Suture Material & Surgical Needles
what are 3 suture complications?
-capillarity -dehiscence -seroma
what are the non-absorbable sutures? (5)
-silk -Nylon -Polyester -Polypropylene -Stainless steel
in the US, what numbers are commonly used for suture size from smallest to largest
0, 1, 2, 3,
according to dr. p which sizes are commonly used in SA sx?
2-0 or 3-0
in how many days is vicryl rapide completely absorbed?
42 days
T/F a 2-0 suture size is larger than 1
FALSE
what are 3 types of staplers?
TA stapler GIA stapler EEA stapler
what is the trade name for polyester?
mersilene
what types of tissue is vicryl used for? 4 examples?
those that heal with rapid increase in tensile strength [ligatures, hollow organs, eye, SQ)
what are 2 alternatives to suturing?
tissue adhesives surgical staples & clips
term describing the degree to which body tends to react to presence of a particular suture material
tissue reactivity
what are common uses for polyglecaprone 25 & example of tissues?
tissues that heal with rapid increase in tensile strength- ex: ligatures, hollow organs, SQ
what are common uses for polydioxanone and example of tissue?
tissues where slightly longer-term strength is required-ex: linea alba
what is surgilene used for? (5)
vascular, ophthalmic, neurologic, cruciate & tendon repairs
which absorbable sutures will lose strength first?
vicryl & vicryl rapide
how long does it take for PDS II/Plus to be completely absorbed?
~6 mo
what are 4 reasons for dehiscence to occur?
-apposition of unlike tissues -sutures too tight -too much tension on sutures -poor suturing technique
when would you NEVER use tissue adhesives? (5)
-bite wounds/heavily contaminated wounds -puncture or deep wounds -lacerations >5cm -MM -near the eye or in SQ tissues
what are advantages to staples?
-decreased sx time -secure & reliable hemostasis -can reach areas with minimal accessibility
what are advantages of swaged suture?
-decreased tissue trauma -ease of use -sterile out of package
what are the criteria for selecting needle curvature? (2)
-diameter of wound -depth of wound
accelerated absorption can occur under which conditions? (3)
-fever -infection -material becomes wet prior to implantation
what are the common uses for vicryl plus? (7)
-ligatures -infected/contam sites -repro tract -oral mucosa -orthopedic -general tissue -cases at high risk surgical infection
3 determining factors for needle selection?
-needle point -needle shape/curvature -needle size
what are the 4 types of absorbable sutures?
-surgical gut -polyglactin 910 -polydioxanone -polyglecaprone 25
what are the 4 characteristics of a needle?
-suture attachment -shape -point & cross section -size
what are the 4 characteristics of suture material
-tensile strength -pliability & memory -surface friction & knot security -tissue reactivity
what must you take into account when choosing the perfect suture material? (4)
-tissue type & healing potential -surgical environment -suture material characteristics -LASTLY-surgeon's preference
in how many days will vicryl be completely absorbed?
56-70 days
when does complete absorption of monocryl occur?
90-120 days
what property makes surgical gut super strong?
>90% collagen
T/F: barbed suture material requires knots
FALSE
T/F synthetic suture reacts more than natural fibers
FALSE- reacts less
T/F: multifilament sutures should be used in contaminated environments
FALSE- should NOT!
what is GIA stapler used for?
GI anastomosis
what type of tissue reaction does surgical gut have?
INTENSE! most reactive suture
what type of fiber is surgical gut?
Natural (made from sheep/bovine intestine)
what is the trade name for polydioxanone?
PDS II or PDS Plus
T/F: loss of tensile strength does not equal rate of absorption
TRUE
T/F: polyester causes more tissue reaction than any other synthetic material
TRUE
T/F: vicryl is rapidly degraded in infected urine
TRUE
what is the trade name for polyglactin 910?
Vicryl
Vicryl comes in 3 forms, what are they?
Vicryl Vicryl Rapide Vicryl Plus
what is the rare condition in dogs that can occur with PDS?
calcinosis circumscripta
what is the term for the process whereby fluid & bacteria are carried into interstices of multifilament fibers leading to persistent infection?
capillarity/wicking
surgical gut tissue reaction is most severe in which species?
cat
the length from needle point to swaged end on the inside of the needle is referred to as _____ length
chord length
what are the 2 lengths of needles
chord length needle length
when is tissue glue indicated? (4)
close short skin incisions small skin lacerations declaw tail dock
what can be used to decrease surface friction
coating
what tissue is spatula point needle used for?
cornea
what needle shape is most commonly used?
curved
term describing the failure of sutures to hold an incision closed
dehiscence
when is a straight needle used
easily accessible areas
what is EEA stapler used for?
end-to-end anastomosis
what method is used for absorption of natural fiber suture?
enzymatic digestion
what is the trade name for nylon?
ethilon or nurolon
why are barbed sutures not commonly used in vet med?
expensive
what is a swaged suture attachment?
eyeless, suture affixed to end of needle
what is the most common reason for seroma formation?
failure to close underlying dead space
common uses of nylon
general soft tissue approximation, ligation, cardiovascular, ophthalmic & neurological procedures
common uses of silk? examples?
general soft tissue approximation, ligation, cardiovascular, ophthalmic & neurological procedures
what type of strength loss is seen with nylon
gradual loss of tensile strength over time
what is the time for strength loss of silk?
gradual loss over time
which absorption method has less tissue reaction?
hydrolysis
what is a disadvantaged to eyed suture?
increased tissue trauma needle can be reused->more likely to become dull (?)
what conditions increase enzymatic digestion? [2]
infection & inflammation
what type of tissue reaction seen with polyester
intermediate
what is vicryl rapide exposed to in order to increase rate of absorption?
irradiation
what does a suture pack labeled "plus" indicate?
it has antimicrobial properties
advantage of eyed suture
it is cheaper than swaged suture
ability of suture material to hold a knot is referred to as
knot security
what type of tissue reaction is seen with prolene?
least reactive non-absorbable
what are hemoclips & ligaclips used for
ligation of vessels less then 11mm in diameter
what affects strength loss of surgical gut?
local environment
what defines absorbable suture?
loses >50% of tensile strength in less than 60 days
what defines a non-absorbable suture?
maintains >50% of tensile strength for greater than 60 days
what type of tissue reaction is seen with vicryl?
minimal
what type of tissue reaction does silk have?
moderate, most reactive of the non-absorbable
what is the trade name for Polyglecaprone 25?
monocryl or monocryl plus
surgical gut has what type of filament structure?
monofilament
what are the 2 types of suture structures
monofilament vs multifilament
what is the order of filament type from most to least likely to have capillarity
multifilament>coated multifilament>monofilament
what are the 2 fiber properties of silk?
natural & braided
what are the 2 types of suture fibers
natural vs synthetic
the length from needle point to swaged end on the outside of the needle is referred to as ______length
needle length
does polypropylene lose strength?
no
what type of strength loss is observed with polyester?
no loss of tensile strength- strongest non-metallic suture material
what are common uses of stainless steel? (3)
orthopedics, hernia repair, sternotomy repair
what tissue is blunt point needle used for?
parenchymal organs
what are 2 types of absorbable barbed suture? (note: non-barbed forms exist)
polydiaxonone polyglactin
what are 2 types of non-absorbable, barbed suture? (note: non-barbed forms exist)
polypropylene nylon
why should you be cautious when using silk in a bladder?
potential nidus for calculus formation
what is the trade name for polypropylene?
prolene or surgilene
in which tissues is vicryl rapide commonly used? examples (2)?
rapidly healing tissues ex: superficial mucosa, periocular skin
what is the purpose of vicryl plus being coated with antibacterial?
reduce risk of bacterial overgrowth at suture line
what needle points would you use on skin? (2)
regular cutting reverse cutting
what does pliability refer to?
related to the ease with which suture material is handled
what tissue do you use staples on & how would you apply them?
skin! apply with wound edges slightly everted
which suture has the highest tensile strength of all suture materials?
stainless steel
which suture is metallic, mono or multifilament?
stainless steel
what is the shape of the hand-held needle?
straight (keith)
what are the 5 groups of suture material classifications?
structure absorption fiber origin antimicrobial barbed suture
term relating to "roughness" of outer surface of suture or tissue "drag"
surface friction
what is an eyed suture attachment?
suture must be threaded through eye
what are the properties of polypropylene?
synthetic & monofilament
hydrolysis absorption occurs with which type of suture?
synthetic suture
what are the 3 properties of all polyglactin 910?
synthetic, braided-multifilament, coated or non-coated
what are the 2 properties of monocryl?
synthetic, monofilament
what are the 2 properties of polydioxanone?
synthetic, monofilament
what are the properties of nylon?
synthetic, multifilament (ethilon) & monofilament (nurolon)
what are the properties of polyester?
synthetic, multifilament +/- coating
which needle point would you use on muscle & tendon?
tapercut
which needle point would you use on hollow organs?
taperpoint
what does memory refer to?
tendency of a suture material to return to its original shape
is stainless steel the most or least reactive suture?
the LEAST reactive
what does tensile strength measure
the ability of a material to resist breakage
what is the swaged end of a needle?
the end attached to suture material
when is TA stapler used?
thoracoabdominal sx (lung or liver lobe resection)
