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The larger the monofilament suture, the ________ the knot security.
worse
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Process by which fluid and bacteria are carried into the interstices of a multifilament suture.
capillarity
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The force required to untie or break a knot as compared to the force required to break an untied strand of suture.
relative knot security
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The force that a knotted suture strand can withstand before it breaks.
knot tensile strength
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Tensile strength of the suture should not need to exceed the ________________.
tensile strength of the tissue (ie. tougher tissue/ more tension on tissue---> bigger, tougher suture)
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The ability of a suture material to return to a previous shape after deformation and its proclivity for knot slippage is known.
suture memory (more knot slippage...less desirable) [usually a property of synthetic sutures]
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What are the two methods of suture breakdown in absorbable sutures? What method applied to which type of suture?
- phagocytosis- natural suture [CATGUT]- enzymes from bodily tissues, resulting in proteolysis of the suture material.
- hydrolysis- synthetic suture- water penetrates suture filaments, resulting in breakdown of polymer chain (non-enzymatic, typically slower).
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How is chromic gut different from plain gut?
treated with chromic acid salts, increasing tensile strength and increased inflammation
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What do we use gut for? (2)
- close SQ space- not holding layer, suture doesn't need to be there very long
- ligate vessels- clot forms quickly after ligation, suture doesn't need to be there very long
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What are common synthetic sutures? (4)
- Polyglycolic acid- Dexon
- Polyglactin 910- Vicryl
- Poliglecaprone 25- Monocryl
- Polydioxinone- PDS
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Synthetic absorbable sutures break down __________ than natural absorbable sutures.
slower
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What are properties of non-absorbable suture? (4)
- effective tensile strength remains high over time
- monofilament low tissue reactivity
- braided suture can result in nidus for infection or create fistulous tract
- avoid implanting non-absorbable suture below the skin
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What are common natural non-absorbable sutures? (2)
silk, cotton (umbilical tape)
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What are common synthetic non-absorbable sutures? (5)
- Nylon
- Polypropylene
- Polybuster
- Braunamid
- Polyester
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What are veterinary uses of synthetic non-absorbale sutures? (3)
- skin closure
- urethrostomy
- vascular suturing
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What are properties of multifilament sutures? (5)
- high capillarity (wicking- may lead to infection)
- increased inflammation
- good handling
- tissue drag "chatter"
- softer suture ends
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What are properties of monofilament suture? (6)
- less wicking (lower capillarity)
- less inflammation, infection
- poorer handling
- less tissue drag
- stiffer ends
- poor knot security
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What is the main goal for choosing a suture?
heal before suture break down
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Considerations for suture selection. (7)
- specific surgical procedure
- operative site
- handling characteristics
- physical and biological properties
- patient's condition
- presence or risk of infected tissue
- postoperative course
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What are approximate wound healing times for highly collangenous tissues and parenchymal tissues?
- Highly collagenous- 50 days
- Parenchymal- 14-21 days
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What are the breakdown times of rapidly absorbable suture materials? (4)
- 80% loss of strength in...
- Vicryl Rapide- 5 days
- Vicryl- 14 days
- Monocrl- 7 days
- Chromic gut- 7 days
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What are the breakdown times of the prolonged absorbable sutures? (2)
- PDS- 30% strength in 14 days; 50% loss in 28 days
- Maxon- 25% lossin 14 days; 50% loss in 28 days
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Why are swaged needles preferred over eyed needles?
swages needles are less traumatic
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What type of needles do you use in the different tissue types?
taper needles EXCEPT use cutting needles in skin and tough collagenous tissues
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Describe taper, cutting, and reverse cutting needles. Include the use of each.
- Taper: round shaft; parenchymal tissues
- Cutting: triangular shaft w/ cutting edge on concave side; use on collagenated tissues and skin
- Reverse cutting: triangular shaft w/ sutting edge on convex side, stronger than cutting; use on intradermal
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