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152 Cards in this Set
- Front
- Back
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suture material
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any strand of material used to ligate blood vessels or approximate tissues
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tensile strength
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the amount of tension or pull which a suture strand will withstand before it breaks
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suture with the greatest tensile strength
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stainless steel wire
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suture with the least tensile strength
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natural fibers (silk, cotton, linen)
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what is the criteria for a good suture
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must have greatest tensile strength consistent with its size limitations
must be easy to handle must be in packaging for sterile use safe to use |
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what is the goal of suturing
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wound is closed in a manner that promotes optimal healing in minimum time
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what is the size of the suture
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the diameter
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what is the accepted practice with sutures
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use the smallest diameter suture that will hold the tissue adequately
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what is the relationship between the number of O's and diameter of the suture
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as the number of O's goes up the diameter gets smaller
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what is the relationship between size and tensile strength
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the smaller the size the less tensile strength
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what is the accepted rule in regards to tensile strength
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the tensile strength is atleast as great as the tissue through which it is being placed
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monofilament sutures
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made of single stranded material
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multifilament sutures
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consist of several filaments or strands twisted or braided together
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how long does it take absorbable sutures to lose their tensile strength
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60 days
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what are absorbable sutures used for
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to hold wound edges in approximation temporarily until they have healed sufficiently to withstand normal stress
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how are abosorbable sutures digested
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by enzymes
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what happens to synthetic absorbable sutures
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hydrolyzed
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what are some of the limitations for using absorbable sutures
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fever, infection, or protein deficiency
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what might the limitations due to absorbable sutures
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speed up the absorption
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what might happen if absorbable sutures get wet while handling
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absorbtion process may begin prematurely
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what is surgical gut derived from
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sheep or cattle intima
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what is the downside to surgical gut sutures
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poor tensile strength, poor in vivo knot stadility and high tissue reactivity
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how long does surgical gut retain its tensile strength
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4 to 5 days
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what are the effects of soaking surgical gut in chromic acid salt
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delays absorption and reduces tissue reactivity
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what is preferred to surgical gut
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chromic gut due to decreased reactivity
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vicryl
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polyglactin 910 absorbable
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when does vicryl lose its tensilve strength
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most lost within 60 days after implantation beneath skin
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what are the effects of calcium stearate coating on vicryl
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superb handling and smooth tie down properties
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what is tensile strength of vicryl at 28 days
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8%
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how is vicryl degraded
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hydrolysis so minimial tissue reaction
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in what forms is vicryl available
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braided or monofilament
undyed or violet |
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what can vicryl be coated with
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plyglactin 370 or calcium stearate
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dexon was what
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first synthetic absorbable suture
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what is the tensile strength of dexon at 7, 15, and 28 days
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7=40% loss
15=80% loss 28=95% loss or 5% of original strength |
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when is dexon completely dissolved
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90-120 days
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how is dexon absorbed
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hyrolysis
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which form of dexon is easier to handle
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braided form
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what is dexon plus
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has coating for smooth knot tying and passage through tissue
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what is dexon 2
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synthetic coating of polycaprolate and has better smoothness and knot security than dexon plus
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Dexon S
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brainded and uncoated
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all dexons provide support for what time period
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3wks
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PDS
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paradioxanone
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what is the percent of original tensile strength of PDS at 2, 4, and 6 wks
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2=74% of original
4=58% 6=41% |
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where is PDS useful
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where extended wound tensile strength is required
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when does complete absorption of PDS occur
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about 180 days after implantation
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PDS is available in what forms
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dyed or undyed
monofilament |
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PDS 2
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decreased stiffness and smoother handling characteristics while keeping tensile strength
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PDS 2 is available in what colors
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violet, clear, blue
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Monocryl
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synthetic absorbable monofilament sutures
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what is moncryl ideal for
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subculicular closure, soft tissue approximation and ligations
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what colors does moncryl come in
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dyed violet and undyed
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how much of the tensile strength of monocryl is reatained at 7 and 14 days
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7=60-70% retention
14=30-40% |
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when is orginal strength of dyed monocryl lost
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by 28 days
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how much of the tensile strength of undyed moncryl is retained at 7 and 14 days
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7=50-60%
14=20-30% |
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maxon
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absorbable monofilament suture
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maxon is similar to what
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PDS (Ethicon)
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maxon strength is suprerior to what after implantation
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PDS and vicryl
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maxon has high strength for how long
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up to 21 days
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how is maxon degraded
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dyrolysis
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when is maxon completely degraded
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180-210 days
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maxon may be what
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absorbable suture of choice
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what are non-absorbable sutures made from
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non-biodegradeable materials and are encapsulated or walled off by the bodys fibroblasts
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how long do non-absorbable sutures retain their strength for
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longer than 60 days
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non-absorbable sutures are composed of what
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single or multiple filaments of metal, synthetic, or organic fibers rendered into a strand by spinning or twisting or braiding
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what type of stainless steel suture offers optimium strength, flexibility, and compatibility with implants
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316L stainless steel
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what are the disadvantages of stainless steel sutures
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difficulty in handling, possible cutting, pulling and tearing of patients tissue, fragmentation and kinking
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what type of suture is a ethilon nylon suture
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synthetic non-absorbable suture
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what are ethilon nylon sutures well suited for
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skin retention and skin closure because of elastisitity
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what colors is ethilon nylon available in
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clear, dyed green or black
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does ethilon nylon degrade
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yes 15-20% per year via hydrolysis
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what is required more in monofilament ethilon nylon than braided
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more throws in the knot
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what type of suture is prolene
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synthetic non-absorbable suture
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does prolene degenerate or weaken
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no
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what is prolene ideal for
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running intradermal closure
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what extra things are required with prolene
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extra knot throws due to extreme smoothness
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what happens to prolene when swelling receeds
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suture will remain loose
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prolene is widely used in what fields
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orthopedic and podiatric surgery
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prolene is recommended in what cases
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where minimal reaction is desired ie contaminated and infected wounds
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kieth needle
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straight needle with cutting edges
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what is a keith needle used for
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abdominal skin closure and tendon repair
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novafil is what type of suture
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synthetic non-absorbable monofilament
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what is novafil made from
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polybutester, polyglycol, and polybutylene
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what in novafil might surpass polypropylene
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stretching
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novafil has good what
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eleasticity
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when is novafil good
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when you expect wound edema
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what happens to novafil when swelling subsides
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remains tight
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silk is what type of suture
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non-absorbable suture
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what type of silk suture provides the best handling
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braided
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what is the long term tensile strength of silk in vivo
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losses all tensile strength by 1yr and cannot be detected in body after 2yrs
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what would be a better classification for silk
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slowing absorbing
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what type of suture is nurolon nylon suture
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non absorbable braided multifilament
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where is nurolon nylon used
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in tissues where multifilament non-absorbable is acceptable
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what type of suture is mersilene
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sythetic non-absorbable multifilament
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what is mersilene the first of
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synthetic braided suture to last indefinately in the body
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what is ticron
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silicone coated braided polyester suture
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ticron provides maximal what
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security in approximation of tissues under stress conditions
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ticron is similar to what
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ethibond
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ethibond is what type of suture
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synthetic non-absorbable suture multifilament
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what is advantage of ethibond to other polyester suture materials
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excellent handling characteristics with less tissue reaction
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why is ethibond not commonly used
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due to cost
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tevdek is what
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polytetrafluoroethylene impregnated polyester suture
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non-absorbable suture with greatest relative fricition coefficient
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stainless stell
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non-absorbable suture with least relative fricition coefficient
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monofilament synthetics
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non-absorbable suture with greatest tissue reaction
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monofilament polypropylene
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non-absorbable with least tissue reactivity
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natural fiber materials
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needles are made of what material
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stainless steel
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what are the types of needles
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half-curved
3/8 curved 1/2 curved 5/8 curved closed eye french eye swaged |
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what is a conventional cutting needle
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needle with triangular point and cutting edge along inner curvature of needle body
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what is a reverse cutting needle
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needles that have triangular shape thoughout their entire length and cutting edge along the outside needle curvature to prevent tissue cutout
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taper needle
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diamond needle point with round or oval body with no cutting edges
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percision point needle
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reverse cutting needles specially polished and carefully honed for plastic surgery
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when would you use blunt point needles
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helpful when performing procedures on high risk patients ie HIV
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needle holder
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surgical instrument used to hold and drive a surgical needle during suturing
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what are the different kinds of jaws on needle holders
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smooth jaws, jaws with tungsten carbide particles, jaws with teeth
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what are the key principles of suturing
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low tension on wound
proper materials and needle skin penetration 90 degrees proper tension knot tightening neelde handling |
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recommendation for deep tissue ie capsule
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cutting needle 3-O material
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recommendation for subQ layer
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taper needle 4-O material
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recommendation for dermal layer
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percision needle 5-O material
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what are suture choices for fascia
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prolene, PDS 2 (yound healthy)
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sutuer choices for muscle
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PDS 2, vicryl, prolene
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what is the caution with suture knots in muscle with thin patients
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may be felt under skin
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suture choice in subQ fat
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vicryl
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suture choices in subcuticular
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monocryl clear, vicryl
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suture choices in skin
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nylon or polypropylene (silk)
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suture choices in tendon
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prolene, ethibond, other polyesters, and nylon
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suture choices in bone
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surgical stainless steel
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suture choice for infected contaminated wounds
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non-absorbable monofilament, nylon placed in tissue but not tied
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commonly used suture in podiatry for capsule
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2-O or 3-O vicryl
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commonly used suture in podiatry for subQ
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4-O vicryl
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commonly used suture in podiatry for skin
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4-O nylon or prolene
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commonly used suture in podiatry for subarticular
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5-O vicryl clear not dyed in the skin
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single interrupted suture technique
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single stitches separately placed tied and cut
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what is the advantage of simple interrupted
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provides more secure closure because if one strand breaks the remaining sutures will wold wound edges in approximation
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what is disadvantage to simple interrupted
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time consuming
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when may simple interuppted be used
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if wound is infected because microorganisms less likely to travel along interrupted sutures
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what is vertical mattress
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needle is threaded through skin superficially then rethreaded deeper than the first and tied off in vertical position
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what is horizontal mattress
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same as vertical except from a horizontal position
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continuous suture techniques
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single suture strand is passed back and forth between the two edges of the wound to close a tissue layer tied only at each end of suture
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where does a continuous techinique derive its strength from
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from tension distributed evenly along the full length of the suture strand
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what do you need to avoid with continuous technique
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tissue strangulation
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what happens with suture breakage with continuous technique
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disrupt the entire line of continuous suture
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what happens with infection and continuous technique
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infection can be transmitted along the entire length of the strand
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bunnell stitch is used for what
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approximate two tendons
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staples are ideal for what
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large wounds
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staples leave a poor what
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scar
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dermabond
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sterile, liquid topical skin adhesive for approximation of wound edges or trauma induced lacerations or surgical incisions
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when is dermabond indicated
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when little swelling expected
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what happens to wound closure time with dermabond
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shortened by 20-50% over sutures
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dermabond is comparable to what suture
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5-O suture
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dermabond is limited to what
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extremities
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dermabond is restricted to what
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low tension areas
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dermabond may provide what
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optimal cosmetic results
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