made of? what are its properities/various forms available?natural and BRAIDED varieties. harvested from coccoon of silkworm. may be coated with teflon, wax, oil or silicone
what is the strength loss of silk like? (JUST KNOW RELATIVELY how quickly, not specific #s)30% loss by day 14, 50% loss by 6 months. complete absorption > 2 years (non-absorbable suture!)
what is the tissue reaction like for silk?MODERATE! (it IS a natural fiber).
which suture is the MOST reactive of the non-absorbable sutures? What other bad thing can it cause?SILK is the most reactive of the non-absorbables (because it is a natural fiber!) and it can act as a nidus for calculus formation in the bladder or gallbladder
what are common uses for silk?vascular surgery, ligatures (my silky blood vessels)
Nylon (ethilon)- is it synthetic or natural? is it mono or multifilament?SYNTHETIC-- can be MONO OR MULTI FILAMENT!!! (you can wear one stocking or two)
what is strength loss like for nylon (ethilon)-- mono or multi? (JUST KNOW RELATIVELY how quickly, not specific #s)mono -->30% by 2 years. multi --> 75% by 6 months. (THE MONO holds its strength for longer)
what is tissue reaction like for nylon (ethilon))?minimal
what are common uses of nylon? (ethilon)Skin, tendon repair (you can put your nylons on your skin, or use them as a tendon sling in a pinch if you hurt yourself while dressed up)
Polyester aka? Dacron, Mersilene,Tevdek
Dacron, Mersilene,Tevdek all aka for...?polyester
what are the properties for polyester? (synthetic or natural? mono or multifilament?)SYNTHETIC, MULTIFILAMENT +/- coating (you need multiple fibers to make a polyester jump suit)
what is the strongest suture material that isn't made of metal?POLYESTER! (indestructible polyester jump suit)
what is strength loss like for polyester? (JUST KNOW RELATIVELY how quickly, not specific #s)no loss of tensile strength!!! strongest non-metallic suture material
what is the tissue reaction like for polyester?INTERMEDIATE-- causes more reaction than any other synthetic material! (skin skin reacts to crappy polyester badly too)
which synthetic suture causes the most tissue reaction?POLYESTER (cause think about it, wouldn't a polyester jump suit kinda itch on you too?)
Polypropylene (Prolene, Surgilene)--> synthetic or natural? mono or multifilament?SYNTHETIC, MONOFILAMENT! (only need ONE (mono) person to LENE on!)
what is strength loss of polypropylene like? (JUST KNOW RELATIVELY how quickly, not specific #s)no loss of tensile strength
what is tissue reaction for polypropylene (prolene, surgilene) like?least reactive non-absorbable!
what is the least reactive non-absorbable suture?Polypropylene (lene-ing on you means I wont react badly)
what are common uses for polypropylene?vascular surgery, cruciate repair, tendon repair (I can lene on you because you are strong enough to hold me)
what are the properities of stainless steel suture? (made of? mono or multi?)made of metal, can be mono OR multifilament
what has the highest tensile strength of all suture materials?stainless steel!
what is the tissue reaction of stainless steel?LEAST REACTIVE (hypoallergenic earrings are stainless)
what are common uses for stainless steel suture?orthopedics, hernia repair
what is unique about the barbed suture?NO KNOTSS REQUIRED!!
what are the different types of barbed suture (made of what?) (2)(1) ABSORBABLE: polydiaxonone, polyglactin (2) NON-ABSORBABLE: polypropylene, nylon
(from chart) list from quickest rate of loss of tensile strength to longest?plain gut--> vicryl rapide ( polyglactin)--> monocryl (Polyglecaprone)--> Vircyl--> Chromic Gut / PDS II (tied.)--> silk
Longest Tissue healing time>Trachea > Ligament > Tendon
memorize