Suture Material

What are the major categories used to classify suture material?

Absorbable vs non-absorbable, natural vs synthetic, and monofilament vs multifilament.

What is a non-absorbable suture?

A suture that is not degraded or broken down by the body.

Are non-absorbable sutures permanent?

Yes, although they may lose strength over time.

Where are non-absorbable sutures commonly used?

External skin closures and situations requiring long-term support.

Why are non-absorbable sutures commonly used in skin?

They can be removed once healing occurs.

What type of tissue reaction is expected with most non-absorbable sutures?

Minimal tissue reaction because they are relatively inert.

What is Prolene?

A non-absorbable polypropylene suture commonly used internally, such as for tendons and ligaments.

What are examples of non-absorbable sutures?

Prolene, nylon, stainless steel, staples, and Braunamid (Vetafil).

What is another name for Prolene?

Polypropylene.

What is an absorbable suture?

A suture that is broken down by the body over time.

Are absorbable sutures usually internal or external?

Internal (buried).

What determines how long an absorbable suture lasts?

The specific suture material.

What mechanisms break down absorbable sutures?

Enzymatic degradation, hydrolysis, and inflammation.

Which type of breakdown is most common for modern synthetic absorbable sutures?

Hydrolysis.

Which older absorbable suture is broken down primarily by inflammation and enzymes?

Chromic catgut.

What are examples of absorbable sutures?

Vicryl, Vicryl Plus, Monocryl, PDS II, Maxon, Dexon, and chromic catgut.

What is Vicryl made of?

Polyglactin 910.

What additional ingredient is present in Vicryl Plus?

Triclosan.

What is Monocryl made of?

Poliglecaprone 25.

What is PDS II made of?

Polydioxanone.

What is Maxon made of?

Polyglyconate.

What is Dexon made of?

Polyglycolic acid.

What is chromic catgut derived from?

Sheep, goat, or cattle tissue.

What is a synthetic suture?

A suture made from synthetic polymers.

Do synthetic sutures cause intense inflammation?

No.

What are examples of synthetic sutures?

Vicryl, Monocryl, PDS, Prolene, and Nylon.

What is a natural suture?

A biologically derived suture material.

Do natural sutures cause more inflammation?

Yes.

What are examples of natural sutures?

Chromic catgut and silk.

What is a monofilament suture?

A suture made of a single strand.

What is the major advantage of monofilament suture?

Minimal tissue trauma and tissue drag.

Why are monofilament sutures less likely to cause infection?

They resist harboring microorganisms.

How do knot requirements compare between monofilament and multifilament sutures?

Monofilament sutures require more knots.

What is meant by suture memory?

The tendency of a suture to return to its original shape.

Do monofilament sutures have more or less memory?

More memory.

What are examples of monofilament sutures?

Monocryl, PDS, Prolene, and Nylon.

What is a multifilament suture?

A suture composed of fibers twisted or braided together.

What is another name for a multifilament suture?

Braided suture.

How does multifilament suture compare in tissue drag?

It has greater tissue drag.

Do multifilament sutures require more or fewer knots?

Fewer knots.

Do multifilament sutures have more or less memory?

Less memory.

What are examples of multifilament sutures?

Vicryl and braided silk.

How are suture sizes designated?

Using diameter measurements based on a "0" reference point.

What does a whole number suture size indicate?

Progressively larger sutures (1, 2, etc.).

What does a size such as 2-0 or 4-0 indicate?

Progressively smaller sutures.

Which is larger, 2-0 or 4-0?

2-0.

Which is larger, 1 or 2?

2.

When removing suture memory from a package, where should the strand be grasped?

Near the needle and at the free end.

How is package memory reduced?

By gently stretching the strand.

How should the suture foil package be opened?

Tear in the direction indicated.

Why should the package be opened as directed?

To provide best needle exposure.

What is meant by arming the needle?

Grasping the needle properly in the needle holders.

Where should the needle be grasped when arming it?

About two-thirds of the distance between the tip and swage.

What is the overall goal of wound closure?

Approximate, not strangulate.

What does "approximate, not strangulate" mean?

Bring tissue edges together without excessively tightening them.

What are the three basic categories of suturing techniques discussed?

Simple sutures, mattress sutures, and subcuticular sutures.

What is a simple interrupted suture?

Individual stitches that are each tied separately.

Where should knots be placed with simple interrupted sutures?

On one side of the wound.

What are simple interrupted sutures commonly used for?

Uncomplicated laceration repair and wound closure.

What is the major advantage of simple interrupted sutures?

Failure of one stitch does not affect the others.

What is a horizontal mattress suture?

A two-step mattress pattern providing added strength.

When is a horizontal mattress suture commonly used?

Fascial closure and calloused skin.

What type of tissues commonly benefit from horizontal mattress sutures?

High-tension tissues.

How is a horizontal mattress suture performed?

A simple stitch is made, the needle is reversed, and a second adjacent stitch is placed using the same bite size.

What is the purpose of a vertical mattress suture?

Precise tissue apposition and skin edge eversion.

What is meant by eversion?

Slight outward turning of wound edges.

How is the first bite of a vertical mattress suture placed?

Far from the wound edge ("far-far").

How is the second bite placed?

Near the wound edge ("near-near").

Which mattress pattern is remembered as "far-far, near-near"?

Vertical mattress.

What is a subcuticular suture?

A suture pattern placed within the dermis beneath the skin surface.

Is subcuticular suturing usually interrupted or continuous?

Usually continuous (running).

What type of bites are taken with a subcuticular suture?

Intradermal horizontal bites.

Why are subcuticular sutures used?

To decrease crosshatch scarring and allow sutures to remain longer.

What cosmetic advantage does a subcuticular pattern provide?

Reduced crosshatch scarring.

What is a purse-string suture commonly used for?

Closing circular openings.

What specialized suture pattern was mentioned for large animal procedures?

The Buhner suture technique.

Which suture type causes the most inflammation: natural or synthetic?

Natural.

Which suture type harbors fewer microorganisms: monofilament or multifilament?

Monofilament.

Which suture type has greater tissue drag: monofilament or multifilament?

Multifilament.

Which suture type generally requires more knots: monofilament or multifilament?

Monofilament.

Which suture type generally has less memory: monofilament or multifilament?

Multifilament.

Which absorbable suture is commonly tested as being monofilament?

Monocryl.

Which absorbable suture is commonly tested as being braided?

Vicryl.

Which non-absorbable suture is commonly tested as being used in tendons and ligaments?

Prolene.

Which natural absorbable suture causes significant inflammation?

Chromic catgut.

Which synthetic absorbable suture is known for long-lasting support?

PDS II.

Which phrase is the most important principle of suturing?

Approximate, not strangulate.