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68 Cards in this Set
- Front
- Back
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Ideal suture
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1. easy to handle
2. react minimully in tissue 3. Inhibit bacterial growth 4.Hold securely whenknotted 5. Resist shrinking when knottd 6. Non caillary 7. Nonallergenic 8. Non carcinogenic 9. Absorb w/ minimal tissue reaction after tissue has healed |
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Suture size theory
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1.Use smallest diameter that will adequately hold tissue
2. Suture need b no stronger than sutured tissue |
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Suture - smallest to largest
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10.0 smallest - hairlike
5.0 3.0 2.0 0 #1 - #7 |
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Appropriate suture size for skin tissue
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2.0 or 3.0 skinn
3.0 - small animals |
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Suture list from most flexible to least flexible
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Silk > Braided polyester> nylon & surgical gut
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Suture surface & coating
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1. amount of drag
2. Amount of tissue trauma 3. rough - more tissue damage 4. smooth - need more tension * less knot security |
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By surface - tyes of sutures
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1. Monofilaent - most smoot
2. Braided - more drag 3. Coated braided - more smooth, less capillarity, |
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Types of coatings on braided suture
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1. Teflon
2. silicone 3. wax 4. calcium stearate |
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Define capillary
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process x which fluid & bacteria are carried into the interstices of multifilament fibers`
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Which sutures are capillary
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all braided materials
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When should cappilary suture maerial NOT be used
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in contaminated or infected sites
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What is tensile strength
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measured by force (in pounds) that the suture strand can withstand BEFORE breaking when knotted
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Define knot security
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1.holding capacity of suture expressed as a % of its tensil strength
2.Strength required to untie or break a defined knot x loading part of the suture loop |
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define absorable suture material
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little if any tensile strength after 60 days
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What does coating suture material achieve
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reduces capillary
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What is the process of absorption
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1. enzymatic degradation & phagocytosis
2. Hydrolysis |
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What 2 factors influencing absorbability of sutures
& which is most important(*) |
*1.loss of tensile strenth
2.rate of absorption |
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Which suture material creates the most tissue reaction
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1. Foreign protein material - gut & silk - most
2. monofilament synthetic - least |
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List of most to least reactivity of suture material
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gut > synthetic multifilament > synthetic monofilament > metal
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Why is tissue reaction to sutures so important
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1. Impedes healing of normal tissues
2. Presence of infection or contaminaation has greater fx on the more reactive sutures ( gut breaks down faster in infected tissue 3. Nonabsorb & some synthetic can act as nidus for stone formation in the lumen of organs in urinary & biliary tract |
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Name 3 synthetic suture types
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1, polyglycolic acid PGA - Dexon (BRAIDED)
2. Polyglactin 910 - vicryl(BRAIDED) 3. polydioxanone - PDS (MONOFILAMENT) |
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Examples of nonabsorbable suture material
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1. silk
2. stainless steel |
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Examples of natural absorbable suture material
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Surgical gut
1. collagen strips of sheep. hog or beef 2. tanning makes it stronger |
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Advantages ofnatural absorbable suture material
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1. absorbed by phagoytosis
2. nat. gut absorbed in 3-5 days 3. easy to handle, doesn't shrink, doesn't strngulate |
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Disadvantages of natural absorbable suture material
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1. marked inflammatory response
2. harbors bacteria 3. absorbs water 4. swells resulting in loosening of knotw |
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Difference btwn absorbable vs. non - absorbable
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Time
absorbable - few months non- absorbable - few years |
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PGA points of interest
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1. synthetic polyester in fine fils & braided
2. absorbed by hydrolysis - 3. not affected by infected or inflamed tissue 4. stronget than gut for at least 15 days DownSIde 5. harder to handle than gut 6. can saw thru tissue |
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Vicryl points of interest
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1. polyglactin 910
2. synthetic braided material 3. copolymer of glycolic & lactic acids 4. more hydrophobic than PGA - slower to hydrolyze 5.Easy to handle, min tissue damage, good knot security |
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PDS points of interest1
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1.polydioxanone
2. synthetic MONOfilament 3. absorption w/in 180 days 4. Good fro slow healing tissues Downside: 1. $$$, greter memory |
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Least to most damage of suture to steam sterilization
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3 autoclaves w/o tensile strength damage
1. polyester, 2.nylon, 3.polypropylene, 4.metalics Mild damage: 1. silk 2. caprolactum Severe damage 1. gut 2. polyethylene 3. ODS 4. Vicryl (polyglactin |
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Natural Types of non-absorbable suture
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1. silk
2. stainless steel |
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Syntheic types of non-absorbable suture
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1. Nylon (ethilon
2. Polypropylene - Prolene 3. Polybutester - novafil 4. polyester 5. polymerized caprolactum - vetafil, braunamid |
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Suture tips
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1. strength of material no greater than strength of tissue to stitch
2. relative knot security decreases as suture size increases 3. in buried knot: * multifil or metl - cut close * monofil w/ emory & polyester - leave 3-4 mm to prevent untying * skin sutures - lv 0.5 - 1.0 cm to aide suture removal |
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Disadvntages of nylon
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1.poor handling,
2. poor knot security |
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Advantages of prolene (polypropylene
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1. doesn't weaken in time
2. good for permenant sutures are needed |
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Advantages of nylon
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1. Inexpensive
2. strong 3. insites minimal tissue reaction |
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Best use of polybutester (novafil
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1. repair of ligaments & places where you need stretch
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Types of polyester
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1. coated- tevdek & ticron
2. uncoated: mersilene, dacron |
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Advantges of polyester
Disadvantages |
1. good handing but needs lots of throws to knot securely
1. Tissue drag 2. > tissue reaction (esp uncoated) 3. chronic infection 4. drainig fistulae are possible |
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Advantages of polymerized caprolactum
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1. high tensile strength
2. low tissue reaction |
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Examples of polymerized caprolactum
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1. vetafil
2. braunamid |
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disadvantages of polymerized caprolactum
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same as polyester
1. Tissue drag 2. > tissue reaction (esp uncoated) 3. chronic infection 4. drainig fistulae are possible |
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Types of needles
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1. eye needles -
2. swayed needle (suture material implanted |
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PoI of eye needles
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1. can be reused as long as not bent or broken
2. Disadvantages: increased drag thru tissue 3. Fench eyed - has 2 holes 0 more secure hold on suture material |
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PoI of swayed needle
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1. smoother stitching b/c narrower
2. good for cardio vascular & GI sx Disadvantages: $$$$ |
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Needle configuration (shape)
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1. straight
2. curved 3. half curved 4.half circle |
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Types of needle points
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1. tapered - separates cells instead of cutting them -
* more drag but less damage 2. Reverse cutter - MORE COMMON * corrects for change 3. cutting needle - * each corner is cutting * has surface * disadv: may cut larger hole than tissue 4. we wil never see |
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Best needles to inprove your technique
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1. reverse cutting
2. cutting needle |
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Name of a eyeless needle
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swayed
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Which of the ff is NOT a type of needle point
a. reverse cuting b. taper c. side cuttin d. swayed |
D. swayed
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An example of nonsnthetic absorbable suture material is
a. surgical gut b. PDS c. Silk d. nylon |
a. surgical gut
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What is scientific name for Vetafil
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caprolactrum
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which of the ff suture mat is persists int eh body for the longest time
a. PDS b. Prolene c. Chromic cat gut d. vicryl |
b. prolene - non-absorbable
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Which suture size is best for eye sx
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6-0
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What is the advantage of monofil overmultifil
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Passes thru tissue more easily.
Suture eaction is due to suture material - not whether mono or multi |
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Which of ff isan absorbable suture material
a. PDS b. prolene c.. silk d. cotton |
a. polydioxanone (PDS)
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Factors affecting suture absorption
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1. presence of infection - fster
2. location of suture -pancreas 3. composition of suture material - catgut over polyglactin |
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Which of the ff are mose likely to cause stitch granulomas if left too long
a. silk b. cotton c. nylon d. prolene |
c. nylon
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Rank teh following from greatest to least tensile strength
a. 00 gut, 3-0 Vicryl, 1 chromic gut, 6-0 silk b. 1chromic gut, 00 gut, 3-0 vicryl, 6-0 silk c. 60 silk, 3-0 vicry, 00 gut,1 chromic gut d. 6-0 silk, 3-0 Vicryl, 1chromic gut, 00 gut |
B. 1 chromic gut, 00 gut, 3-0 Vicryl, 6-0 silk
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Which eedle type is resuable
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eyed
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What are major criterion to classify suture material
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1.absorbable vs. non
2. syntheic vs. natural 3. braided vs.mono |
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Advantage ofnraided suture ove monofil
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Better friction & knot security
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Which of the ff is nonabsorbable suture, less than 2-0 in size
a. 3-0 chromic gut b. 4-0 silk c. 99 dermalon nylon d. 0 polydioxanone (PDS |
b. 4-0 silk
REMEMBER SIZE IS IN REVERSE |
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When should you NOT use cutting edge needles
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when an air-tight or watertight suture line is required
* lung, urinary bladder, instetine |
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When to use cuttign - edged needle
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skin, eye tissuem some facial tissue
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When to use reverse- cutting needles (K needles)
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sometimes referred b/c of increased needle shank strength
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When to use taper needles
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spread open tissue ( not cut) so avoids hemorrhage & sealed suture line
Hollow organs |
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Needles used to suture hollow organs
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1. taper & reverse cutting
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