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(3) Biomaterials and implants
Terms in this set (65)
Iron, chrome, nickel, molybdenum, carbon
What makes up stainless steel?
Which of the components that makes up stainless steel do patients usually have allergic reactions too?
This element can be used for a more rigid device that is generally less reactive
This is defined as an electronegative corrosion accruing between dissimilar metals
This can be used additionally sometimes in some joint replacement products
Polylactic L-acid (PLLA)
These absorbable implants degrade to lactic acid via hydrolysis and retains strength 36 weeks and degrades in 2-3 years.
Polyglycolic acid (PGA)
These absorbable implants degrade to glycolyic acid and glycine. Elliptical and provides compression secondary to shape. Brittle and rigid. Highest likelihood of complication
These are utilized in the 1st MTPJ and is made of biologically inert silicone
Cement with polymethylmethacrylate
This can be used as a spacer during resection and heat labile antibiotics can be added to it
This is derived from neonatal foreskin and also contains small amount of bovine collagen
This is similar to aplifgraf and is also derived from neonatal foreskin
This tissue graft comes from acellular porcine submucosa
This tissue graft stems from acellular porcine bladder
This tissue graft comes from human cadaveric tissue
This tissue graft is donated from human skin
This tissue graft is a bilayer composed of silicone (top layer) and bovine collagen (achilles tendon in cow) and glycosaminoglycans (shark cartilage). Usually used for deeper wounds
Unite Biomatrix (Pegasus)
This tissue graft comes from equinus pericardium and is usually used for deeper wounds and tendon reinforcement
This tissue graft is made from collagen and cellulose
This tissue graft is made strictly from bovine collagen
Amniotic membrane (grafix)
This tissue graft is made form human placental tissue
Absorbable suture materials can be used for?
Non absorbable suture materials can be used for?
Natural absorbable sutures
This is made of pig collagen, sheep intestine, cow intestine, cat gut. May be
(treated with chromic salts to increase strength and decrease hydrolysis). Digested by lysosomal enzymes in
Vicryl, dexon, PDS, mason, monocril
What are the synthetic absorbable suture materials?
-braided and may be coated
-65% tensile strength at 14 days
-hydrolyzed to CO2 and H20 in 80-120 days
-vicryl rapid: hydrolyzed in 42 days; loses strength in 7-10 days
: coated with broad spectrum antibiotic
-braided and may be coated
-70% tensile strength at 14 days
, longest lasting absorbable (hence the "max")
-20-30% tensile strength at 14 days
Natural non absorbable suture
This can be make of silk or cotton/linen. Silk is made from silk worm, takes a year to hydrolyze, and has very low tensile strength. Cotton/linen is the weakest suture.
Nylon, polypropylene, polyester, fiber wire, stainless steel
What are the synthetic non-absorbable sutures?
-both monofilament and braided available
-highest "knot slippage" rate: monofilaments are at higher risk
-can be used in contaminated/infected wounds. Least reactive
Non-absorbable, synthetic monofilaments (like polypropylene)
What sutures are the best to use in contaminated/infected wounds?
-strong suture and may be used for tendon repair
-braided, may be coated with silicone
-polyethylene multifilament core with braided polyester jacket
-monofilament or braided (braided called flexon)
-strongest suture with longest absorption rate
-used for bone fixation and tendon repair, but may corrode bone at stress points
How are suture classified?
2-0 or 3-0 vicryl
Capsule closure suture?
3-0 or 4-0 vicryl
Subcutaneous tissue closure suture?
4-0 nylon or prolene
Skin closure suture?
The tensile strength of wound equals tensile strength of suture
Why are sutures are removed at 10-14 days?
This gives surgical instrument hardness
This provides a prevention of corrosion to the instrument
Extreme hardness for grasping surfaces
300 series austenitic
This series of stainless steel is used for implants and internal fixation. Resists corrosion with resilience
400 series (martensitic)
This series of stainless steel is used in cutting instruments. Hardness maintains sharp edges and jaw alignments
-most common: 10, 15, 11, 62 on mini handle
-purpose: sharp (blade) and blunt (handle) dissection
-cutting edge width:
-tissue: metzenbuam, mayo, iris, crown and collar (sistrunk)
-non tissue: suture, utility, bandage
-mosquito (hasted), kelly, crime
-purpose: grasping and holding
-1-2 (rat tooth), adson-brown, atraumatic (potts-smith)
-purpose: grasping and holding
-hand held: skin hooks, sennets, rangel, malleable, army-navy, volkmann rake, meyerding
-self retaining: wetilaner, holzheimer, heist
-purpose: retraction and exposure
-most common: freer, azure, key, credo, mcglamry, langenbeck
-most common: joseph, maltz, bell, parks
Osteotomes, chisels, gauges, mallets, bone cutting forecasts, rongeurs, trephine, curettes, etc.
Clinically inert, no inflammatory or foreign body response, non carcinogenic, nonallergenic, structurally stable, capable of sterilization, capable of fabrication in desired forms, serve as scaffold for new bone growth and gradual biodegradation
What are the ideal implant materials?
Tapered form swaged on metallic wire, provides compression secondary to shape. Flexible and malleable
Acute cellular response
-immediate after implantation, implants are covered with proteins that denature and elicit inflammatory response. Denatured fibrinogen accumulates neutrophils and macrophages
-detritic synovitis: foreign body reaction to shards of silicone materials in lymphatic system
-environment stress cracking: surface defects on polyetheurethane implants secondary to chronic inflammation. Chronic inflammation results from fragmentation and leads to intracortical lysis and cyst formation
Tissue remodeling response
Normal for implants to have fibrous capsule formation
S. aureus and S. epidermis infections. Malignancy and type III hypersensitivity reactions extremely rare
Advantages: decreased stress shielding, no second operation for removal
Disadvantage: more expensive than metallic screws, but are cheaper in long run if you remove > 31% of metallic screws
Advantages of absorbable screws? Disadvantages?
Surgical stainless steel
-iron, 17-25% chrome, 10-14% nickel, 2-4% molybdenum, 1% carbon
-nickel most commonly causes reaction: allergic eczematous dermatitis
-very inert, integrates into surrounding bone, resists corrosion, decreased capsule formation
-addition of 6% aluminum and 4% vanadium increases strength similar to steel
-nitrogen implantation forms stable oxide layer
-black metallic wear debris often seen, no toxicity or malignancy associated with this
Cobalt, chrome, alloys
-30% cobalt, 7% chromum, <0.034% moly/carbon
-used in joint replacement prostheses
Breakdown of metallic alloys because of electrochemical interactions with environment
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