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Sx Skills - Suture Materials & Surgical Needles 1

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drraythe's version from 2016-05-05 11:09

Suture Material Intro

Question Answer
What are the 4 major suture material characteristics?(1) Tensile strength
(2) Pliability & memory
(3) Surface friction & 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 when force is applied along its length
What is pliability?Related to the ease w/ 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 ↓ surface friction
Which types of fibers cz more tissue rxns than the other?NATURAL fibers cz way more tissue rxns than synthetic suture
Surgical gut vs silk - which will cz a worse tissue rxn?The gut, bc it's made from tissue (even tho both are natural fibers!)
How do you say 2-0 & what size is it compared to size 0?It’s said as "2-ought" & it's basically like saying double-zero (00)
2-0 is smaller than 0
Which is bigger... 3 or 3-0?3 bc 3-0 is like saying 000 (tiny!)
What are the 2 ways to classify suture material based on...structure?Mono vs Multifilament
What are the 2 ways to classify suture material based on...absorption?Absorbable vs Non-absorbable
What are the 2 ways to classify suture material 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 >60 days
**What is the definition of an absorbable suture?Loses >50% of tensile strength in <60 days
How does loss of tensile strength relate to rate of absorption?They do NOT equal each other!
What are the 2 methods of absorption & which TYPE of suture material corresponds w/ the type of absorption?(1) ENZYMATIC DIGESTION → Natural fibers
(2) HYDROLYSIS → Synthetic suture
Which type of material will have an ↑ rate of absorption in the presence of infxn/inflammation?NATURAL fibers, bc this environment accelerates
ENZYMATIC digestion which is what breaks down natural fibers
Which method of absorption/corresponding suture material will cz less tissue rxn?Synthetic fibers are broken down by HYDROLYSIS, where water molecules penetrate suture material czing breakdown of suture polymer chain. This involves no enzymes, so it czs less tissue rxns
(Complications) What is Capillarity (wicking)?Process whereby fluid & bacteria are carried into the interstices of multifilament fibers → can lead to persistence of infxn
(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 & why?NOT in contaminated environments, bc 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 czs 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, multifilament
What is surgical gut made of?Made from submucosa of sheep intestine or serosa of bovine intestine (>90% collagen)
What are the 2 kinds of surgical gut?Plain gut or chromic gut (treated w/ chromic acid)
What is strength loss like for surgical gut? (Plain & 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 rxn is there to surgical gut? WHO is the rxn the most severe it?INTENSE rxn - It is the most reactive suture material (plain > chromic). cats have the most severe rxn (funny cz it can be called cat gut)
Is surgical gut absorbable?Yes, absorption is complete by 70 days
Polyglactin 910 aka?Vicryl (Vicryl sounds galactic)
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 +/- 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 rxn is there to Polyglactin 910 (Vicryl)?Minimal (it's synthetic!)
What are the common uses of Vicryl (Polyglactin 910)?Tissues that heal w/ rapid ↑ in tensile strength (i.e. ligatures, hollow organs, ophthalmic, subcutaneous tissue) (Vikings can rapidly deal w/ 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 w/ an INFXN (makes material degrade really fast)
Vicryl Rapide (Polyglactin 910) is different from regular Vicryl how? (Describe its properties)Still synthetic & can be braided or multifilament. HOWEVER, the suture is subjected to irradiation to ↑ 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 rxn of Vicryl Rapide like?Minimal
What are common uses of Vircyl Rapide (Polyglactin 910)?Rapidly healing tissues i.e.) superficial mucosa, gingiva, periocular skin
Polyglactin 910 Antibacterial (AKA Vircryl Plus) → how is this different from regular vircyl? What are the properties of it?It’s still a synthetic braided or multifilament suture, but the "PLUS" is bc it is coated w/ 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 rxn like for Polyglactin 910 Antibacterial (Vircyl Plus)?Minimal
What are the common uses for Vicryl Plus?Ligatures
Infected/contaminated sites
Reproductive tract, oral mucosa
Orthopedic

General tissue
Cases at high risk surgical infxn
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 rxn like for PDS (Polydioxanone)?Minimal. HOWEVER, Calcinosis Circumscripta described in dogs (rare)
Which type of suture can RARELY cz Calcinosis Circumscripta in dogs?PDS (Polydioxanone)
When is PDS (Polydioxanone) most commonly used?Tissues where slightly longer-term strength is reqd. I.e. 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 rxn like?Minimal
What is Monocryl (Polyglecaprone) usually used for?Tissues that heal w/ rapid ↑ in tensile strength
i.e.: ligatures
Hollow organs
Ophthalmic
Subcutaneous tissue
(similar to Vicryl)
*Which sutures are NON-ABSORBABLE? (6)Silk (natural)
Nylon
Polyester
Polypropylene
Stainless steel
Barbed
What is silk suture made of? What are its properties/various forms available?Natural & BRAIDED varieties. Harvested from Cocoon of silkworm. May be coated w/ 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 rxn 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 cz?SILK is the most reactive of the non-absorbable (bc it is a natural fiber!) & it can act as a nidus for calculus formation in the bladder or gallbladder!!! (you don't want silk worms in your bladder!)
What are common uses for silk?Vascular Sx, 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 1 stocking or 2)
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 rxn 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 rxn like for Polyester?INTERMEDIATE - czs more rxn than any other synthetic material! (skin reacts to crappy polyester badly too)
Which synthetic suture czs the most tissue rxn?POLYESTER (cz 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 1 (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 rxn 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 Sx
Cruciate repair
Tendon repair
(I can lene on you bc you are strong enough to hold me)
What are the properties 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 rxn of Stainless Steel?LEAST REACTIVE of ALL suture material (hypoallergenic earrings are stainless)
What are common uses for Stainless Steel suture?Orthopedics
Hernia Repair
What is unique about the barbed suture?NO KNOTS REQD!!
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?(quickest loss) Plain gut → Vicryl Rapide (Polyglactin) → Monocryl (Polyglecaprone) → Vircyl (Polyglactin) → Chromic Gut / PDS II → Silk (Slowest loss)
*Longest Tissue healing time?Trachea > Ligament > Tendon
memorize