Suture & Suture Selection (Part 2)

Maximal strength

when a wound ahs reached _____, sutures are no longer needed

Non-absorbable suture (absorbable suture with extended wound support may also be used; up to 6 months)

tissues that *ordinarily heal slowly*, such as *fascia and tendons* should usually be closed with this type of suture

stomach, colon, bladder

tissues that heal rapidly, such as (3) may be closed with *absorbable sutures*

infection

foreign bodies in potentialy contamindated tissues may convert contamination to —-

-to use: monofilament

-to avoid: multifilament

to avoid conversion of potentially contaminated wound into an infected one, what suture should be used and should be not?

-close and prolonged apposition of wounds

-avoidance of irritance

where cosmetic results are important, (2) will produce best result

Nylon or polypropylene

to achieve cosmetic results, use the *smallest inert monofilament* such as (2)

-avoid skin suture

-close subcuticularly

to achieve cosmetic results, avoid ___ and close ___ whenever possible

Topical Skin Adhesive

under certain circumstances, to secure close apposition of skin edges, a ____ such as Dermabond Topical skin adhesive or vetbond may be used/

crystalloids

foreign bodies in the presence of fluids containing high concentrations of ____ may act as a *nidus* for precipitation and stone formation

rapidly absorbed

in the *urinary and biliary tract*, ___ sutures are used

retention sutures

if the postoperative course of the patient may produce sudden strains on the suture line, reinforce it with _____.

7

heaviest size of suture

12-0

finest size of suture

tensile strength of the suture and tissue to be sutured

the important factor in deciding suture size is the relationship between —- and ——

finer diameter sutures

—— sutures make *smaller knots, provide less tissue reaction and result in minimal scar formation*

finer

the —- the gauge, the less tissue trauma is caused by the passage of the suture

Monofilament

(Monofilament/multifilament) sutures should be used in skin to prevent wicking or capillary transport of bacteria.

Good

*Synthetic monofilament nonabsorbable* sutures generally have (good/fair) knot security and are relatively noncappillary.

Handling

*polymerized caprolactam (supramid, vetafil)* has good ____ characteristic, but it is *braided* and *should not be buried in deeper tissue.*

Absorbable

____ sutures may be used in *skin*, but they should ultimately be removed because *absorption requires contact with body fluids*

subcutaneous

_____ sutures are used to *obliterate dead space and reduce tension on skin edges*; multifilament or monofilament absorbable suture material is preferred.

interrupted or continuous (however, most surgeons routinely close with simple continuous)

The *rectus fascia (abdominal closure)* may be closed with either ___ or ___ suture pattern.

3 or 4 square knots (6 or 8 throws)

The knots should be tied carefully, how many square knots should be placed?

True

T/F. *standard absorbable suture* (polydioxanone or polyglyconate) may be *preferable* to prevent large amounts of foreign material from remaining permanently in the incision.

Continuous

When a ____ suture pattern is used, a *standard absorbable or nonabsorbable monofilament suture* with good knot security should be used. (Polypropylene, polybutester, polydioxanone, polyglyconate)

Muscle (absorbable or nonabsorbable sutures may be used)

—— has *poor holding power* and is *difficult to suture*

Liver, spleen, and kidneys

Parenchymal organs such as (3) are generally sutured with *absorbable monofilament*, as multifilament sutures tend to cut through because of the increased drag

Absorbable monofilament

______ sutures are generally recommended in *hollow viscus organs such as trachea, GI tract, or bladder* to prevent tissue retention of foreign material once the wound is healed.

Calculogenic

*Nonabsorbable suture* may be ____ when placed in the *urinary bladder or gallbladder* and may be extruded into the lumen when implanted in intestine.

Polyglycolic acid

_____ suture *rapidly dissolves* when incubated in *sterile urine (days)* or *infected urine (3 days)*

Highly contaminated or infected wounds

If possible, sutures should be avoided in ___ wounds. Because even the least-reactive nonabsorbable sutures elicit some degree of infection in tissue contaminated with E. coli or Staph. aureus

Fistulate

*multifilament nonabsorbable sutures* should *not* be used in *infected tissue* because they potentiate infection and may ___

Less (that's why they are preferred)

*synthetic monofilament nylon and polypropylene sutures* may elicit (more/less) infection in *contaminated tissue* than metallic sutures

Surgical gut

*Absorbable suture material is preferred*; however, ____ should be *avoided* bcoz its absorption in infected tissue is *unpredictable*

Absorbable

*Vessels* should be ligated with what suture material?

Polypropylene

*Vascular anastomoses* are typically performed with *monofilament non absorbable* such as ___

Take note

*Non absorbable* suture should also be used for *vascular grafts*

-eye

-body

-point

3 basic components of surgical needle

-closed eye

-swaged (eyeless)

two types of needle eye

swaged-on needle/ swadged needle

needle type that is permanently attached to the suture

closed eye

needle type that is similar to a household sewing needle, and the eye itself is available in a variety of shapes

T

T/F: the suture and needle are of approximately the same diameter

-round

-oval

-flat

-triangular

shapes of the body of needle

cutting

flat and triangular bodies have ___ edges

taper

round or oval bodied needles usually ____ from the small diameter at the point to a larger diameter at the eye.

opthalmic

*1/4 circle* needles are primarily used in ____ procedures

3/8 circle

______ needles are more easily manipulated than one-half circle needles because they *require less pronation and supination of the wrist*

Cutting needles

____ needles generally have two or three opposing cutting edges and are designed for use in *tissues that are difficult to penetrate, such as skin*

Conventional cutting needles

With ____ needles, the *third cutting edge is on the inside (concave) curvature of the needle.*

More cut out

The location of the inside cutting edge may promote _______ of tissue because *it cuts toward the edges of the wound* or incision.

Reverse cutting needles

______ needles have a *third cutting edge on the outer curvature of the needle*

Side cutting needles

______ needles are *flat on the top and bottom* and are generally used for ophthalmic procedures.

Taper needles

______ needles have a *sharp tip* that pierces and spreads tissues without cutting them

-intestine

-subcutaneous tissue or fascia

Taper needles are generally used in easily penetrated tissues, such as _____ (2)

Tapercut needles

_____ needles which are a *combination of a reverse cutting edge tip and a taper point body*, generally used for suturing *dense, tough fibrous tissue* such as tendon, and for some cardiovascular procedures such as vascular grafts

Bluntpoint needles

_____ needles have a *rounded, blunt point* that can dissect through friable tissue without cutting.

They are occasionally used for suturing *soft, parenchymal organs, such as the liver or kidney.*

Inches or in metric units

Needle size may be measured in ___ or ____ units.

Chord length

The straight line distance from the point of a curved needle to the swage

Needle length

The distance measured along the needle itself from point to end

Radius

The distance from the center of the circle to the body of the needle if the curvature of the needle were continued to make a full circle

Diameter

The gauge or thickness of the needle wire. Very small needles of fine gauge are needed for microsurgery.

-eyeless needle

-needle with eye

Classification of surgical needles according to *eye*

-straight

-curved

Classification of surgical needles according to *shape*

-round

-conventional cutting

-reverse cutting

Classification of surgical needles according to *cutting edge*

-triangular

-round

-blunt

Classification of surgical needles according to *tip*

-plastic needle

-micro point needle

-cuticular needle

-spatula needle

Classification of surgical needles: *others*

[!!!]

[!!!] One basic assumption must be made in considering the ideal surgical needle for a given application, namely, that the tissue being sutured should be altered as little as possible by the needle since the only purpose of the needle is to introduce the suture into the tissue for apposition.

Easy to penetrate

Generally speaking, *taper point needles* are most often used to suture tissues that are _____

Tough, hard-to-penetrate tissues

*Cutting or TAPERCUT needles* are more often used in ______ tissues.

Taper point

When in doubt about whether to choose a taper point or cutting needle, choose the _____ for everything *except skin sutures*

[!!!]

[!!!] Select the length, diameter, and curvature of the needle accdg to the desired placement of the suture and the space in which the surgeon is working.

Suture size

When using eyed needles, try to match needle diameter to _____. Swaged needles, where the needle is already attached ti the suture strand, eliminate this concern.

1/3 to 1/2

Grasp the needle ____ to ____ of the distance from the swaged end to the point - in the middle third of the needle.

Same

Apply force in the tissue to be sutured in the (same/opposite) direction as the curve of the needle

Small needle

Do not take excessively large bites of tissue with a _____

Dull

Do not force a ___ needle through tissue. Use a new needle

[!!!]

[!!] Do not force or twist the needle in an effort to bring the point out through the tissue. Withdraw the needle completely and then replace it in the tissue or use a larger needle

[!!!]

[!!!] Avoid using the needle to bridge or approximate tissues for suturing

[!!!]

[!!!] do not damage taper points or cutting edges when using the needle holder to pull the needle through tissue. Grasp as far back on the body as possible

Unti na lang yon, mas gets pag binasa na lang e

Basahin niyo na lang yong PLACING THE NEEDLE IN TISSUE & TISSUE HANDLING