Suture Material and Needles

How do we classify Suture classifications

• absorbable vs non-absorbable

• monofilament vs multifilament

• synthetic vs organic or metallic (natural)

What are the suture characterisitcs

• Size

• Flexibility

• Capillarity

• Knot tensile strength

• Relative knot security

What are the Ideal Characteristics for Suture Materials

• Excellent handling & knot security

• High tensile strength

• Easily sterilized

• Non- toxic

• Non- allergenic

• Does not promote bacterial colonization

• Absorbed without inciting reactions

What do we mean by Absorbable

materials that lose tensile strength by day 60

Describe the matieral for absrobale

Can be natural or synthetic

Non- absorbable is what

All other non- absorbable materials will eventually be absorbed but are still considered “non- absorbable”. Ultimately, walled off/ encapsulated by fibrous tissue.

What are examples and which one we dont use for Non- absorbable:

• Polypropylene- never

• Stainless steel- never

What do we mean by natural

Absorbed through macrophages via enzymatic degradation

What is an example of Natural

Surgical gut

What is Synthetic

• Absorbed through non- enzymatic hydrolysis of ester bonds which results in CO2 and H2O as the eventual byproducts

• Rate of absorption is NOT affected by inflammation or infection*

What are examples of Synthetic

• PDS (polydioxanone)

What are examples of Metallic:

• Stainless steel suture

• Staples

What is a blunt tip

Dissect through friable or crumbling and delicate tissue without hemorrhage

When do we use blunt tip

o Liver or kidney

o Muscle or facia

What is a taper needle

o Pointed tip, spreads delicate tissue without cutting it, low trauma to tissue

o Path of needle seals behind as it passes

o Lacks cutting power

When do we use a taper needle

oUsed for hollow organs, vascular tissue, subcutaneous tissue

What is a Taper cut used for

o Combines a cutting tip with a taper needle body

o Often a reverse cutting tip

o LA uses

o Not ideal for hollow organs like bowel

what is Reverse cutting

• Cutting surface is on the convex (outer side has third cutting edge)

▪ Less tissue cut out

▪ Stronger than cutting needle of same size

▪ Preferred in SA soft tissue general surgery, commonly used

What is Cutting needles

• For cutting through dense tissue

oSkin, esp. bovine skin

oConnective tissue

What are examples of Cutting needles

• Reverse cutting

• Cutting

• Side cutting

What is Swaged suture

This is a finite length of suture individually packaged with a needle clamped onto the end of the suture.

What are the pros for Swaged suture

• Sterile, single use, needle is always sharp

• No knot/ threading to pass through tissues, less tissue trauma

• Efficient- no needles to load or unload

What are the cons for Swaged suture

• Costly, dependent on needle/ material

• No customization of lengths

Indications for suture types: skin what do we use

• Monofilament

• Absorbable

If the suture type is Monofilament and Absorbable what should we see

• Absorbable should be removed if not buried since absorption requires contact with bodily fluids for absorption

• Good relative knot security, non-capillary

• PDS/ PDO

What is the indication for sutures on/in the SKIN for Non- absorbable

• Removed

• Nylon, polypropylene

• Staples

When do we use Abdominal closure:

• Facial layer closure- the body’s strongest tissue type

• Pattern choice influences suture choice

When do we use Abdominal closure: Interrupted vs continuous

• Slightly larger suture if continuous pattern

When do we use Abdominal closure: Nonabsorbable vs absorbable

• Good knot security is important

• Consider how much suture is being placed in the tissues...FB?

• PDO/ PDS, etc. because longer absorption times are preferred

In Equine do we use polypropylene?

In equine, do not put polypropylene in a horse body wall due to risk of

suture sinus formation

For equine instead of using polypropylene what do we use instead

polydioxanone, polyglyconate

What are the indications for Muscle & Tendons

• Poor holding power, hard to suture

• Absorbable or nonabsorbable

• Pattern placement considerations in relation to muscle fiber direction

When we are on the tendons doing a suture what material do we use

use strong, nonabsorbable, minimally reactive material

What are examples of Parenchymal organs

Spleen, liver, kidneys

What suture do we use for Parenchymal organs

• Absorbable, monofilament suture

• Reduced drag and tissue trauma

• Swaged suture

What organs are Hollow viscus organs

Trachea, GI tract, U bladder, Gallbladder

What kind of sutures do we use for Hollow viscus organs

• Absorbable, monofilament

• Prevent retention of foreign material

• Calculogenic (nonabsorbable) may promote stone formation

What kind of sutures do we use for Infected or contaminated wounds

If possible- avoid sutures

• Even non-reactive absorbable, monofilament may elicit an infection if E. coli or S.aureus

• NO silk or polyester/ non- absorbable

• Potentiate infection

• May fistulate

• If unavoidable; then absorbable except for surgical gut

• If N/A: Nylon vs polypropylene instead of metallic suture typically

What are the characterisitcs of Suture on the Reel

• Economical

• No needle

• Custom lengths

• More commonly seen in LA field surgery and some Shelter

Medicine settings

• Must maintain sterility when obtaining a length of suture

• Cold sterile...?

• Separate needles to be threaded onto suture

The generic name is Chromic gut what is the characteristics, loss of TS, full absorption, knot security, and tissue rxn

• Brand Name: none

• Characteristics: Absorbable/ multifilament/ natural

• Loss of TS: 33% at 7days

• full absorption: 60 days

• Knot Secruity: poor wet

• tissue rxn: severe

The generic name is Polygalactin 910 and the brand name is Vicryl/vicryl plus what is the characteristics, Loss of TS, full absorption, knot secruity, and tissue rxn

• Characteristics: absorbable/multifilament/synthetic

• Loss of TS: 25% at 14 days, and 50% at 21 days

• full absorption: 56-70 days

• knot security: good

• tissue rxn: mild

The generic name is Polygalactin 910 and the brand name is Vicryl rapide what is the characteristics, Loss of TS, full absorption, knot secruity, and tissue rxn

• Characteristics: absorbable/multifilament/synthetic

• loss of TS: 50% at 5 days, 100% at 14 days

• full absoprtion: 42 days

• knot secruity: good

• tissue rxn mild

The brand name is Polyglycolic acid what is the brand name, characteristics, loss of TS, full absorption, knot security, tissue rxn

• brand name: Dexon S(uncoated) Dexon II (coated)

• characteristics: Absorbabe/multifilament/ synthetic

• loss of TS: 35% at 14 d, 65% at 21 d

• full absorption: 60-90 days

• knot secruity: good

• tissue rxn: mild

The generic name is Glycolide/lactide polymer, what is the brand name, charactererstics, loss of TS, full absorption, knot secruity, tissue rxn

• brand name: Polysorb

• characteristics: Absorbable/multifilament/ synthetic

• loss of TS: 20% at 14 d, 70% at 21 d

• full absorption: 60 days

• knot secruity: Excellent

• tissue rxn: Minimal to none

The generic name is Polydioxanone what is the brand name, characterisitcs, loss of TS, full absorption, knot secruity, tissue rxn

• brand name:PDS II/ PDO

• characteristics: Absorbable/ monofilament/ synthetic

• loss of TS: 14% at 14 d, 31% at 42 d

• full absorption: 180 days

• knot secruity: Good

• tissue rxn: Mild

The generic name is Polyglyconate, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Maxon

• characteristics: Absorbable/ monofilament/ synthetic

• loss of TS: 30% at 14 d, 45% at 21 d

• full absorption: 180 days

• knot security: Good

• tissue rxn: Mild

The generic name is Poliglecaprone 25, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Maxon

• Characterisitc: Absorbable/ Monofilament/synthetic

• Loss of TS: 40-50% at 7 d, 70-80% at 14 d

• full absorption: 90-120 days

• knot secruity: good

• tissue: mild

The generic name is Glycomer 631, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Biosyn

• Loss of TS: 25% at 14 d 60% at 21 d

• chracterisitic: Absorbable/ Monofilament/synthetic

• full absorption: 90-110d

• knot security: good

• tissue: mild

The generic name is Polyglytone 6211, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Caprosyn

• Characteristics: Absorbable/monofilament/ synthetic

• loss of TS: 40-50% at 5 d, 70-80% at 10 d

• full absorption: 56 days

• knot security: excellent

• tissue rxn: mild

The generic name is Silk, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Perma- Hand

• Characteristics: Nonabsorbable/ multifilament/ natural

• loss of TS: 30% at14 d 50% at 1 year

• full absorption: >2 years

• knot secruity: Poor

• tissue rxn: severe

The generic name is Polyester, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Mesilene, Ethibond, Dacron

• characterisitcs: Nonabsorbable/ multifilament/ synthetic

• Loss of TS and Full absorption": none

• knot security: poor

• tissue rxn: moderate

The generic name is Polyamide (Nylon), what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Ethilon (mono), Nurolon (multi), Dermalon (mono)

• characterisitcs: Nonabsorbable/ mono or multifilament/ synthetic

• Loss of TS: 30% at 2 years (mono) 75% at 180 days (multi)

• full absorption: none

• knot security: fair

• tissue rxn: minmal to none

The generic name is Polypropylene, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Prolene, Surgilene, Flurofil

• characterisitcs: Nonabsorbable/ Monofilament/ synthetic

• Loss of TS: none

• full absorption: none

• knot security: excellent

• tissue rxn: Minimal to none

The generic name is Polymerized caprolactam, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: Supramid, Vetcassette II

• characterisitcs: Nonabsorbable/ multifilament/ synthetic

• Loss of TS: none

• full absorption: none

• knot security: good

• tissue rxn: moderate

The generic name is Stainless steel wire, what is the brand name, charactertistics, loss of ts, full absorption, knott secruity, tissue rxn

• brand name: flexion

• characterisitcs: Nonabsorbable/ multifilament/ mono

• Loss of TS: none

• full absorption: none

• knot security: excellent

• tissue rxn: mimial to none