What material and pattern would you use to close the linea alba and why?
- slowly absorbed, synthetic monofilament (PDS , maxon , biosyn)
- simple continuous
- Fascia is high collagen and holds sutures well but poorly vascularised so takes a long time
What material and pattern would you use to close the subQ fat and why?
- rapidly absorbed synthetic monofilament (monocryl, caprosyn)
- simple continuous
- little collagen and heals quickly
closure of the skin on the ventral midline , what pattern and material and why?
- synthetic monofilament non-absorbable (nylon , prolene)
- if apposition of sub Q pattern is good then ford interlocking
- if poor apposition at subQ level then simple interrupted
suture pattern and material to close the GIT (except colon) and why?
- rapidly absorbed synthetic monofilamnet (monocryl)
- simple continuous / interrupted
- material persists for 2-3 weeks which allows healing
Suture pattern and material to close / anastomosis of the colon and why?
- slowly absorbed synthetic monofilament (PDS , maxon , biosyn)
- simple interrupted / continuous
- colon takes longer to heal than rest of the GIT
suture pattern and material for closing the bladder and why?
- rapidly absorbed synthetic monofilament (monocryl)
- simple continuous
- heals quickly and urine not shown to affect it
suture pattern and material for closing the uterus after caesarean section and why?
- slow / rapidly absorbed synthetic monofilament (monocryl, PDS , maxon, biosyn)
- simple continuous with inverting pattern oversewn
- visceral would so rapid ish absorbable
What are the ideals for suture material for tissue interaction?
- maintains strength till wound is strong enough
- rapid resorption / encapsulated without complications
- easily removed
- minimal tissue reaction
- doesnt favour bacteria
- minimal drag
What are the ideals for suture material for the surgeon?
pliable
low memory
good knot security
What are the ideals for suture material for its material properties?
easy to sterilise
non-capillary / electrolytic / corrosive / allergenic / carcinogenic
What are the ideals for suture material for its practicality?
cost
availability
size
How can suture material be classified?
- natural vs synthetic
- absorbable vs not
- multifilament vs monofilament
- coated
- colour
- packaging
What are the differences in natural vs synthetic material?
- NATURAL = more tissue infl , varied absorption rate
- SYNTHETIC = less reaction , predictable
what are the differences between absorbable and non - absorbable material?
- ABSORBABLE = temporary support and strength lost in under 60 d
- NON = encapsulated by tissue, strength maintained for over 60 d
How is natural vs synthetic material absorbed?
synthetic - by hyrdrolysis
natural - by phagocytosis
What are the differences in multifilament vs monofilament material?
MULTI - easier to handle, more knot security , higher capillarity
MONO - less tissue drag , can weaken when crushed
What is the capillarity of suture material?
Capillarity is the process by which fluid and bacteria are carried into the interstices of multifilament fibers. Capillary suture materials should not be used in contaminated or infected sites. Coating reduces capillarity of some sutures.
when should multifilament / catgut material never be used?
contaminated wounds
why type of suture should be used in the skin?
inert
for fascia / tendon what property do you need in your suture?
slow / non absorbable
what should you never do with a multi use casette?
bury the suture
What are the 7 classes of suture material?
- synthetic absorbable multifilament
- synthetic absorbable monofilament - short
- synthetic absorbable monomilament - long
- synthetic non absorbable multifilament
- synthetic non absorbable monofilament
- natural absorabable multifilament
- natural non absorbable multifilament
synthetic absorbable multifilament
- examples
- tissue interaction
- tensile strength and loss
- handling and knotting
- use
- EXAMPLE = vicryl , dexon, polysorb, panacryl
- TISSUE INTERACTION = absorbed by 60-90d
- TENSILE STRENGTH = 33% (7d) , 80%(14d), 100%(21d)
- HANDLING AND KNOTS = good, some drag
- USE = vessel ligation , soft tissue closure
synthetic absorbable monofilament - short action
- examples
- tissue interactin
- tensile strength
- handling and knotting
- use
- EXAMPLE = monocryl , caprosyn
- TISSUE INTERACTION = absorbed by 90 - 120 d
- TENSILE STRENGTH = high , 50%(7d), 100%(21d)
- HANDLING AND KNOTS = soft, pliable, low memory
- USE = soft tissue closure , visceral closure
