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52 Cards in this Set
- Front
- Back
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Characteristics of ideal suture
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-sterile
-monofilament -inert -easy to handle -secure knots -sufficient strength -inexpensive -absorbable -nontoxic -nonteratogenic -nonallergenic -noncarcinogenic |
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Knot security
-based on |
-coefficient of friction
-memory -extensibility -human factors |
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First suture material used
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-Surgical gut
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Surgical Gut
-made out of |
-submucosa of sheep intestine or serosa of beef intestine
-98% pure collagen -tanned with chromic salts to delay absorption and decrease reactivity ****should not use anymore, better stuff |
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Suture
-types |
-absorbable
-nonabsorbable -multifilament -monofilament -coated -lubricated |
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Suture size from smallest/weakest to largest/strongest
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-6-0
-5-0 -4-0 -3-0 -2-0 -0 -1 -2 -3 -4 |
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USP textile sizes
-used for what kind of sutures |
-synthetic
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Suture
-size variations |
-size nomenclature varies by manufacturer (00 = 2-0)
-strength varies in different sizes of the same suture -Suture of different materials with the same size will have different strengths |
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Suture
-general weakest size -general strongest size |
-weakest: 6-0
-strongest: 5 |
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Needle size is what?
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-% of circle
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Needles
-point types |
-taper
-cutting -reverse cutting -tapercut |
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Needles
-main needle used |
-reverse cutting needle
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Taper needles
-use |
soft tissue where dense collagenous tissue is at a minimum
-SQ -Bowel -etc |
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Cutting needles
-use |
-pierce through tough tissue such as tendon or skin
*never use near vessel or nerve |
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Swaged needles
-benefits over eyed needles |
-less trauma (small holes)
=easier to use -commercially available in packets |
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Needles
-labeling |
-many times reverse cutting needles will be labeled as needles
-look at image profile |
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Dyed suture
-benefits |
-easier to see
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Dyed suture
-prroblems |
-may "tattoo" skin of white-skinned animals
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Braunamid Suture
-reason why shouldn't be used |
-braided
-coating comes off -eyed needle |
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Multifilament
-negatives |
-drag bacteria
-knots -crimping -handling -has "capillarity": drags fluid & bacteria can hang on |
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What should never be done with braided non-absorbable suture?
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-never bury
*try to never use at all |
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Suture absorption
-Chromic catgut |
-phagocytosis
-enzymatic degredation |
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Suture absorption
-synthetics |
-hydrolysis then phagocytosis
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Strength after placement
-importance |
-long healing vs. slow healing patient
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Absorbable sutures
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-catgut
-polydioxanone (PDS) -Polyglactin 910 (Vicryl) -Polyglyconate -Polyglycolic acid -Poliglecaprone 25 (Monocryl) -Glycomer 631 -Lactomer 9-1 -Braided absorbable |
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Absorbable suture
-why is % loss after 14 days important |
-it's when collagen begins to get back to normal strength
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Are nonabsorbable sutures nonabsorbable?
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-No
-will eventually break down over time |
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Nonabsorbable suture
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-Nylon (Ethilon)
-Polybutester -Polypropylene -Polyester -Silk -Steel -Caprolactam |
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Polybutester
-reason for use |
-stretchability
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Polypropylene
-reason for use in cardiac surgery |
-least thrombogenic
-mild reactivity |
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How to make suture choice
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-what does the animal need? (health/activity level)
-what does the tissue need? (suture strength, tissue contamination, tissue type) -what are you familiar with? -what special suture characteristics? |
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Don'ts when using suture
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-don't bury monofilament nonabsorbable in contaminated areas
-don't bury caprolactam -don't use polyglycolic acid suture in the bladder -don't use surgical gut in contaminated areas -don't use suture you don't know |
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Staples
-material |
-stainless steel suture
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Staples
-benefits |
-very strong
-very fast |
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Staples
-disadvantages |
-expensive
-no advantage for wound healing |
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Specialized Staple Instruments
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-Thoracoabdominal (TA) series
-Gastrointestinal Anastomosis Device (GIA) -Ligate, Divide, & Staple (LDS) |
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Staples
-TA & GIA function |
-lay down a double or triple row of staples and then can transect the tissue between the staple lines
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Tissue adhesive
-type |
-Cyanocrylate ("superglue")
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Cyanocrylate
-catalyst |
-moisture
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Cyanocrylate
-use |
-Don't bury (non-absorbable)
-first appose tissue then place on top so that it can slough off with new keratin formation |
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Medzip
-function |
-zipper sutured onto skin to go back into opening
***WTF???? |
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BoneWax
-use |
-plug bone marrow
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GelFoam
-use |
-use for hemostasis
-initiates the clotting cascade |
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Critical elements of suturing
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-bite size = layer thickness
-distance between sutures is 2x bite -going partially through a layer will provide better apposition -apposed edges are always stronger than everting or inverting -when in doubt go with appositional |
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Muscles attached to the linea alba
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-Rectus
-External oblique -Internal Oblique -Transversus |
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When closing the linea alba, what do you not want to do?
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-bite through the rectus ----> necrosis
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If you didn't cut through the linea alba, how should you close?
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-suture outer sheath
-don't go into muscle |
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Why is ford interlocking patter never used on cats?
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-if a cat claw gets caught on it, the whole thing is tearing out
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Suture patterns used for the closing of hollow organs
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-continuous lembert
-connell -cushing |
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Tendon suture patterns
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-three loop pulley
-bunnells suture -far-near near-far -continuous cruciate pattern |
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Interrupted pattern
-benefits |
-resist tension better
-have more knots |
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Continuous suture pattern
-benefits |
-quicker to apply
-use less suture |
