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68 Cards in this Set

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Ideal suture
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
Suture size theory
1.Use smallest diameter that will adequately hold tissue

2. Suture need b no stronger than sutured tissue
Suture - smallest to largest
10.0 smallest - hairlike
5.0
3.0
2.0
0
#1 - #7
Appropriate suture size for skin tissue
2.0 or 3.0 skinn
3.0 - small animals
Suture list from most flexible to least flexible
Silk > Braided polyester> nylon & surgical gut
Suture surface & coating
1. amount of drag
2. Amount of tissue trauma
3. rough - more tissue damage
4. smooth - need more tension * less knot security
By surface - tyes of sutures
1. Monofilaent - most smoot
2. Braided - more drag
3. Coated braided - more smooth, less capillarity,
Types of coatings on braided suture
1. Teflon
2. silicone
3. wax
4. calcium stearate
Define capillary
process x which fluid & bacteria are carried into the interstices of multifilament fibers`
Which sutures are capillary
all braided materials
When should cappilary suture maerial NOT be used
in contaminated or infected sites
What is tensile strength
measured by force (in pounds) that the suture strand can withstand BEFORE breaking when knotted
Define knot security
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
define absorable suture material
little if any tensile strength after 60 days
What does coating suture material achieve
reduces capillary
What is the process of absorption
1. enzymatic degradation & phagocytosis
2. Hydrolysis
What 2 factors influencing absorbability of sutures

& which is most important(*)
*1.loss of tensile strenth
2.rate of absorption
Which suture material creates the most tissue reaction
1. Foreign protein material - gut & silk - most

2. monofilament synthetic - least
List of most to least reactivity of suture material
gut > synthetic multifilament > synthetic monofilament > metal
Why is tissue reaction to sutures so important
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
Name 3 synthetic suture types
1, polyglycolic acid PGA - Dexon (BRAIDED)
2. Polyglactin 910 - vicryl(BRAIDED)
3. polydioxanone - PDS (MONOFILAMENT)
Examples of nonabsorbable suture material
1. silk
2. stainless steel
Examples of natural absorbable suture material
Surgical gut

1. collagen strips of sheep. hog or beef
2. tanning makes it stronger
Advantages ofnatural absorbable suture material
1. absorbed by phagoytosis
2. nat. gut absorbed in 3-5 days
3. easy to handle, doesn't shrink, doesn't strngulate
Disadvantages of natural absorbable suture material
1. marked inflammatory response
2. harbors bacteria
3. absorbs water
4. swells resulting in loosening of knotw
Difference btwn absorbable vs. non - absorbable
Time
absorbable - few months
non- absorbable - few years
PGA points of interest
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
Vicryl points of interest
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
PDS points of interest1
1.polydioxanone
2. synthetic MONOfilament
3. absorption w/in 180 days
4. Good fro slow healing tissues
Downside:
1. $$$, greter memory
Least to most damage of suture to steam sterilization
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
Natural Types of non-absorbable suture
1. silk
2. stainless steel
Syntheic types of non-absorbable suture
1. Nylon (ethilon
2. Polypropylene - Prolene
3. Polybutester - novafil
4. polyester
5. polymerized caprolactum - vetafil, braunamid
Suture tips
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
Disadvntages of nylon
1.poor handling,
2. poor knot security
Advantages of prolene (polypropylene
1. doesn't weaken in time
2. good for permenant sutures are needed
Advantages of nylon
1. Inexpensive
2. strong
3. insites minimal tissue reaction
Best use of polybutester (novafil
1. repair of ligaments & places where you need stretch
Types of polyester
1. coated- tevdek & ticron
2. uncoated: mersilene, dacron
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
Advantages of polymerized caprolactum
1. high tensile strength
2. low tissue reaction
Examples of polymerized caprolactum
1. vetafil
2. braunamid
disadvantages of polymerized caprolactum
same as polyester
1. Tissue drag
2. > tissue reaction (esp uncoated)
3. chronic infection
4. drainig fistulae are possible
Types of needles
1. eye needles -
2. swayed needle (suture material implanted
PoI of eye needles
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
PoI of swayed needle
1. smoother stitching b/c narrower
2. good for cardio vascular & GI sx

Disadvantages: $$$$
Needle configuration (shape)
1. straight
2. curved
3. half curved
4.half circle
Types of needle points
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
Best needles to inprove your technique
1. reverse cutting
2. cutting needle
Name of a eyeless needle
swayed
Which of the ff is NOT a type of needle point
a. reverse cuting
b. taper
c. side cuttin
d. swayed
D. swayed
An example of nonsnthetic absorbable suture material is
a. surgical gut
b. PDS
c. Silk
d. nylon
a. surgical gut
What is scientific name for Vetafil
caprolactrum
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
Which suture size is best for eye sx
6-0
What is the advantage of monofil overmultifil
Passes thru tissue more easily.

Suture eaction is due to suture material - not whether mono or multi
Which of ff isan absorbable suture material
a. PDS
b. prolene
c.. silk
d. cotton
a. polydioxanone (PDS)
Factors affecting suture absorption
1. presence of infection - fster
2. location of suture -pancreas
3. composition of suture material - catgut over polyglactin
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
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
Which eedle type is resuable
eyed
What are major criterion to classify suture material
1.absorbable vs. non
2. syntheic vs. natural
3. braided vs.mono
Advantage ofnraided suture ove monofil
Better friction & knot security
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
When should you NOT use cutting edge needles
when an air-tight or watertight suture line is required
* lung, urinary bladder, instetine
When to use cuttign - edged needle
skin, eye tissuem some facial tissue
When to use reverse- cutting needles (K needles)
sometimes referred b/c of increased needle shank strength
When to use taper needles
spread open tissue ( not cut) so avoids hemorrhage & sealed suture line

Hollow organs
Needles used to suture hollow organs
1. taper & reverse cutting