Week 8 - suture materials

What are the 7 terms for suture materials?

1. Synthetic - natural

2. Monofilament - multifilament

3. Absorbable - non-absorbable

4. Tensile strength

5. Memory

6. Tissue drag

7. Hydrolysis - enzyme digestion

Synthetic - natural

Either man made or made of a natural material

Monofilament - multifilament

One strand vs many strands braids together

Absorbable - non-absorbable

Suture material is considered non-absorbable if it retains tensile strength after 1 year

Tensile strength

Maximum pressure that can be applied to suture

Memory

Holds shape = high memory

Doesn’t hold shape = low memory

Tissue drag

Suture material can snag as it drags through tissue

Hydrolysis

Less reaction and passive so water dissolves material

Enzyme digestion

Active inflammation process so enzymes can break down the material

Name 3 absorbable suture materials

Catgut, Vicryl/Polysorb, Monocryl/PDS

Is catgut synthetic or natural?

Natural - ruminate intestine

Is catgut absorbable or non-absorbable

Absorbable

How is catgut broken down?

Enzymes

What are the 2 varieties of Catgut

Chromic and plain

What is the tensile strength of chromic catgut?

21-28 days

What is the tensile strength of plain catgut?

10-14 days

Should you use chromic or plain catgut?

Chromic since plain looses tensile strength in 10-14 days when sutures are supposed to be taken out

When would catgut be used?

Mainly farm as its low expense

Is vicryl/polysorb synthetic or natural?

Synthetic

Is vicryl/polysorb absorbable or non-absorbable?

Absorbable

Is vicryl/polysorb monofilament or multifilament?

Multifilament

How is vicryl/polysorb broken down?

Hydrolysis

What is vicryl/polysorb have tensile strength?

High tensile strength

What is the tissue drag of vicryl/polysorb?

Less drag due to coating

What is the wicking/capilliarity of vicryl/polysorb?

High = bacteria going into braiding

What is the absorbable time for polysorb?

Fully absorbed in 56-70 days

What is the absorbable time for vicryl?

Fully absorbed in 60-90 days

Is PDS/Monocryl synthetic or natural?

Synthetic

Is PDS/Monocryl absorbable or non-absorbable?

Absorbable

Is PDS/Monocryl monofilament or multifilament?

Monofilament

How is PDS/Monocryl broken down?

Hydrolysis

What is the tissue drag on PDS/Monocryl?

Low tissue drag

What is the memory of PDS/Monocryl?

Low memory

What is the knot security of PDS/Monocryl

Fair

What is the wicking of PDS/Monocryl?

Low capillarity/wicking

What is the tensile strength of PDS?

Reduced to 70% after 14 days

What is the tensile strength of Monocryl

Reduced 30-40% after 14 days

What is the absorption of PDS?

Fully absorbed by 180 days

What is the absorption of Monocryl?

Fully absorbed by 90-120 days

What wounds are PDS/moncryl good for?

Infected wounds

What are 2 non-absorbable materials?

Nylon and Prolene

What are the two types of nylon?

Supramid and Ethilon

Is Nylon/Prolene synthetic or natural?

Synthetic

Does Nylon/Prolene have memory?

Yes high memory

What is the tensile strength of Nylon/Prolene

Indefinite

What is the knot security of Nylon/Prolene

Fair knot security

Is nylon monofilament or multifilament?

Either;

Ethilon is monofilament

Supramid is mono and multifilament

Is Prolene monofilament or multifilament

Monofilament

What nylon filament has a lower tissue drag and a low capillarity?

Monofilament

When to use non-absorbable suture materials?

• Skin sutures

• Tie back surgery

The wicking effect

Occurs when fluid is drawn into the suture material from the environment or surrounding tissues

What will wicking cause?

Surgical site infections as fluid might contain bacteria

What is the suture material sizing?

Ph. Eur or Metric

What does Ph. Eur or Metric mean?

European Pharmacopoeia

What is 3-0 equivalent to in metric?

2 metric

What is 2-0 equivalent to in metric?

3 metric

What are the three types of needles?

• Round bodied

• Taper Point

• Cutting needles

What are the two types of cutting needles?

Conventional cutting and reverse cutting

Round bodied

Designated to separate tissue fibres rather than cut them, used for friable tissue

Taper point

Gradually broadens from the tip to allow greater separation of the tissues

Cutting needles

Cut through tissue, used for dense tissue e.g. skin

Conventional cutting

Cutting edge on the inside edge of the needle

Reverse cutting

Cutting edge on the outside edge of the needle

When would a conventional cutting needle be better?

Large animal

When would a reverse cutting needle be better?

Small animal and equine

What are surgical staples are normally made of?

Stainless steel or titanium

What are benefits of staples?

• Rapid placement

• Low tissue reaction - efficient healing

• Strong wound closure - appropriate for wounds under tension

Considerations of staples

• Must be removed

• Can increase scarring due to less accuracy with tissue alignment