Sutures

What size sutures are used for Microsurgery and ophthalmic surgery?

11-0 to 6-0

What size sutures are used for retention sutures?

2-7

What size sutures are used for general closure and OBGYN?

4-0 to 2

What are the B&S sizes from smallest to largest?

40 & 38, 35, 34 & 32, 30, 28, 26, 25, 24, 23, 22, 20, and 18

What are the USP sutures sizes from smallest to largest?

6-0 to 7

What size sutures are used in plastic and cuticular surgery?

7-0 to 2-0

Loop suture

A laparoscopic continuous suture strand attached to a needle with a loop on the end of the needle that allows the stitch to be pulled tight

Suture Reel

A spool or reel of suture material wound into a round reel, used when multiple ties are needed in quick succession is called

3 characteristics of sutures

Absorbable/Nonabsorbable, Natural/Synthetic, and Monofilament/Multifilament

How does absorption differ from bioactivity?

Absorption describes how the suture reacts in the presence of body tissue, whereas bioactivity is the body's response to the suture

What types of sutures will not degrade in the presence of infection?

All types of sutures except metal can degrade if infection is present

V-Loc

An absorbable thread, essentially a barbed Maxon suture that gets introduced into the pelvis through the tube.

What are the advantages and disadvantages or a continuous suture?

An advantage is that it is rapid and doesn't use much material. However, if one point along the suture breaks during healing, the entire strand may pull out

Three uses for sutures

Approximation, ligation and anastomosis

What structure(s) heal rapidly/quickly and should be closed with an absorbable suture?

Biliary tract and Peritoneum

Five types of needle points

Blunt Tapered Cutting Tapercut Spatula

B&S

Brown and Sharp

What sutures comes in, and should bathe in the pack until ready for use?

Chromic or Gut

What kind of sutures are used for cosmetic procedures?

Clear, inert, monocryl,

What type of stitch is a purse string suture?

Continuous

Acronym CR type on suture package represents

Control release

What type of needle is used on the skin, tendons, or ligaments?

Cutting

Type of needle preferred for suturing the skin?

Cutting needle

What layer heals slowly, is the strength of the abdominal wall and is closed with absorbable sutures?

Deep fascia

Name 7 nonabsorbable synthetic suture substances

Dermalon, Surgilon, Ethilon, Prolene, V-Loc, Fiber/Tiger wire, Stainless steel

Which suture strands are nonabsorbable, natural, multifilaments?

Ethibond and Silk

Multifilament

Ethilon, Vicryl, Silk, Fiber/Tiger wire

What anatomical structure heals rapidly and may leak?

GI tract

When are stainless steel sutures used?

General closure, retention sutures, neuro surgery, tendon repair, and orthopedics

Rentention sutures

Heavy suture material is placed through the skin and carried down to the fascia or peritoneum and brought up through the layers on the opposite side After the abdominal layers are closed, the two ends are brought together and threaded through bolsters that distribute the pressure of the closure

What type of sutures are placed in areas that are under the skin, individually placed, knotted and cut?

Interrupted sutures

Four types of needle eyes

Introduction Control-Release Suture Double-Armed Suture Free Needle

Two types of needle curvatures

Introduction Keith Needle

What structure(s) heal rapidly, has little connective tissue so sutures don't tend to hold, and are closed with absorbable sutures?

Liver, Kidney and Spleen

Name 4 absorbable synthetic suture substances

Maxon, PDS, monocryl, and vicryl

Which suture strands are absorbable, synthetic, monofilament sutures?

Monocryl and Vicryl

Monofilament

Monocryl, Prolene, PDS, Steel, Gut (Plain or Chromic), Maxon

Name 5 absorbable sutures

Monocryl, Vicryl, PDS II, Chromic & Gut

Acronym MS typed on suture pack represent

Multiple strands

What layer heals slowly, tends not to loose strength if split rather than cut, is usually closed with nonabsorbable suture but can be closed with absorbable suture?

Muscles

French or Spring eye

Needle eye that has two eyes connected by a slit from the top through the eyes with ridges that holds the suture in place

Swage eye

Needle eye that is pre-attached suture to the needle

Closed eye

Needle eye that looks like a sewing needle and the hole shape is round, rectangular, or square

Critical areas of the body, and connective tissues require what type of suture?

Nonabsorbable

The serosal layer of the GI tract should be closed with what type of suture?

Nonabsorbable

When doing an anastomosis, what type of suture would you use?

Nonabsorbable

cause little or no tissue reaction and pass very easily through delicate tissues of the eye or blood vessels; has a very high tensile strength, but the tensile strength does break down over time.

Nylon

Three sutures that have memory or recoil

Nylon Prolene and Chromic

Name a nonabsorbable synthetic suture substance

Permahand/Silk

Two absorbable natural suture substances

Plain gut and Chromic gut

are extremely strong, easy to handle, and relatively inert in tissue.

Polyester

extremely inert monofilament suture. Its smooth surface makes it popular for plastic, ophthalmic, and vascular surgery. Because of its high tensile strength, it is used for retention sutures, particularly in abdominal wall closure.

Polypropylene

knots are flat and do not tend to back out when placed properly. However, it is hard to manage in larger sizes.

Polypropylene

In vascular surgery, you should wet the surgeons hands when using what suture to release it's memory?

Prolene

Name 3 types of barbed sutures

Quill SRS, V-Loc, Stratafix

What type of sutures are used in areas where great strength is required to add support to the closure

Retention sutures

have great tensile strength and are very flexible

Silk

3 natural sutures

Silk, Cotton, Stainless steel

Name 4 nonabsorbable sutures

Silk, Prolene, Ethibond & Stainless steel

What structure heals fairly slowly, but is fairly touch and is closed with nonabsorbable suture?

Skin

Brown and Sharpe (B&S) is found on what type of suture material?

Stainless steel

Identify the suture strand that kinks easily, and the ends are needle-sharp

Stainless steel

What is the most inert suture?

Stainless steel

are the strongest and have almost no inflammatory properties. However, it kinks easily and the sharp ends can puncture gloves and drapes.)

Stainless steel

What layer does not tolerate suture well, but usually requires a few absorbable sutures to eliminate dead space?

Subcutaneous fat

What layer heals slowly, and has the greatest strength?

Superficial fascia

What type of needles are used inside the body?

Tapered

Why is the blunt needle now advocated for general suture?

The blunt needle now is advocated for general suture use because it significantly reduces the risk of needlestick injury and transmission of blood-borne diseases

What factors affect bioactivity?

The chemical structure of the suture material and the condition of the patient affect bioactivity

USP

U.S. Pharmacopeia

How are old sutures removed?

With a straight, fine hemostat. If the surgeon needs to cut the suture, use either a fine tipped suture scissor or a #11 blade

Purse string suture

a continuous suture technique for closing the end of a tubular structure [lumen], such as the appendix, it's most common application. One end of the suture is anchored, and stitches are placed around the periphery of the open lumen. The suture is drawn tight around the neck of the lumen and tied.

Throw

a loop that forms a knot

Running suture

a method of suturing that uses one continuous suture strand for tissue approximation

Monofilament

a single continuous fiber made by extruding and stretching a synthetic material

Suture reel

a spool of suture material is wound into a round reel. The reel is used when multiple ties are needed in quick succession.

Tie on passer

a strand of suture material attached to the tip of an instrument

Tapered needle

a suture needle that has a round body that tapers to a sharp point

Interrupted suture

a technique of bringing tissue together by placing individual sutures close together

Quill barbed suture

a time-saving closure device that eliminates the need to tie knots to secure the closure.

Retention suture

a type of interrupted technique used to provide additional support to wound edges in abdominal surgery; heavy sutures are placed through all the tissue layers of the body wall several centimeters from the sliding off the vessel.

Subcuticular suture

a type of running suture, used for cosmetic closure and in pediatric patients; the needle is placed within the dermis from side to side bringing the skin edges together with no suture material visible from the outside

what type of procedures would retention sutures be used for

abdominal procedures

The submucosal layer of the GI tract should be closed with what type of suture?

absorbable

Stratafix

an absorbable, monocryl, antibacterial, knotless tissue control device developed to facilitate soft tissue approximation by providing the performance characteristics and wound holding security of conventional PDS™ Plus Suture with added features that offer increased efficiency and control

Inert

causing little or no reaction in tissue or with other materials

What type of tissue are toothed forceps used on?

connective tissue, including the skin

What is the subcuticular or buried stitch used for?

cosmetic closure or pediatric patients

When are double-armed needles used?

for circular tissue, such as in ophthalmic surgery, or for hollow structures, such as blood vessels or the intestine

Traction suture/bridle suture

in ophthalmic surgery, a temporary traction suture placed through the sclera used to pull the globe laterally for exposure of the posterolateral surface. It is called this because of its resemblance to the reins of a horse's bridle

biological environment

inert; multifilament

Multifilament

many filaments together form one strand of suture; can be further classified as twisted or braided

In what types of wounds are silk sutures used?

most deep tissues, especially in intestinal, vascular, ophthalmic, and neurosurgical procedures

What type of tissue are smooth forceps used?

mucous membrane organ tissue [e.g., the spleen and kidneys] and on any tissue that bleeds easily

Braided

multiple fibers are intertwined

Twisted

multiple fibers are twisted in the same direction

Double armed suture

one pack contains a single suture strand with a needle attached at each end

Dehiscence

separation of the edges of a surgical wound during healing

Vessel clip

stainless steel, titanium, or plastic device that is placed over a blood vessel to occlude it; an alternative to the suture tie.

Absorbable suture

suture material that is broken down and metabolized by the body [gut, chromic, compound polymers, synthetic, natural biologic, ]

Nonabsorbable suture

suture material that resists breakdown in the body [silk, nylon, polyester, polypropylene, Gore-Tex, stainless steel]

Capillary action

the ability of suture material to absorb fluid

Tensile strength

the amount of force or stress a suture can withstand before breaking

Swage

the area of an atraumatic suture where the suture strand is fused to a needle

Subcuticular suture

the needle is threaded close to the surface of the skin but not through it

Evisceration

the protrusion of abdominal viscera though a wound or surgical incision

What is surgical gut derived from?

the submucosal layer of beef or sheep intestine

Control release suture

the surgeon releases the suture from the swage by pulling straight back sharply

Continuous sutures

the suture is first pulled to nearly its full length at one end of the incision, and the short end is either knotted or secured with a hemostat; the suture is pulled snug with each stitch

What type of wounds might surgical gut be used?

tissues that heal rapidly

Ligate

to place a loop or tie around a blood vessel or duct

Why are plastic or rubber bolsters used

to prevent it from cutting into the patient's skin

What are stick ties used for?

to tie off a tubular structure or vessel

Knot security

type of knot, throw or tie of strand

Double armed sutures

used to approximate blood vessels or other circular structures

The superficial fascia is closed with what type of suture?

usually nonabsorbable, but may be absorbable

Two types of interrupted sutures

vertical and horizontal mattress suture

What structure is closed with either absorbable or nonabsorbable suture that heals rapidly and may ooze?

vessels