Suture Material Selection for Wound Closure: A Comprehensive Guide, Exams of General Surgery

Download Suture Material Selection for Wound Closure: A Comprehensive Guide and more Exams General Surgery in PDF only on Docsity! Wound closure Properties to consider when choosing suture (Hemostat book pg 30) - Choice of suture material: based on each individual and what will maximize processing of healing. proper choice will approximate tissue with LITTLE trauma, and eliminates dead space. Cellular response: Tissue reacts to suture. Edema will appear in skin or subcutaneous tissues, surgeon will consider this when placing tension and suture. Elimination of Dead Space: When a suture is placed correctly where wound edges are correctly approximated and no air remains in between layers. Placed with a drain or applying pressure dressing will help eliminate dead space as well. Wound Stress: Must be ensured the approximated wound is adequately immobilized to prevent suture disruption. Dead Space - Most critical aspects of wound closure. Occurs from separation of wound edges that have not been correctly approximated or from air that remains trapped between layers of tissue. Inert - Lack of motion or reaction A suture that causes no-to-little tissue reaction Suture materials - Approximate tissues while healing takes place to ligate blood vessels or tubal structures First choice for tissue that does not needed continued support? - Absorbable suture When continued strength/support is necessary? - Nonabsorbable suture Fascia and skin are strong but - heal slowly Gastrointestinal tissue is weak but - it heals quickly monofilament suture - Single strand of fiber Pros: lower chance of infection, low friction allowing it to easily slide through tissue Cons: Poor knot security, memory of suture Non-absorable suture is used on what types of wounds? - Wounds that need more than 10 days of healing Catgut suture - A dissolvable suture made from sheep skin intestine Used on tissues that heal rapidly Only naturally occurring ABSORBABLE suture in the US Occasionally used by oral surgeons multifilament suture - is more pliable, allowing knots to hold more easliy an absorable type of suture it has many fibers Plain Surgical Gut - Digested and absorbed quicky by tissues, this rapid reaction can cause inflammation. An ABSORBABLE type of suture Standard handling Usually dyed BLACK Loses tensil strength when exposed to moisture and should be USED DRY!!! actually a VERY SLOW ABSORBING suture not used in presence of infection Used in urinary and bile tracts no memory Cotton Suture - Class II NONABSORBABLE suture Stainless Steel Suture - Class III Nonabsorable suture Monofilament and twisted multifilament varities High in tensil strength Has difficulty handling, be careful minimal tissue reaction Most inert can be used with infection used in: abdominal wound closure, hernia repair, sternal closure, cerclage, tendon repair, bone repair, retention sutures, respiratory tract Ethilon Nylon Suture - Nonabsorable suture Monofilament strands High tensile strength Extremely low tissue reaction Memory is low, so more knots are needed If dipped in saline, can help with pliability and easier to handle, some come premoistened Used in plastics, opthalmology and microsurgery Nurolon Suture - Multifilament strand that is braided White or black dyed more tensile strength and less tissue reaction than silk used where all multifilament nonabsorable sutures are accepted Mersilene Suture - NONABSORABLE SYNTHETIC first syntehtic braided suture shown to last INDEFINITELY in body Precise, consistent suture tension Minimize breakage Uncoated, theerefore it has higher coefficient of friction when passed through tissue Ethilbond Suture - Nonabsorable synthetic This is lubricated with POLYBUTILATE (very first synethtic coating developed specifically for SURGICAL use) Usually braided, it easily passes through tissue and provides excellent pliability, handling qualities, and smooth tie-down with each throw of knot. Used in cardiovascular surgery, primarily, for vessel anastomosis, placement of prosthetic materials. Minimal tissue reaction holds knots VERY well Prolene (polypropylene) - Nonabsorable synthetic Used in general, CV, plastic and ortho Do not adhere to skin, therefore it is used as a pull out suture Inert, providing proven strength, reliability and versatility. Recommended for areas where minimal suture reaction is desired, AKA INFECTED AREAS AND CONTAMINATED AREAS!!! Available clear or dyed blue Taper needles are - Used in deeper wounds Keith needles are - (Straight) and cannot be loaded, must be handled Needle must be __ from swaged on needle - 1/3rd Parts of a suture needle - Tapered needles - Used internally Gradually tapers to a sharp point, making the smallest possible hole in tissue Suturing soft tissues (muscle, subcutaneous fat, peritoneum, dura, and GI tract, genitourinary, biliary and vascular tissue) Taper cut needle - reverse cutting edge on tip and a round body Point of needle is tapered Used for dense fibrous connective tissues (fascia, tendon, and periosteum) Blunt needles - primary suture line - main suture that approximates the wound edges for first intention healing to occur secondary suture line - Sutures placed to support and ease the tension on the primary suture line, thus reinforcing the wound closure and obliterating any dead spaces continuous stitch / running stitch - Primary Suture Line that consists of a single strand of suture placed as a series of stitches often used for closure of long incisions Tied after first stitch is placed on one end and tied again once placed on other end If any segment breaks, results in dihisence or evisceration, therefore shouldnt be used where tissue may be under a lot of tension and stress. not used on infections interrupted suture - Primary suture line that chosen to close tissues under tension. Used in abdominal fascia and tendons, and infections. Instead of all suture placed throughout, it is placed, cut and tied - placed, cut and tied- etc. Figure of 8 suture - Mattress suture - A technique of suturing in which one passes the suture material through the tissue on one side of the wound, and across the incision, and through the tissues on the opposite side, and then passes the suture material through the opposite side tissues and back through the tissues of the original side. Purse string suture - a suture made around the circumference of a circular opening or puncture to close it or to hold the margins in position Retention sutures - A type of interrupted technique used to provide additional support to wound edges in abdominal surgery. Bridge - Suture - (temporary interrupted suture) individual stitch knotted at the tissue edge; may be applied prior to embalming to align tissues Bolster - suture - pieces of plastic or rubber tubing threaded over retention suture ends before the ends are tied Button Suture - Tendon sutures may be pulled through buttonholes and tied over a button to prevent tissue damage. Traction suture - Suture strand (usually nonabsorbable) placed around a structure for retraction to the side of the operative field. Ligating and Dividing Stapler - ejects two ligating clips side by side and then divides the tissue between the clips with a single activation circular or end-to-end anastomosis (EEA) stapler - used for end to end intestinal resection, joins two arms of the intestine with a double row of staples used in GI tract and rectum surgeries intraluminal Sizers - Basically EEA sizers Thoracoabdominal Stapler - used to ligate internal vessels and structures; comes in a variety of sizes cuts and staples TA(30) AND TA(90) (Numbers are how many staples are thrown out) Purse-string stapler - The purse-string stapler is used only in open procedures. Gastrointestinal Stapler - Used in GI ONLY comes in 2 pieces, hands in 2 pieces Fibrin Glue - biologic adhesive and hemostatic agent Used in dermal defects, tears, organ tears, wound healing, bone repair and cavities Evicel - Biologic tissue adhesive Autologous or Homologous Plasma - Biologic tissue adhesive Pooled-donor plasma - Biologic tissue adhesive Dermabond - Synthetic tissue adhesive