A3: Suture Material and Needles

Created by candiceclarke 

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What is the purpose of suture material?

Hold tissues together while healing occurs

The body sees suture material as a ____ ______ and may _______.

-foreign material -react

The degree of tissue reaction to suture material is based on what four factors?

1. Type of material 2. Type and location of tissue 3. Presence of infection 4. Individual's immune system

List some qualities of the ideal suture material (7)

1. Monofilament 2. Small size with high tensile strength 3. Completely absorbable 4. Inexpensive 5. Easily manipulated 6. Good knot security 7. No tissue reaction

What are the three parameters that define suture materials?

1. Braided vs. Monofilament 2. Absorbable vs. Nonabsorbable 3, Synthetic vs. Natural Origin

Why is braided suture material different from monofilament?

1. Braided has more tissue drag 2. Braided is made of individual fibres braided together while monofilament is made of one strand 3. Monofilament has a decreased chance of wicking infection into tissues (braid wicks)

When is absorbable suture material used?

When sutures are buried in the body and removal isn't possible

Non-absorbable suture material is used in the ______ it must be _______, Is there ever a time it is used in the body?

-skin -removed -Only time it's used in the body is as a support mechanism (i.e. stabilizing joints)

Natural suture material supports _______ ________. Is it expensive?

-Bacterial growth -No

Cat gut is actually _____ gut, is it absorbable?

-Sheep -Yes

Is silk absorbable? Is it braided?

-No -yes

which are the two braided suture materials? which one is occassionally braided?

vicryl and silk -stainless steel

list the three natural suture materials

1. plain catgut 2. chromic catgut 3. silk

Which of the suture materials are non-absorbable? (5)

1. Silk 2. Stainless steel 3. Braunamide/supramide 4. Prolene 5. Staples

Which of the suture materials are absorbable? (5)

1. Plain catgut 2. Chromic catgut 3. Vicryl 4. Monocryl 5. PDS

How long until plain catgut absorbs?

3-5 days

How long until chromic catgut absorbs?

5-10 days

How long until vicryl and monocryl absorbs?

it maintains strength for 21 days and isn't fully absorbed for even longer

How long until PDS absorbs?

complete absorption in 182 days

Which suture material is similar to vicryl but has higher tensile strength and is less reactive, but it has more memory?

Monocryl

Which suture material is easy to handle, stable in a contaminated wound and causes minimal tissue reaction

Vicryl

Which suture material is elastic, easy to handle, causes a tissue reaction, harbours bacterial growth, absorbs water and swell which may loosen it's knot and is absorbed in 3-5 days?

Plain catgut

Which of the suture materials is elastic, easy to handle, causes a tissue reaction, harbours bacterial growth, absorbs water and swell which may loosen it's knot and is absorbed in 5-10 days?

Chromic catgut

Which of the suture materials has a higher tensile strength than vicryl, has memory which makes knot handling more difficult and takes the longest of all to absorb?

PDS

Which of the suture materials has good strength and handling, is inexpensive, but supports bacterial growth?

Silk

Which of the suture materials is non-corrosive and inert, has high tensile strength but is difficult to handle, makes bulky knots and has sharp ends?

Stainless steel

Which of the suture materials causes minimal reaction, loses strength after six months has high memory and poor knot security?

Braunamide/Supramide

Which of the suture materials causes minimal reaction, but has high memory and poor knot security?

Prolene

Which of the suture materials is non-corrosive, is easy to handle and apply, but can scar if left on too long and requires expensive equipment?

Staples

Do suture materials have an expiry date?

Yes its on the package

Cassettes containing suture material must be stored how?

Upright and with the caps securely closed

Avoid doing what to suture material or it may cause weak points that can break?

Clamping with instruments

The size of the suture is given numerical numbers ranging from _____ (largest -it's used in large animal or _______ surgeries) to _______ (extremely small, used for ______ and _________ surgeries)

-5 -orthopedic -10-0 -vascular -opthalmic

what is the range of suture material sizes we use in small animal surgeries?

1, 0, 2-0, 3-0, 4-0

what is the range of suture material sizes we use in large animal surgeries?

5, 4, 3, 2, 1,

Any suture with a number and then -0 is asked for as _______ or ________. Materials smaller than 1 starts at _____ and then we add the -0 to indicate it is smaller

-# zero -#aught -0

What size of suture material would we use for opthalmic surgery, blood vessels, microsurgery?

<5-0

What size of suture material would we use for mucosa, gingiva abd pocket pets?

4-0

What size of suture material would we use for cats and small dogs, the abdominal wall, hollow organs, skin in small animals, gingival and ligating blood vessels?

3-0

What size of suture material would we use for skin in dogs, abdominal wall in medium dogs, hollow organs and ligating blood large blood vessels?

2-0

What size of suture material would we use in the abdominal wall in large dogs and orthopedic surgery?

0 to 1

What size of suture material would we use in large animals and orthopedic surgery?

>1

T or F There is no universal standard for the sizing or shaping of suture needles

T

List three possible categories for surgical needles

1. Suture Attachment Method (Swage, French, Square) 2. Configuration of needle body (Curved, Straight, S shaped) 3. Point and Cross section types (Round, Triangular Cross Section, Triangular Reverse Cutting)

Which type of needle has no eye and the suture attached directly from the needle? List on advantage and one disadvantage to this type of needle

-Swage Attachment Needle Advantage: minimal tissue drag Disadvantage: One use only, can be expensive

Needles with holes that require suture to be threaded on are _____ needles. List one advantage and one disadvantage

-Eyed -Advantage: Reusable and can cut suture length you want -Disadvantage: Need to pass double suture through causes double extra tissue irritation also may become dull with repeated use

Which type of needles require needle drivers

1. Half-curved 2. Curved

How are curved needles defined?

By the amount of circle they represent (3/8, 1/2, 5/8 of a circle)

Which type of needles are pushed through the tissue while holding the needle by hand? (2)

Serpentine and Straight

List three types of needles based on point and cross section

1. Taper (Non-cutting) 2. Triangular Cross Section: Cutting 3. Triangular Cross Section: Reverse Cutting

What kind of cross section does a Taper (_________) needle have? What is this used on?

-Non-cutting -Circle -Used on soft tissues

What kind of cross section does Triangular cross section: _____ needles have? What are they used on?

-Cutting -Triangular with point on inside of needle curve (upwards) -Used on tough tissues like skin, gingiva and cornea

What kind of cross section does Triangular cross section: reverse cutting needles have? What does this do?

-Triangle with apex on back of needle (downward) -The flat edge is in direction of pull on suture, this prevents further damage to cut edges of tissue

Which type of needle is used more cutting or reverse cutting?

Reverse cutting

What are three things to check for when cleaning needles?

1. Dulled tips 2. Bent or crimped bodies 3. Smooth cutting edge

If you dispose of a needle in the ______ ________, be sure to do what?

-Sharps container -Be sure to replace old needle with a new one in the pack before the pack is sterilized

Why should needles which are being sterilized by placed in a needle holder?

They will be easier to find and have less chance of puncturing a glove when searching

What two things is the choice of suture material based on?

1. Location of sutures 2. Surgeon's preference

Suture material is available in _______ or ____-__ lengths

-spools -prepackaged

List some positive characteristics of spools of suture (4)

1. Economical if used in large amounts 2. Less waste - can cut desired length 3. Sterile inside spool 4. Ability to choose needle type and size to suite each procedure

List a negative characteristic of spools of suture

1. Easy to contaminate if not removed from spool using aseptic technique - the material hanging outside of the spool is no longer sterile

List some positive characteristics of prepackaged lengths of suture (3)

1. Convenient 2. One use suture inside peel pack ensures sterility if used prior to expiration date 3. Can come with or withour a needle swaged on

List some negative characteristics of prepackaged lengths of suture

1. Expensive 2. Must maintain inventory of materials in different combinations of suture and needle size/type to suit needs of procedures

T or F Immersion of unused portion of suture materials in cold sterile disinfectants can resterilize and allow for reuse

F it can cause materials to break down and is not recommended

What suture pattern would be used to close the abdominal wall?

3 layer closure, simple continuous pattern

What suture pattern would be used to close the skin if we do not want to remove the sutures? What suture material is used to close the skin?

-Continuous pattern subcuticular -Absorbable (vicryl)

What size of scalpel blade would be used for a 20kg dog spay?

#10

What suture material would the OR nurse need to get ready for a 20 kg dog spay at Olds College

1 vicryl on a taper needle and 3-0 vicryl on a cutting needle

What are hand ties useful for?

Tying knots that are deep inside tissue or body cavities, also for tying in catheters

When should we recommend suture removal for most small animal procedures?

10-14 days

Interrupted Horizontal Mattress

Interrupted Cruciate or Cross Mattress Suture

Simple Continuous Suture

Ford Interlocking Suture

Define Suture

To oppose two tissue edges

Define ligate:

Tie around a vessel to achieve hemostasis

Define Transfix:

a type of ligature where suture material is also passed through tissue surrounding the vessel

Define Dehiscence:

seperation of a suture line (one or more layers)

seperation of a suture line (one or more layers) is termed...

dehiscence

Suturing wounds always provides the fastest healing time but can only be done on what kind of wounds?

Fresh, non-contaminated

What can we do with older wounds so we may suture a primary closure?

Surgically debride to freshen edges

In what two ways can suture patterns be described?

1. Interrupted 2. Continuous

What does the choice of suture pattern used depend on?

1. Type of tissue 2. Surgeon's preference

For suture closure to be successful it is important that there is what? In what species is this especially important?

-Minimal to no tension across the incision -Horses

List three interrupted patterns

1. Simple interrupted 2. Interrupted cruciate (cross mattress) 3. Interrupted horizontal mattress

List commonly used continuous patterns

1. Simple continuous 2. Subcuticular 3. Ford Interlocking

One of the most important parts of the suture is the ______, why?

-Knot -If the knot fails the suture will fail

If the knot fails the _____ will fail, this is especially critical with ___________ patterns, why?

-Suture -Continuous -Because they only have one knot at either end

In order for a knot to hold it must be a _____ knot and not a _____ knot or a ________

-Square -Granny -half hitch

For knot security it is recommended that there are at least ____ _________ knots or _______ put together as _____ _______ knots

-four simple -throws -two square

A _______ knot creates more fiction due to the _____ _____ on the _____ throw and can aid in ensuring correct _______ of the suture

-Surgeon's extra twist -first -tightness

Simple Knot aka _____

Throw

Square Knot

Surgeon's Knot

Sutures should only be removed when what two things have occurred?

Tissues are 1. Healed 2. Have good strength

What is important to remember when removing sutures?

It is important not to drag contaminated surface suture material back into the wound.

When removing sutures use ______ ______ and cut where while holding what?.... never do what?

-Suture scissors -While holding the suture ends or the knot with a dressing forcep or your fingers -Never cut the knot

Transfixation Ligature

Reverse cutting needle ( flat edge in direction of pull, sharp edge toward wound)

What is the benefit of a reverse cutting needle compared to the cutting needle and where in the body are they used most?

A reverse cutting needle has a sharp edge on the outer curve of the needle that is directed away from the wound edge, which reduces the risk of the suture pulling through the tissue which may happen with a cutting needle whose sharp edge is toward the wound. For this reason, the reverse cutting needle is used more often than the cutting needle in cutaneous surgery

Subcuticular pattern (continuous under the skin in the subcutaneous layer)

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