Auer Ch 16 Suture

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3 ways to classify suture:

Back 1

degradation behavior (absorbable vs non absorbable), composition (natural vs synthetic), structure (mono vs multifilament)

Front 2

define absorbable suture:

Back 2

suture undergoes degradation & loss of tensile strength within 60 days

Front 3

How are natural absorbable materials degraded?

Back 3

Proteolytic enzymes

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How are synthetic absorbable materials degraded?

Back 4

Nonenzymatic hydrolysis of ester bonds (independent of inflammation) +/- phagocytosis

Front 5

What are the advantages & disadvantages of multifilament suture?

Back 5

Good handling, good knot tying, good knot security but increased capillarity, increased drag

Front 6

What are the advantages & disadvantages of monofilament suture?

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Less tissue drag, less reaction, less risk of infection, less risk of prettied loops to collapse but higher stiffness, greater memory, poorer handling (low coefficient of friction), less knot security

Front 7

What affects suture flexibility?

Back 7

torsional stiffness & diameter

Front 8

What is suture elasticity?

Back 8

Capability of a material to undergo elastic deformation under tension & return to its original length after stretching

Front 9

Define coefficient of friction:

Back 9

measure of the slipperiness of a suture that affects the tendency of the knot to loosen after it has been tied

Front 10

What is tissue drag?

Back 10

Resistance & subsequent trauma when pulled through tissue

Front 11

Define capillarity:

Back 11

process by which bacteria and fluid are carried into the interstices of a multifilament suture material

Front 12

Define tensile strength:

Back 12

force that the untied suture strand can withstand before it breaks when forces is applied in the direction of its length

Front 13

Define knot holding capacity:

Back 13

maximum load to failure when tension is applied to knotted suture material

Front 14

Define relative knot security:

Back 14

RKS (%) = (knot holding capacity/ tensile strength) x 100

Front 15

What is the difference between a regular cutting needle and a reverse cutting needle?

Back 15

Both have triangular cross-sectional area but the regular cutting has the sharp cutting edge on inner curvature of the needle point & shaft and reverse cutting has cutting edge on outer curvature of the needle point & shaft

Front 16

What is the disadvantage of the regular cutting needle?

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Placement of cutting surface can lead to cut out of tissue

Front 17

What is a taper cut needle?

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Combination of reverse cutting with a round shaft to limit cut or enlarge hole when needle passes through tissue

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What is a spatula needle?

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Flat on top and bottom of needle with cutting on the side

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What is a blunt point needle?

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Rounded, blunt point that can penetrate soft or friable tissues without cutting them

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What is loop security?

Back 20

Capability to maintain a tight suture loop as a knot is tied

Front 21

What is knot security?

Back 21

Effectiveness of the knot at resisting slippage when load is applied

Front 22

What does knot security depend on?

Back 22

Structural configuration of the knot and type of suture material

Front 23

What characteristics of suture affect knot security?

Back 23

Memory, coefficient of friction

Front 24

What are the advantages of continuous patterns?

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Smaller volume of suture material, decreased surgery time, more even distribution of tension, better holding power against stress, tighter seal of skin & hollow viscera

Front 25

What are the advantages of interrupted patterns?

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Increased security (if 1 suture fails all will not fail), precise reconstruction of irregular margins, precise control of tension, less interference with blood supply, no purse string effect on hollow viscera

Front 26

What are the advantages & disadvantages of intradermal patterns?

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No suture removal, no skin irritation, no suture track infections, excellent cosmesis but increased surgery time, less security than skin closure

Front 27

What suture materials are best for gi surgery?

Back 27

Absorbable synthetic (polyglycolic acid, polyglactin 910, polydioxanone)

Front 28

What suture materials are best for urinary surgery?

Back 28

Absorbable synthetic (if no urine exposure then poliglecapprone, if risk of urine exposure then polyglyconate or polydioxanone)

Front 29

What is the least thrombogenic suture?

Back 29

Polypropylene

Front 30

TA: how many rows of staples?

Back 30

2 (green, blue) 3 (white)

Front 31

TA: material of staples?

Back 31

Titanium

Front 32

TA: types of stapler units?

Back 32

Reuseable stainless steel OR disposable reloadable

Front 33

TA: cartridges for reuseable stainless steel stapler?

Back 33

30, 55, 90 mm

Front 34

TA: cartridges for disposable reloadable stapler?

Back 34

30, 45, 60, 90

Front 35

TA: staple types and dimensions:

Back 35

white crown width 3.0 leg length 2.5 closed height 1.0mm; blue crown width 4.0 leg length 3.5 closed height 1.5; green crown width 4.0 leg length 4.8 closed height 2.0mm

Front 36

GIA: types of stapler units:

Back 36

reusable stainless steel, disposable reloadable

Front 37

GIA: rows of staples:

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4

Front 38

GIA: staple material:

Back 38

stainless steel or titanium

Front 39

GIA: staple dimensions:

Back 39

green crown width 3.0 leg length 4.8 closed height 2.0mm blue crown width 3.0 leg length 3.8 closed height 1.5mm

Front 40

ILA: type of stapler units:

Back 40

reuseable stainless steel

Front 41

ILA: row of staples:

Back 41

4

Front 42

ILA: staple material:

Back 42

stainless steel, titanium

Front 43

ILA: staple dimensions:

Back 43

green crown width 3.0 leg length 4.8 closed height 2.0mm blue crown width 3.0 leg length 3.8 closed height 1.5mm

Front 44

LDS: size of staples:

Back 44

regular 5.8 wide x 5.2 tall 5.3 closure width 6.35 mm distance between staples or wide 8.0 wide x 7.2 tall 7.3 closure width 9.53 distance between staples

Front 45

What thickness does LDS compress tissue to?

Back 45

0.75mm

Front 46

What is the ratio of ligating clip to vessel diameter?

Back 46

The diameter of the vessel should be 1/3-2/3 the size of the clip

Front 47

Surgical gut: filament, absorption, tensile strength:

Back 47

multifilament, 2 phases: 1) molecular bonds cleaved by acid hydrolytic & collagenlytic activity 2) digestion & absorption by proteolytic enzymes; mono >14 days tensile strength, multi retains strength for 14-28 days

Front 48

Polyglactin 910: trade name, filament, absorption, tensile strength:

Back 48

vicryl, braided multifilament, 56-70 days by hydrolysis, 25% reduction in strength at 14 days, 50% at 21 days, 100% at 35 days

Front 49

Polyglycolic acid: trade name, filament, absorption, tensile strength:

Back 49

dexon, braided multifilament, 60-90 days by hydrolysis(rapid in alkaline, degradation products antibacterial), strength reduced by 35% at day 14, 65% at day 21

Front 50

Braided lactomer: trade name, filament, absorption, tensile strength:

Back 50

polysorb, braided multifilament, 56-70 days by resorption, superior to polyglactin 910 strength is 80% of original at day 14 and 30% of original at day 21

Front 51

Glycomer 631: trade name, filament, absorption, tensile strength:

Back 51

biosyn, monofilament, 90-100 day resorption time, 75% of original at day 14 and 40% of original at day 21

Front 52

Polyglytone 6211: trade name, filament, absorption, tensile strength:

Back 52

caprosyn, monofilament, complete resorption by day 56, all strength lost by day 21

Front 53

Polydioxanone: trade name, filament, absorption, tensile strength:

Back 53

PDS, monofilament, 180 day hydrolysis, 25% reduction by day 14, 30% reduction by day 28, 50% reduction by day 42

Front 54

Polyglyconate/ maxon: filament, absorption, tensile strength:

Back 54

monofilament, start hydrolysis day 60 end in 180 days, reduced strength by 25% at day 14, 50% at day 28 and 75% at day 42

Front 55

Polyglyconate/ monosyn: filament, absorption, tensile strength:

Back 55

monofilament, resorption in 60-90 days, strength reduced by 30% at day 7, 50% at day 14, 80% at day 21

Front 56

Poliglecaprone: trade name, filament, absorption, tensile strength:

Back 56

monocryl, monofilament, hydrolysis in 90-120 days, strength reduced by 50% at day 7, 75% at day 14, 100% day 21

Front 57

Nylon: trade name, filament, tensile strength:

Back 57

dafilon, mono or multifilament, mono loses 30% strength by 2 yrs, multi has no strength after 6 mo

Front 58

Polycaprolactam: trade name, filament, tensile strength:

Back 58

supramid, multifilament, no tensile strength after 6 mo

Front 59

Polyester: trade name, filament, tensile strength:

Back 59

ethibond, mono or multifilament, very high sustained tensile strength

Front 60

Ultra high MW polyethylene: trade name, filament, tensile strength:

Back 60

fiberwire, multifilament, superior strength & less elongation than polyester

Front 61

Polypropylene: trade name, filament, tensile strength:

Back 61

prolene, monofilament, moderate tensile strength

Front 62

Polybutester:

Back 62

novafil, non-absorbable monofilament

Front 63

Silk:

Back 63

braided, natural, multifilament, loses 80% tensile strength in 8 days

Front 64

Use of 4S modified roeder knot:

Back 64

sliding knot for extracorporeal laparoscopically placed suture

Front 65

Appropriate suture and size for 4S roeder knot:

Back 65

polydioxanone, polyglyconate better than polyglactin 910, polyglycolic acid. Use size 1 or 2

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1/4
3/8
1/2
5/8

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