Vsur601 Suture Types And Characteristics (Richardson Lecture)

Front 1

Knot security

Back 1

-Knot fixation and security

-Depends on several qualities
-Dependent upon technique

-Larger diameter sutures and less friction create weaker knots
-SHOULD NOT be a major problem with any commonly used suture material
-NOT usually a major factor in selection

Front 2

Drag

Back 2

-Coefficient of friction on tissues
-Multifilaments have more drag than monofilaments
-Multifilaments can be coated to decrease friction

Front 3

Memory

Back 3

-Tendency of material to hold a shape
-Continuous patterns with high memory materials tend to coil
-Monofilaments have more memory than multifilaments are are harder to handle

Front 4

Elasticity

Back 4

-"Give" without breaking

-may be a positive or a negative

Front 5

Capillarity

Back 5

-Describes the ability for fluid to be wicked along the suture thread

-Multifilament materials have higher capillarity
-Worst with smaller fiber composition suture like silk

Front 6

Rate of absorption

Back 6

-How quickly sutures dissolve

-Should be proportionate to returning strength of healing tissue

Front 7

Reactivity

Back 7

- Gauge of reactivity with the body

-Primarily a problem with “natural” materials like gut, silk and cotton

Front 8

Non-absorbable suture types

Back 8

-Nylon (Ethilon®)
-Polypropylene (Prolene®, Fluorofil®)
-Polyester (Mersilene®, Ethibond®)
-Polyethylene core with polyester “jacket” (FiberWire®)
-Caprolactam (Vetafil®, Braunamid®, Supramid®)
-Stainless Steel (wire and staples)
-Silk

-Polyethylene and polyester (Fiberwire®)
-ePTFE (GoreTex)
-Expanded poly(tetrafluorethylene)
-Linen
-Cotton
-Horse hair (mane/tail)
Ant mandibles- first staples used.

Front 9

Absorbable suture types

Back 9

-Surgical Gut
-Polyglactin 910 (Vicryl®)
-Polyglycolic Acid (Dexon®)
-Polydioxanone (PDS®)
-Polyglyconate (Maxon®)
-Poliglecaprone 25(Monocryl®)

Front 10

Stainless Steel (316 L)

Back 10

-Monofilament

-Non-absorbable

-Very poor handling

-Perfect knots
-Staples are NOT perfectly secure
-Non-Reactive
-Very strong

Front 11

Nylon (Ethilon®)

Back 11

-Monofilament (nearly always)

-Non-absorbable
-Elastic
-Non-reactive (slowly degraded)
-Mediocre handling and knotting
-Low drag
-Not particularly strong

Front 12

Polypropylene (Prolene®, Fluorofil®)

Back 12

-Monofilament

-Non-absorbable
-Poor Handling Characteristics
-Good Knotting (if tied tightly)
-Non-Reactive

Front 13

Polyester (poly[ethylene terephalate])

Back 13

-Non-absorbable

-Can be uncoated (Mersilene®) or polybutilate coated (Ethibond®)
-Braided
-VERY Strong
-Handles and knots fairly well
-Mildly reactive (trivial issue)

Front 14

Polybutester (Novafil®, Vascufil® (coated))

Back 14

-Very elastic synthetic monofilament

-Non-absorbable

Front 15

Polymerized Caprolactam/Twisted polyamide (Vetafil®, Braunamid®, Supramid®)

Back 15

-Non-absorbable

-Multifilament twisted coated fiber

-polymerized polyamide
-Good handling, excellent knotting
-Inexpensive (often used in large reels)
-Capillary
-Moderately reactive
-Loses strength slowly

Front 16

Silk

Back 16

-Non-absorbable

-Braided
-Highly capillary
-Highly reactive
-Loses strength
-Superb handling characteristics
-Virtually never the suture of choice

Front 17

Surgical gut

Back 17

-Multifilament -twisted submucosa of ruminant intestine
-Highly inflammatory
-Rapid loss of strength
-Plain or Chromic
-Chromic acid/chromum salts inhibit breakdown
-Handles well but fragile
-Good knot security (poorer in larger sizes)
-RARELY the optimal suture

Front 18

Polyglactin 910 (Vicryl®)

(copolymer of lactide and glycolide)

Back 18

-Absorbable

-Braided
-Degraded by hydrolysis
-Minimally reactive
-Good handling

-fair knotting
-Uncoated and Coated (Ca stearate)

-Dexon S and Dexon II are near equivalent

Front 19

Polydioxanone (PDS®)

Back 19

-Monofilament

-Absorbable
-Slower absorption (holds strength longer)
-Non-Reactive
-Poor Handling (high memory)
-Good knotting but slightly brittle
-Maxon® -near equivalent
-Insorb® absorbable subcuticular staples

Front 20

Poliglecaprone 25 (Monocryl®)

Back 20

-Monofilament

-Absorbable
-Moderate strength (<PDS)
-Relatively rapid absorption (>PDS)
-Minimally reactive
-Handles better than PDS
-Caprosyn® near equivalent

Front 21

Suture type needed for skin

Back 21

-Monofilament nonabsorbable (usually remove later)

Front 22

Suture type needed for subcuticular tissue

Back 22

-Braided synthetic absorbable

Front 23

Suture type needed for hollow viscera (intestines)

Back 23

-Braided or monofilament synthetic absorbable

Front 24

Suture type needed for fascia

Back 24

Synthetic absorbable (monofilament?)

Front 25

Suture type needed for ligation

Back 25

Synthetic absorbable

Front 26

Features of eyed and swaged suture needles

Back 26

eyed - reusable and economic

swaged - less traumatic and faster

Front 27

Features of tapered and cutting suture needles

Back 27

tapered - tapered to type; atraumatic

cutting - reverse or regular cutting

Front 28

Types of suture needle shapes

Back 28

1/2 circle, 3/8 circle, 1/4 circle, straight etc.

Front 29

Inverting suture patterns types

Back 29

-Cushing
-Connell
-Lembert
-Halsted
All are used in hollow viscera

Front 30

Tension reducing suture pattern types

Back 30

-Cruciate
-Horizontal Mattress
-Vertical Mattress
-Near-Far-Far-Near

-Far-Near-Near-Far

Front 31

Simple suture pattern

Back 31

-Workhorse of surgery

-Interrupted or continuous

Front 32

Subcuticular suture pattern

Back 32

-“buried” skin suture
-Engages the dermis
-Small diameter absorbable

Front 33

Ford Interlocking suture pattern

Back 33

-Attractive
-Easy to place
-Easy to remove
-Uses more suture material

Front 34

Cruciate suture pattern

Back 34

-Simplest tension holding suture

Front 35

Horizontal Mattress suture pattern

Back 35

-Strong tension suture
-Everting
-Eversion can be minimal with intradermal placement
-May affect skin margins’ blood flow
-Interrupted or continuous

Front 36

Vertical Mattress suture pattern

Back 36

-Tension Suture
-May be everting or appositional (if the inner bite is partial thickness)
-Less effect on skin edge blood flow

Front 37

Near-Far-Far-Near suture pattern (and permutations)

Back 37

-Good tension suture
-Advantage is that you do not have to “backhand” any of the bites unlike mattress patterns

Front 38

Cushing suture patterns

Back 38

-Inverting
-Sutures placed parallel with margin
-Does not penetrate lumen
-Stay close to the edge
-Place first suture “backwards”
-Continuous more common

Front 39

Connell suture patterns

Back 39

-Identical to Cushing except that the lumen is penetrated
-Penetration of lumen is less of an issue with modern suture materials

Front 40

Gambee suture patterns

Back 40

-Used in intestines
-Appositional

Front 41

Lembert suture patterns

Back 41

-Interrupted or continuous

-Inverting
-Very secure
-Bites are perpendicular to edge

Front 42

Halsted suture pattern

Back 42

-A horizontal mattress done with Lembert “bites”
-Inverting pattern holding tension

Front 43

Mayo overlap

Back 43

-Used to imbricate tissues

-Effectively shortens tissues in the direction of the tissue bites
-Result is a flat overlap instead of a plication