Auer > Chapter 16 - Suture Materials and Patterns > Flashcards

Chapter 16 - Suture Materials and Patterns Flashcards

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1
Q
  1. Name the 3 categories of classification for suture
A
  • degradation behavior (absorbable vs. nonabsorbable)
  • composition (natural vs. synthetic)
  • structure (monofilament vs. multifilament)
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2
Q
  1. Define absorbable suture
A
  • undergoes degradation and lose most of their tensile strength within 60 days.
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3
Q
  1. Name 3 things that mediate suture degradation
A
  • hydrolysis
  • enzymatic digestion
  • phagocytosis
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4
Q
  1. Define nonabsorbable suture
A
  • not significantly degraded after implantation and are indicated where extended wound support or implant function is required.
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5
Q
  1. T/F: Natural suture material is degraded by nonenzymatic hydrolysis of ester bonds whereas synthetic suture material is degraded by proteolytic enzymes
A
  • F, natural by enzymes, synthetic by hydrolysis
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6
Q
  1. Name 3 substances suture can be made from
A
  • naturally occurring substances
  • synthetic polymers
  • metallic fibers
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7
Q
  1. Define multifilament suture
A
  • composed of several filaments twisted or braided together.
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8
Q
  1. Name 3 advantages of multifilament suture
A
  • good handling
  • good knot tying
  • better knot security
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9
Q
  1. T/F: Multifilament suture can be coated to reduce drag. The coating decreases knot security
A
  • True
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10
Q
  1. Name 3 disadvantages of multifilament suture
A
  • increased capillarity
  • facilitates penetration of bacteria
  • increases drag resistance while being pulled through tissue
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11
Q
  1. Name 4 advantages of monofilament suture
A
  • lower tissue drag
  • less risk of infection
  • reduced tissue reaction
  • less tendency of pretied loops to collapse
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12
Q
  1. Name 4 disadvantages of monofilament suture
A
  • higher bending stiffness, greater memory, lower coefficient of friction
  • poorer handling properties
  • less knot security
  • stiff cut ends can cause tissue irritation and mucosal ulceration
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13
Q
  1. What determines the flexibility of suture?
A
  • torsional stiffness and diameter of suture
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14
Q
  1. What is elasticity?
A
  • the capability of a material to undergo elastic deformation under tension, returning to its original length after stretching
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15
Q
  1. T/F: High suture elasticity will allow it to stretch with edema but return to its original size once the swelling has decreased
A
  • True
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16
Q
  1. The surface characteristics of suture determine the ____ and ____ of the suture
A
  • tissue drag
  • coefficient of friction
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17
Q
  1. T/F: Suture with a smooth surface have low tissue drag and require greater tension to achieve good apposition of the tissues and have lower knot security
A
  • True
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18
Q
  1. Define capillarity
A
  • the process by which bacteria and fluid are carried into the interstices of a multifilament suture material (wicking)
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19
Q
  1. T/F: Immune cells are able to penetrate the interstices of multifilament suture to help decrease the risk of bacterial population on the suture
A
  • F, immune cells cannot penetrate the interstices of multifilament suture, thus persistent infection can result
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20
Q
  1. Define memory
A
  • the capability of a suture to return to its original shape after deformation by tying.
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21
Q
  1. Define tensile strength
A
  • the force that the untied suture strand can withstand before it breaks when the force is applied in the direction of its length
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22
Q
  1. Define knot hold capacity
A
  • the maximum load to failure when tension is applied to the knotted suture material (either knot slip or knot break)
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23
Q
  1. Define relative knot security
A
  • knot-holding capacity expressed as a percentage of the un knotted suture’s tensile strength
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24
Q
  1. What is loop security?
A
  • The ability to maintain a tight suture loop as a knot is tied
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25
25. Name 7 biomechanical principles that should be taken into account when selecting suture material
- should be as strong as the normal tissue through which it is placed - tensile strength reduction over time of the chosen suture material should corresponding to the healing characteristics and gain in wound strength of the sutured tissue - a suture is not needed after a wound has healed - strength of a wound is more dependent on the involved tissue’s ability to hold a suture than the strength of the suture material itself. - Elastic suture materials are indicated for skin closure to adapt to wound edema; suture materials with high stiffness are required to serve as a prosthesis and for abdominal closure, herniorrhaphy, or joint imbrications. - The use of oversized suture material may weaken the repaired wound by causing excessive tissue reaction - For a wound under tension, increasing the number of sutures applied (and/or use of tension relieving sutures) is preferable to increasing the suture size.
26
26. T/F: For a wound under tension, increasing the suture size is preferable to increasing the number of sutures in the wound
- F, preferable to increase the number of sutures
27
27. T/F: Strength of a wound closure is more dependent on the tissues ability to hold suture than the strength of the suture itself
- True
28
28. Name 3 shapes of suture needles
- straight - half curved - curved
29
29. What size needle is best when suturing in confined and/or deep locations?
- 5/8-circle needles
30
30. In most cases, what size needles are preferred because they do not require extensive rotational movement of the hand
- ½-circle needles or 3/8-circle needles
31
31. What are the 3 basic components of the suture needle?
- suture attachment end (swaged or eyed) - body - point
32
32. Name two ways the needle can be attached to the suture
- swaged - eyed
33
33. What is the ideal needle length?
- long enough to penetrate both wound margins
34
34. The ____ and _____ of the needle are the main determinants of its behavior in tissue
- shape of the point - shape of the body
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35. _____ point needles are the least traumatic to tissue and minimize inadvertent damage to vessels and nerves
- taper
36
37. Name 3 tissues for which the use of cutting needles is indicated
- skin - tendon - fascia
36
36. Name 3 tissues for which the use of taper needles is indicated
- muscle - subcutaneous tissue - viscera
37
38. What are the different types of needle points? (6)
- Taperpoint - Tapercut - Cutting - Reverse cutting - Spatula point - Blunt point
38
39. Where is the cutting surface on a traditional cutting needle?
- on the inner curvature
39
40. In what direction does a traditional cutting needle cut?
- towards the wound margins
40
41. Where is the cutting surface located on a reverse cutting needle?
- the convex, outer curvature of the needle
41
42. Describe a taper cut needle
- combines the reverse cutting point with round taper body (round shaft will not cut through tissue or enlarge the needle hole when passed)
42
43. Describe spatula needles
- flat on the top and bottom and have a side-cutting action (certain ophthalmology procedures)
43
44. What is the weakest part of a suture?
- the knot
44
45. What is a Deshamps needle?
- A long, thin instrument with a palm-held handle and a thin needle-like extension that bends laterally at right angles at its tip and then continues as a semicircle in the same plane. It is designed to place ligatures around vessels in poorly accessible sites and can be used for suturing in deep, confined areas.
45
46. ____ and ____ knots are prone to slip
- Granny - half-hitch
46
47. What is considered the most reliable knot configuration?
- a superimposition of square knots
47
48. T/F: Clamping the first throw of a square knot to maintain tissue tension does not negatively affect the mechanical properties of common multifilament or monofilament suture
- F, clamping can reduce breaking strength by 10% if a mosquito forceps and not a needle holder is used for clamping.
48
49. Clamping the first throw of a square knot to maintain tissue tension decreases the breaking strength of monofilament suture by _____
- 10%
49
50. Define loop security
- ability to maintain a good loop after the first throw is thrown
50
51. Define knot security
- the likelihood that the knot will not fail, knot holding capacity
51
52. Knot security depends on ____ and ____
- structural configuration of the knot - type of suture material
52
53. The characteristics of suture material that effect knot security are __ _ and ____
- memory - coefficient of friction
53
54. A suture end length of at least ___ is recommended to optimize knot integrity
- 3mm
54
55. For 2-0 suture, how many throws are needed to make a secure knot with dexon, vicryl, and polypropylene
- 3
55
56. For 2-0 suture, how many throws are needed to make a secure knot with nylon and PDS
- 4
56
60. T/F: Knot security decreases with increased suture size
- True
56
58. When ending a continuous suture line, how many additional throws are needed to ensure knot security?
- 2 or 3 additional throws
57
59. T/F: A fatty wound environment can increase the number of throws needed to create a secure knot
- True
57
57. With larger diameter suture, how many throws are needed to make a secure knot?
- 5
58
61. Define intrinsic tension
- the tension on the tissue constricted within the suture loop
58
67. ____ suture material is best for laparoscopic surgery and why?
- monofilament - They perform well for knot rundown, have low tissue drag, do not lose loop characteristics when wet.
58
64. Name 3 factors that affect extrinsic tension
- wound size - location - relationship to skin lines - amount of surrounding loose tissue
59
62. What is a risk of excessive intrinsic tension
- can cause ischemic necrosis
59
66. Name 2 disadvantages of loop suture
- total amount of suture is increased - a bulky four-stranded knot results at the end of the suture line
60
63. Define extrinsic tension
- the pulling tension from outside the suture loop
61
68. What knot is advantageous for laparoscopic procedures?
- 4S-modified Roeder knot
61
69. Name 5 advantageous of interrupted suture patterns
- increased security because failure of one suture does not jeopardize the entire suture line - precise reconstruction of irregular wound margins - precise control of tension at each point of the wound margin - less interference with blood supply of the wound margins - no purse-string like effect when tightening the suture applied in hollow viscera.
61
65. Name 2 advantages of loop suture
- avoid the knot at the beginning of the suture line - provides a larger surface area as the suture passes through the tissue
62
70. What are the advantages of continuous suture patterns? (5)
- Less suture material in the tissues - Decreased surgery time - More even distribution of tension - Better holding power against stress - Tighter seal of skin and hollow viscera
63
72. Appositional sutures are used for _____; inverting used for _____; everting used to __ __
- anatomically precise closure - close hollow viscera - eliminate dead space and counteract the tendency of wound edges to invert during healing
63
71. Name the 3 ways suture can appose tissue
- direct (apposition) - everting - inverting
64
74. The capability of suture pattern to withstand tensile forces is related to the ____
- number of segments that are parallel to the line of tension
64
73. Tension sutures redistribute the tension across _____
- wound edges
65
75. Name the appositional/everting suture patterns (10)
- Simple interrupted - Interrupted intradermal/subcuticular - Cruciate - Gambee - Interrupted Vertical Mattress - Allgöwer corium vertical mattress - Interrupted horizontal mattress - Simple continuous - Continuous intradermal - Ford interlocking
66
76. What are the inverting suture patterns? (5)
- Cushing - Connell - Lembert - Parker-Kerr - Purse String
67
80. ____activity remains high within 5mm of a skin incision
- collagenase
68
78. What type of suture is ideal for closing skin?
- monofilament suture
68
77. What are the tension-relieving suture patterns? (7)
- Interrupted vertical mattress - Interrupted horizontal mattress - Quilled/Stented - Near and far patterns - Walking suture - Locking loop/modified Kessler - Three-loop pulley
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79. Skin sutures should be place ____ from the incision edge
- 3-5mm lateral
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81. T/F: Wounds perpendicular to tension lines are pulled into better apposition and require less suture than wounds parallel to tension lines
- F, wounds along tension lines are easier to appose and require fewer suture
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82. Skin sutures should be placed ___ apart
- 5mm
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84. How should SQ sutures be placed?
- simple continuous pattern with bites made perpendicular to the long axis of the incision
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83. What is the purpose of closing SQ tissue?
- to eliminate dead space and decrease tension across the wound margin before placement of the skin sutures
73
92. T/F: The gastrointestinal tract has rapid postoperative healing
- True
73
85. Fascia is considered fast/slow healing tissue
- slow
73
89. Why is a suture length to incision length ratio important for linea closure (continuous pattern, not Brounts cruciates)?
- considered optimal for providing sufficient reserve suture material to accommodate incisional lengthening during episodes of abdominal distention
74
86. T/F: for fascia, simple continuous suture pattern has higher load to failure than simple interrupted
- True
75
94. Sutured cystotomy sites need to withstand a voiding pressure of up to ____
- 90cm H2O
76
90. What type of suture should not be used in infected wounds and why?
- Multifilament nonabsorbable because they allow biofilm formation, potentiate infection, may lead to fistulation.
76
87. What should the tissue bite size be for closing the linea and how far apart should the bites be?
- 15mm, 15mm apart
76
91. T/F: Suture placed perpendicular to muscle fibers are more likely to pull out; therefore suture should be placed parallel to the muscle fibers
- F, parallel is more likely to pull out; suture should be placed perpendicularly.
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88. If the linea is closed appropriately, what is the ratio of suture length to wound length
- 4:1
78
93. Physical strength of GI closure is dependent on _____ during the lag phase of wound healing
- suture or staple strength
79
96. Exposure to ___ urine results in accelerated hydrolysis of absorbable suture material
- Alkaline
79
95. T/F: For cystotomy closure, the suture should provide adequate strength during the lag phase of healing followed by rapid absorption to reduce the risk of cystolith formation in case of mucosal penetration
- True
80
97. Name 2 suture patterns that can be used to close tendon laceration
- locking loop - three-loop pulley
81
98. T/F: The locking loop is more resistant to gap formation under tensile loading compared to the the 3 loop pulley
- F, the 3 loop pulley is more resistant to gap formation under tensile loading
82
99. What type of suture material should be used to close tendons ?
- strong, nonabsorbable sutures or slowly absorbable sutures with high tensile strength retention
83
100. Vascular repair should be performed with what type of suture?
- absorbable monofilament
83
104. What are the benefits of ultra high molecular weight polyethylene suture material for implant prosthesis?
- stronger, less tissue drag, and provide better knot security
84
101. What is the least thrombogenic suture material?
- polypropylene
85
102. What type of suture has the least reactivity with neural tissue?
- non-absorbable sutures with low tissue reactivity, such as polypropylene or nylon.
86
103. What type of suture should be used for implant prostheses?
- strong, nonabsorbable suture materials, such as polyester sutures
87
105. Antimicrobial coated sutures are coated with what?
- triclosan
88
106. What is the purpose of anchors?
- to attach soft tissues to bone or to fix a suture as a prosthetic implant
89
107. What is the purpose of suture buttons?
- To distribute the pressure exerted by a strand of suture over a larger area of tissue.
90
108. Name 5 benefits of surgical staples
- reduced surgery time - less tissue trauma - less intraoperative contamination - preservation of blood supply - utility in areas of difficult accessibility
91
109. Describe the staple line of a thoracoabdomial stapler
- one double-staggered row of B-shaped staples to seal tissues and vessels with preservation of microcirculation
92
110. T/F: TA staplers seal tissue and vessels with preservation of the microvasculature
- True
93
111. TA staplers have a _____ shaped opening through which tissue is inserted
- U-shaped
94
112. What TA staple size is most used?
- 4.8mm staples
95
113. Name 2 gastrointestinal staplers
- Gastrointestinal anastomosis (GIA) - Intestinal linear anastomosis (ILA)
96
114. GIA staplers have staples in ____ rows of staples and the cartridge contains a ___ that divides the tissues between the ___ and ___ staples
- 4 staggered - cutting blade - 2nd - 3rd
97
115. The GIA staplers transect the tissue between what rows of staples
- between the 2nd and 3rd staples
98
118. T/F: the TA stapler divides into two halves that can be placed into the lumen of bowel
- F, a GIA stapler divides in 2 halves
98
116. The incision cut by the cutting blade of a GIA stapler is ___ from the last staple at the distal end of the cut
- 8mm
99
117. The GIA stapler can be used in what type of organs
- hollow viscus
100
120. T/F: The green and blue cartridges of the TA and GIA staplers are the same height, leg length and width
- True
100
119. Staples of the TA, GLA and ILA have what shape when they are closed? what is the benefit of this shape
- They have a B shape when closed, permits blood flow through the tissue enclosed by the staple
101
121. What is the ligating dividing stapler?
- a pistol-shaped instrument that places 2 vascular staples made of stainless steel or titanium simultaneously while a cutting blade divides the blood vessel-containing tissue between them. (LDS stapler)
102
122. Metal staples are commonly made out of _____ or ______
- titanium - stainless steel
103
123. LDS staples should not be used on tissue that cannot be compressed to _____
- 0.75mm
104
124. Name 3 advantages of ligating clips
- ease of application in poorly accessible areas - structural stability - reduction of surgery time
105
125. T/F: When using ligating clips, the diameter of the vessel should be 1/3-2/3 the size of the clip
- True
106
126. _____ of the vessel should extend beyond the ligating clip to prevent slippage
- 2-3mm
107
127. Name 4 disadvantages of using ligating clips
- relative instability of the clip in the applicator - insecurity of an inadequately applied clip - potential slippage - permanence of metallic clips in the tissue
108
128. Why should caution be used when manipulating tissues after placement of vascular clips?
- They are more easily dislodged than suture ligations
109
129. Skin staples are made of _____ and have a ____ shape
- surgical stainless steel - U
110
130. Skin staples are appropriate for closure of ______
- rapid closure of surgical incisions that are not subjected to appreciable tensile forces
111
133. What are fibrin glues composed of?
- concentrated fibrinogen, thrombin, calcium chloride
111
131. Skin staples provide wound edge ____ without strangulation of the tissue
- eversion
112
132. What are the advantages of topical tissue adhesives? (4)
- faster closure - reduced cost - ease of application - no need for suture removal
113
134. Name 3 advantages of fibrin glues
- tissue compatibility - biodegradability - efficacy when applied to wet surfaces
114
135. Name 3 advantages of steri strips
- maintain the integrity of the epidermis (resulting in less tension of the wound) - do not adhere to mobile areas under tension or to moist areas - can be used over sutures to provide a partially closed environment and improve cosmesis.
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