SUTURE & MORE (copy)

Absorbable

Never used on vessels and arteries

Less likely to cause a reaction (infection or granuloma) than non-absorbable

Non-absorbable

Used for: mesh, anastomosis, valves, tendon repair and blood vessels

Types: Prolene, Ethibond, Silk & steel, Nylon (Ethilon, neurolon), Gore-tex

Multifilament-Braided

Strong, ties easy, coated to help pass through tissue

Do not use with infection-braids can harbor bacteria

Monofilament

Smooth, hard to tie knots, glides through tissue easily, use for infection, lots of memory

Dyed

Visible (easy to see to remove)

Undyed

Used for cosmetic

Plain gut-YELLOW

Absorbable, natural

Monofilament

from beef/cattle or sheep intestines

handling weakens suture

not treated with a salt solution (“Plain”)

Don’t open until ready to use

Alcohol-based soaked to not dry out

7 day tensile

There is a fast-absorbing gut-5 day tensile-mostly face/eye/dental

Chromic-Beige

Similar to Plain gut except:

treated with a salt solution

14 days tensile

Gore-Tex

Monofilament

Nonabsorbable

Polydioxanone/PDS-Silver

Absorbable, synthetic, monofilament

Provides a long duration of wound support

PDS-Pretty Darn Strong (lasts pretty darn long)

High memory

Used to close fascia (slowest layer to heal)

After 6 weeks it still has 60% tensile strength but can last beyond 6 months

Usually dyed (purple)

Polyglactin 910/Vicryl-PURPLE

Most common of all suture

Can’t be used in presence of infection

Absorbable, synthetic, multifilament

4 week tensile

Nylon & Ethilon MINT GREEN/GREEN

Monofilament (Ethilon)

Braided (Nurolon)

Black

Non-absorbable

Commonly used in neuro

Commonly used with drains

Polyethylene (Ethibond)-CORAL

Commonly used for tendon repair (strong) and heart valve replacement

Multifilament

Green or white

Nonabsorbable & braided

Center core w/ strands all around

Polypropylene (PROLENE)-DEEP BLUE

Nonabsorbable

Inert in tissue

Suture of choice for vascular/cardiovascular

Can be used in the presence of infection

Bright blue

Lots of memory

Stainless steel-YELLOW-OCHRE

The most inert in tissue

Can be used in presence of infection

Has the highest tensile strength

Worst handling qualities

Wire twisters used

Surgical silk- BABY BLUE

Commonly used on the serosa of the GI tract

Must be used dry

CANNOT be used in presence of infection

MULTIFILAMENT

Often used for drain stitch

Monocryl-ORANGE

Absorbable, synthetic, MONOFILAMENT

Tensile strength-2 weeks

Mostly plastics and skin

Very common suture

SIZE OF SUTURE LARGEST TO SMALLEST

-7,6,5,4,3,2,1,0,2-0,3-0,4-0,5-0,6-0,7-0,8-0,9-0,10-0

Thickness of the suture

7-0 & 8-0 size of a strand of hair (TINY AF)

10-0 ophthalmic procedures (eye)

Double Armed

2 NEEDLES

ONE AT EACH END

USED FOR ANASTOMOSIS

Looped

1 needle

Suture folded in half

Pop Off’s

CR/8-Control Release & 8 in a pack (make sure to visualize all for counting purposes)

For extra support-If one loosens there are still others to hold it tight

Multi Strand Pack or Flat Pack (MS4)

Vascular

4 strands

usually double armed (8 needles) (make sure to visualize all for counting purposes

CR/8 Control Release-8 strands

MS/8-Multistrand-8 stands

Barbing Technology

V-loc (absorbable & non-absorbable) & stratifix

Do not have to tie a knot

Used in robot and GYN

Skin closure

not much memory-smaller sutures

Knot tensile strength

Amount of force or pull that a suture strand can withstand before breaking

Time it takes for sutures material to lose 70-80% of its initial strength

Wound support

Lowest tensile strength-Gut

Highest tensile strength-Fiberwire, PDS, Steel

MVP (2,4,6)-Monocryl-2 Vicryl-4 PDS-6 (ALL SYNTHETIC)

TIES/REELS

No needles

18 or 30 inch ties (NOT PART OF SOFT COUNT)

Reels-continuous-(REELS ARE PART OF SOFT COUNT)

Reels- Radiopaque

FREE TIE-Handed as a single strand

TIE-ON-A-PASSER-This is used to occlude deeper vascular

Surgeon often asks for a right angle/mixter before using a tie

Tie passed on tonsil or with debakey

STICK TIE-Means tie with needle

Most often a pop-off

Needles

Made of steel

Eye of the needle

Part of the needle where the suture is attached/SWAGGED on

Closed eye

Hole in the needle is round or square

Holes are bigger

Causes more damage to tissue than eyeless needles

French-eyed

Opening on top so the suture thread can be pulled through quicker

This makes the needle easier to load than a closed needle

Eyeless and double armed

Needle may be swaged on or control release needles

Cutting Needles

Often used on skin or tough tissue (the harder to pass layer)

Less traumatic

Causes less trauma-not have to push so hard-glides easier

Sharp-point is usually triangular

Conventional cutting needle

Surface-seeking

3 razor sharp edges

Place a small cut in the tissue

Used on skin, eyes and tendon sheath

Beveled Conventional Cutting Needle

Recommended for closing lacerations

Made of a unique stainless steel

More resistant to bending

Vert sharp

Not used on delicate or frible tissues like the bowel

Reverse-cutting (most common (precision))

Deep-seeking

Stronger than conventional

Reduced risk of cutting out tissue

Opposite of conventional cutting edges

Commonly used for skin, cosmetic surgery, ophthalmic surgery

Side cutting/Spatula

Used for eye procedures

Spatula-Commonly used on eyes

Flat on top and bottom surfaces

Reduced tissue injury

Taper-Point needles

Penetrate and pass through tissues by stretching not cutting

Sharp tip at the point flattens to an oval or rectangular shape

Used one easy to penetrate layers

Causes more trauma

Subcutaneous layer

Delicate layers

Dura/peritoneum/abdominal viscera

Blunt Point Needles

Dissects friable tissue (instead of cutting)

Points rounded and blunt

Liver/kidneys

Used for liver resection

Keith Needle

Straight needle

Free or swagged (attached to thread)

Used by hand-Not on needle holder

Skin and drains

Continuous running suture

Single strand of suture that runs the entire length of the wound

May need to follow hold tension, keep out of surgeon’s line of sight

Interrupted Suture

Used on tissues under tension

Used on infected tissue

Added support-if one breaks

Subcuticular

Stitches hidden under skin layer

Cosmetic closure

Traction sutures

Used to retract tissues

Commonly used on eyes, heart, fingers, etc

Dermabond (SKIN GLUE)

5 minutes to dry

Can shower

Adds strength

Doesn’t open when pt coughs

Protects from microorganisms

Steri-strips

Used to reinforce the wound

Often used with benzoid or mastisol (liquid adhesives)

Skin Staples

Stainless steel or titanium

Faster than suturing

Usually 28-36 staples (may be reloadable)

Hand surgeon 2 adson forceps to approximate→evert skin edges→assistant staples

Not used on plastic surgery cases

Pledget

Felt piece on needle for reinforcement

Used on valves

Umbilical Tape

No needle

Part of soft count-comes in packs of 2

For retraction

Cotton

Do not cut (this will change the counts)

Vessel loops

Elastic strips

Different colors for identification

Red-arteries

Blue-Veins

White & Yellow-nerves or ducts

Part of soft count-comes in packs of 2 (DO NOT CUT)

Suture boots-BOOTIES

Silicone covers that go on the end of mosquito clamps

Used to identify and hold suture material

Clamp on one end of suture where the needle is

Keeps tract of the 2nd needle and hold traction

Prevents suture material from becoming kinked and causing a large hole in the vessel

Active drains

Drainage occurs by suction (mechanically or manual)

Hemovac

Often used in orthopedic surgery

Moderate amount of drianage

Jackson-Pratt & Blake

Tube and grenade

Thyroid, breast, abdominal procedures

Minimal drainage

Pleur-Evac

Chest drainage system

Water-seal drainage system

One end attaches to chest tube

Other end to the collection system

Works by gravity and suction

Must be lower than chest level when not attached to suction

Passive drains

Drainage occurs by gravity (not attached to suction)

Example:Penrose