Suturing
French eye needles have how many eyes
2, connected by a slit from the top to through the eyes, with ridges that hold the sutures in place
Synthetic polymer sutures provide wound support for
3 weeks to 6 months
How long does plain gut retain its tensile strength
7-10 days
How long does it take chromic gut to absorb
7-21 days
Composite/coated suture
A core strand of one suture material is jacketed with another of a different type
throw
A loop that forms a knot
Running suture
A method of suturing that uses one continuous suture strand for tissue approximation
Absorbable or non absorbable suture; in surgical procedures with high risk of infection because of their classification or the patients condition a strong suture line with resistance to absorption is needed
A non absorbable suture or absorbable suture with long absorption time may be used. Wounds that are actively infected are not sutured
Tie on a 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 sutures
A technique of bringing tissue together by placing individual suture close together
2-0 is an average size for what kind of tissue
Abdominal wall tissue
Absorbable or non absorbable suture; can be used on non critical tissue that heals very quickly like the mouth and epithelial tissue
Absorbable
Absorbable or non absorbable suture; suture knots or remnants that might come in contact with urine or kidney filtrate can become the source of stones or other mineral deposition so this kind of suture is used
Absorbable suture
Made from Franco compound polymers
Absorbable synthetic sutures
Quickly replaced gut suture
Absorbable synthetic sutures
When does silk begin to break down
After about one year, and usually disappears after two years
Deep tissues in a confined space require what kind of curvature
An extreme curvature
Suture materials are used to
Approximate tissues
The process of suturing two appoint tissue edges together
Approximation
Why is finished suture line strong in interrupted suture technique
Because the tension of the wound edges is distributed over many anchor points. Many interrupted stitches produce a secure suture line with minimal scarring
Why are gut sutures opened away from the field
Because they are packaged in an alcohol and water solution that can be a source of fire on the field
Least traumatic and safest needle point
Blunt needle
This needle has a round shaft and a blunt tip
Blunt needle
This needle point does not puncture the tissue but slides between tissue fibers
Blunt needle
Used for suturing tissues and organs that are soft and spongy like the liver, spleen, and kidneys it is now advocated for general suture use
Blunt needle
3 basic types of needle points
Blunt, tapered, cutting
Bioactivity
Body's response to suture
Fiber wire structure
Braided
What forms is nylon available in
Braided or monofilament strands
Virgin silk structure
Braided or twisted
Silk is soft and pliable and available in what forms
Braided or twisted form
Suture materials do what quickly in the presence of infection and certain metabolic conditions
Break down
inert
Causing little or no reaction. In tissue or with other materials
Debridement
Chemical or mechanical removal of necrotic or non viable tissue and foreign bodies following infection or trauma
Bioactivity depends on
Chemical structure of the suture material and condition of the patient
A double armed suture is used for
Circular incisions, like ophthalmic surgery, or for hollow lumens, such as blood vessels or the intestine
Polypropylene comes in what colors
Clear or blue in color
3 types of needle eyes
Closed eye, French eye( split or spring eye), atraumatic suture (swaged)
Two general types of suture techniques
Continuous and interrupted
A needle with the cutting edge on the inside of the curve
Conventional cutting needle
Has a triangular shaft, curve tends to slice tissue in upward direction
Conventional cutting needle
Selection of suture is based on
Critical nature of the tissue, healing time, required strength during healing, requirement for little or no scar formation, urinary tract, risk of infection, skin, and cosmetic closure
Measured as a circumferential fraction in a complete circle
Curvature of a needle
Needle that has a cutting edge along its shaft
Cutting needle
Needle used on fibrous connective tissue ex: skin, joint capsule, tendon
Cutting needle
Detachable suture types
De-tach and control release
Nylon passes through what kinds of tissues very easily
Delicate tissues of the eye or blood vessels
Suture used to close the skin in areas where the incision is subjected to excessive strain
Dermal silk
Non absorbable sutures
Dermalon surgilon ethilon monosof supramid, prolene, fiberwire, steel
What form is polyester suture used in and what colors does it come in
Dry state; green, blue, or white
Compliance/pliability
Ease of handling, pliability makes the suture material easier to manipulate
Vertical and horizontal mattress stitches provide
Extra security to the suture line
T/F polyester based suture is extremely weak
False
T/F polymers are used in a wet state
False
T/F polyester based suture can be monofilament or braided
False; braided
Polypropylene knots are
Flat and do not back out when placed properly
Why is silk the gold standard of suture material
For its pliability, tight knots, and ease of use
Suture packaged in alcohol and water solution
Gut
Can be dipped in saline just before use
Gut suture; prevents the suture from breaking, the suture is dipped not soaked because soaking the suture can makes it soggy and weak and it absorbs easily
Continuous or running suture
Has a knot at the beginning and the end, composed of one continuous strand of suture
Where is plain gut primarily used
In mucous membrane or in tissue where stones can form, such as the biliary or urinary systems
Sutures selected for cosmetic closure are
Inert and usually monofilament to cause the least amount of tissue injury as the suture is drawn through
Individually placed, knotted, and cut
Interrupted suture
Finished suture line is very strong
Interrupted suture technique
Highly inert sutures cause
Little or no bioactivity (inflammation)
Needle is passed through each side f the wound edges, passed underneath one loop of the suture and provides increased hemostasis on the wound edges
Locking stitch
This suture technique requires assistant or scrub to hold traction on the suture length
Locking stitch, this traction keeps the suture from backing out or becoming loose while the next stitch is being placed
Stainless steel suture is dispensed from the package as
Long, precut strands with considerable spring
When the risk of infection is high sutures with what capillarity are preferred
Low
Plasticity
Materials ability to stretch and retain a new shape. Elasticity is good as long as the suture retains its strength when stretched. Increased plasticity contributes to secure knots
Absorbable synthetic substances
Maxon, PDS II, monocryl, monocryl plus, vicryl
11-0 is commonly used in
Microsurgery, light enough to remain suspended in air
Chromic gut structure
Monofilament
Maxon structure
Monofilament
PDS II structure
Monofilament
Plain gut structure
Monofilament
Prolene
Monofilament
Stainless steel
Monofilament
Nylon structure
Monofilament and braided
Vicryl structure
Monofilament and braided
Synthetic polymer sutures are available in
Monofilament and braided form
Stainless steel is available in
Monofilament and twisted forms
Structurally what 3 categories are sutures divided into
Monofilament, multifilament, or composite/coated
Where is silk suture used
Most deep tissues, intestinal, vascular, ophthalmic, and neurosurgical procedures
Braided suture
Multiple fibers are intertwined
Twisted suture
Multiple fibers are twisted in the same direction
What suture materials cause the most tissue reaction
Natural fiber and protein based sutures
Swaged or atraumatic suture
Needle with suture preattached
Absorbable or non absorbable suture; Sutures placed in critical tissue or areas of the body like the heart, blood vessels, and respiratory tract
Non absorbable suture
Absorbable or non absorbable suture; some tissues (usually connective) are under high stress in the body, suture larger in size as well
Non absorbable suture
Used in tissues that require more than 10 days of healing time
Non absorbable suture
First synthetic suture material that's still widely used
Nylon
High tensile strength suture but in larger sizes it's stiff, difficult to handle, and may cut through tissue
Nylon
Wounds prone to infection are sutured with low Capillarity action sutures such as
Nylon or polypropylene
Non absorbable synthetic substances
Nylon, prolene, stainless steel, polyethylene (tiger wire)
Double armed suture is
One with a needle swaged to each end
What are the 3 types of polyester based sutures
PET based, PBT based, polybutester based
How is plain gut digested and how can this be bad
Plain gut is digested quickly and absorbed by tissues, but the rapid reaction can cause tissue inflammation
Absorbable sutures
Plain gut, chromic gut, virgin silk, maxon, PDS II, monocryl, monocryl plus, vicryl,
Absorbable natural substances
Plain gut,chromic gut
Polypropylenes smooth surface make it popular for
Plastic, ophthalmic, and vascular surgery
The coated form is widely used for cardiovascular surgery, because of its strength to size ratio
Polyester based suture
What suture is dyed to make it easier to see on the surgical field
Polymer, but they are available in natural color for superficial tissues
Extremely inert monofilament suture
Polypropylene
What suture has a high plasticity
Polypropylene
Synthetic coating material that resist absorption and decrease suture drag
Polytetrafluoroethylene
Needle eye
Provides the attachment site for the suture
One end of the suture is anchored and stitches are placed around 5e periphery of the open lumen, suture is then drawn tight around the neck of the lumen and tied
Purse string suture
Special continuous suture technique for closing the end of a tubular structure (lumen)
Purse string suture
Suture technique most commonly used on the abdomen
Purse string suture
Closed eye
Resembles a sewing needle but round in shape. eye hole is round, rectangular, or square
If bacteria is present suture materials with high capillarity are able to
Retain and spread infection by means of suture fibers
Heavy sutures are placed through all the tissue layers of the body wall several centimeters from the primary suture line and perpendicular to the incision
Retention sutures
Interrupted suture technique used to provide additional support to wound edges in abdominal surgery
Retention sutures
Plastic or rubber bolsters, or small lengths of tubing, are threaded through the suture to prevent it from cutting into the patients skin
Retention sutures
A needle with the cutting edge on the outside or lower edge of the curve
Reverse cutting needle
Stronger than cutting needle and produces minimal scarring
Reverse cutting needle
Rapid suture technique that alternates the needle from one side of the tissue to the other, and uses little suture material
Running suture
Dehiscence
Separation of edges of a surgical wound during healing
Suture is coated to prevent wicking, handles well, knots remain tight and secure
Silk
2 sutures that have the least memory and greatest pliability
Silk and polyester
All suture material that have the USP label should meet what standards
Size conformity, tensile strength, and sterility
Needles used in ophthalmic surgery to separate corneal and scleral tissue
Spatula needle
Side cutting needle with a flat surface on the top and the bottom
Spatula needle
Needle sharp ends and kinks easily
Stainless steel
Strongest of all suture materials
Stainless steel
This suture material must be kept straight and delivered without kinks or bends, which can tear through tissue as the strand is drawn through
Stainless steel
Used in the approximation of bone and other connective tissue
Stainless steel
Inert suture material for little or no scar formation; in some locations of the body, scarring or granulation tissue around knots can result in loss of function. Repair of structures of the hand, such as a tendon or nerve, require very inert suture materials that must pass through the tissue with no resistance or tissue fraying, even at the microscopic level.
Stainless steel (reserved for connective tissue), nylon, polypropylene are the most inert
What are the most inert all suture materials
Stainless steel, titanium, polypropylene (prolene)
Needle is placed within the dermis from side to side and brings skin edges together in close approximation, and no suture material is visible from the outside, producing very minimal scarring if any
Subcuticular suture
Suture used for cosmetic closure or in pediatric patients
Subcuticular suture
Hemostatic agent
Substance applied to bleeding tissue in order to enhance clotting.
It is the only naturally occurring absorbable suture commonly used in the United states
Surgical gut aka catgut
Protein collagen derived from the submucosal layer of beef or sheep intestine
Surgical gut aka catgut
Absorbable suture
Suture material that is broke down and metabolized by the body
Non-absorbable suture
Suture material that resists breakdown in the body
Wicking
Sutures made of multifilament strands absorb moisture and hold body fluids
Memory of suture
Sutures tendency to retain its original shape or configuration after it is removed from the package
Reverse cutting edge at the tip and a round body
Taper cut needle
Used for suturing dense fibrous, connective tissue ex: fascia, tendon, peritoneum
Taper cut needle
Primarily used for suturing soft tissue like subcutaneous fat, dura, GI, and vascular tissue
Tapered needle
Round body with a tapered sharp point
Tapered needle
This needle punctures tissue making an opening for the body of the needle to follow
Tapered needle
What is the most important quality of a suture
Tensile strength
Suture materials used in the US must be approved by
The FDA and USP (United States pharmacopeia)
Capillary action
The ability of suture material to absorb and wick fluid
Tensile strength
The amount of force needed to break the suture
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 the needle.
Weakest point of a suture
The knot, suture material becomes 10-40% weaker at the knot
anastomosis
The surgical creation of an pending between two blood vessels, hollow organs, or ducts
Detachable suture means
The suture can be detached from the needle by pulling it straight back from the swage
The loop of the knot is also referred to as a
Throw
approximate
To bring tissues together by sutures or other means
Ligate
To place a loop or tie around a blood vessel or duct
What is the primary use of sutures
To repair or reconstruct tissue
Used for very delicate retraction in situations where the edges of the tissue being sutured need to be elevated slightly or simply held in tension
Traction suture
What antiseptic can be incorporated into absorbable synthetic suture
Triclosan
T/F absorbable synthetic sutures are highly inert
True
T/F chromic gut and plain gut are rapidly broken down in the presence of infection
True
T/F most commercial needles are now manufactured with the suture preattached
True
T/F nylon is a highly inert suture material
True
T/F polypropylene can be used when infection is present and left in place for extended periods of time
True
T/F the interrupted suture technique is stronger than a continuous suture technique
True
A multifilament suture can be divided into two types
Twisted, braided
Sutures must be what in diameter to maintain tensile strength
Uniform
Mainly used for ophthalmologic procedures because of its pliability and performance in eye tissue
Virgin silk
Non absorbable natural substances
Virgin silk
When are detachable sutures used
When the surgery calls for rapid placement of multiple interrupted (individually tied) sutures Ex: anastomosis
Monofilament suture
a single continuous fiber made by extruding and stretching a synthetic material.
Multifilament suture
many filaments that together form one strand of suture
Evisceration
protrusion of viscera through an incision
The size of the suture material indicates the
smaller the number, the larger the diameter, the size of the suture indicates strength and application
Suture material can be made from
synthesized chemicals, animal protein, metal, and natural fibers
