Module 7 Suture materials and packaging

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Dec 6, 2023

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Module 7: Suture materials and packaging Introduction Broadly, sutures can be classified into absorbable or non-absorbable materials. They can be further sub-classified into synthetic or natural sutures, and monofilament or multifilament sutures. The suture type chosen varies on the clinical scenario. Absorbable sutures are broken down by the body via enzymatic reactions or hydrolysis. The time in which this absorption takes place varies between material, location of suture, and patient factors. The diameter of the suture will affect its handling properties and tensile strength. The larger the size ascribed to the suture, the smaller the diameter is, for example, a 7-0 suture is smaller than a 4-0 suture. Suture sizes range from 11-0 to 7. Suture Terms When you are looking at a suture, it is important that you understand the following key suture terms: Absorbable: This suture is capable of being absorbed by tissue in a given time frame, allowing the tissue time to heal itself. The time frame varies with each type of absorbable suture. Non-absorbable: This suture resists absorption by tissue. Used when a permanent suture is required or when the suture will be removed later (e.g., on the outside of the body). Monofilament: This suture consists of a single strand. This type of suture does not easily harbor bacteria and glides through tissue smoothly. The drawback to monofilament suture is that it can be harder to handle and does not hold a knot as well as a multifilament suture. Multifilament: This suture consists of more than one strand. The strands are either braided or twisted together. Multifilament suture is easier to handle, holds knots better, and has greater flexibility and tensile strength than monofilament suture. The disadvantage to multifilament is that it can harbor bacteria and therefore should not be used in the presence of infection. Braided: The strands are intertwined. Twisted: The strands are twisted in the same direction.
Coated: This suture is coated to ease handling and help reduce tissue drag (friction). Natural: This suture is made from naturally occurring plants or tissue (e.g., cotton suture). Synthetic: This suture is made from manufactured materials (e.g., nylon suture). Memory: This suture has “memory,” which means it springs back into curls when removed from the package. The scrub person needs to hold each end and give it one gentle pull outward before handing it to the surgeon. Suture Sizes Sutures come in a variety of sizes (known as the gauge ). Suture gauges range from 5 (heaviest suture) down to 11-0 (thinner than a strand of hair). The gauge of suture that a surgeon chooses depends on the thickness and type of tissue being sutured. The heavier sutures are used to approximate bone or are used to put retention sutures in an abdominal midline incision. Sutures that are 2 to 5 gauge are used for tendon repair or high tension structures in orthopedic surgeries. Sutures that are 0 or 1 gauge are generally used on thick tissue (e.g., on abdominal muscle or fascia, during orthopedic surgery). Sutures in the 4-0 to 7-0 range generally are used in plastic surgeries or in cardiovascular and vascular surgery. Sutures in the 8-0 to 11-0 range generally are used for surgery of the eye or in microsurgery procedures (e.g., microvascular, vasovasostomy) ( Fig. 4-1 ). FIGURE 4–1 Suture thickness comparison. Example Video: YouTube: Basics of Sutures Part 2 | The Different Types of Suture Materials and When to Use them Knowledge Check 1 2 3
Question 1 Sutures come in a variety of sizes known as gauge. Suture gauges range from 5 (heaviest suture) down to 11-0 (thinner than a strand of hair). True False Correct View solution Question 2 Sutures that are 2 to 5 gauge are used for tendon repair or high tension structures in orthopedic surgeries. True False Correct View solution Question 3 There are sutures to retain a midline incision, but none to effectively approximate bone. True False Knowledge Check 1 2 3 Question 1 Sutures themselves have one thickness, only the size of the needle changes. True False Correct View solution Question 2 Sutures in the 8-0 to 11-0 range generally are used for surgery of the _____ or and microsurgery procedures. nose ear
eye nerves Correct View solution Question 3 Sutures in the 4-0 to 7-0 range generally are used in plastic surgeries or in cardiovascular and vascular surgery. True False Question 4 Abdominal muscle or fascia in orthopedic surgery would be considered _____________ tissue. normal thin thick Delicate Learn: ST135.07.01.02 Suture Materials Comparison Of Suture Materials Sutures are either absorbable or nonabsorbable. They are composed of various materials, natural and synthetic, which make them suitable for certain procedures or tissues. Tables 4-1 , 4-2 , and 4-3 allow you to compare suture materials made by various manufacturers. Table 4-2 lists the absorbable sutures’ approximate wound support times to allow for further comparisons. TABLE 4-1 Nonabsorbable Sutures SUTURE MATERIAL COVIDIEN PRODUCT (SYNETURE) ETHICON PRODUCT Monofilament nylon Dermalon; Monosof Ethilon Braided nylon Surgilon Nurolon Braided polyester (uncoated) Surgidac Mersilene Braided polyester (coated) Ti Cron Ethibond Monofilament polybutester Novafil Monofilament polybutester (coated) Vascufil Monofilament polypropylene Surgipro; Surgipro II Prolene Hexafluoropropylene VDF Pronova Poly Monofilament steel Steel Surgical Stainless Steel Multistrand steel Flexon Surgical Stainless Steel
Silk Sofsilk Silk; Perma-Hand TABLE 4-2 Other Nonabsorbable Sutures SUTURE MATERIAL SUTURE NAME AND MANUFACTURER Monofilament nylon (ophthalmic) Alcon Nylon Suture (made by Alcon) Twisted silk (ophthalmic) Silk suture (made by Alcon) Monofilament polypropylene (ophthalmic) Polypropylene suture (made by Alcon) Braided polyester (ophthalmic) Polyester suture (made by Alcon) Monofilament suture coated with polycaprolate BioSorb and BioSorb C (made by Alcon); BioSorb C also available as a braided suture Monofilament PTFE (polytetrafluoroethylene) Gore-Tex (made by Gore Medical) TABLE 4-3 Absorbable Sutures SUTURE MATERIAL COVIDIEN PRODUCT (SYNETURE) ETHICON PRODUCT Gut fiber Plain Gut (7–10 day wound support) Surgical Gut–Plain (7–10 day wound support) Gut fiber with chromium salt Synthetic monofilament polyglyconate Chromic Gut; Mild Chromic Gut (10–14 day wound support) Maxon, Maxon Plus (6–week wound support) Surgical Gut Chromic (21–28 day wound support) Monofilament synthetic polyester (polyglytone 6211) Caprosyn (10–day wound support) Coated glycolic acid polymer Dexon II, Dexon S (3–week wound support) Monofilament polyester Biosyn (3–week wound support) Sources: Ethicon Wound Closure Manual (2004); www.syneture.com ; www.Alcon.com . Knowledge Check 1 2 3 4 Question 1 The composition of the materials, natural or ___________, determine whether a suture is absorbable or non-absorbable. expensive synthetic treated One attempt Correct View solution
Question 2 sutures will need to be removed by your doctor at a later date or in some cases left in permanently. Absorbable Nonabsorbable Vicryl Gut One attempt Correct View solution Question 3 PDS shouldn’t be used for cardiovascular or neurological procedures. True False One attempt Correct View solution Question 4 Place the suture material within the correct category, absorbable or nonabsorbable. Absorbable Nonabsorbable Monofilament Polyester- Biosyn Monofilament Polypropylene- Surgipro; Surgipro II- Prolene Braided Polyglactin 910- Vicryl Rapide/Vicryl Gut Fiber- Plain Gut- Surgical Plain Gut Braided Polyester (coated)- Ti Cron- Ethibond Silk-Sofsilk-Silk; Perma-Hand Monofilament Polydioxanone- PDS Braided Nylon- Surgilon- Nurolon Monofilament Poliglecaprone- Monocryl Monofilament Steel- Steel- Surgical Stainless Steel Solution Absorbable Monofilament Polyester- Biosyn Braided Polyglactin 910- Vicryl Rapide/Vicryl Gut Fiber- Plain Gut- Surgical Plain Gut Monofilament Polydioxanone- PDS Monofilament Poliglecaprone- Monocryl Nonabsorbable Monofilament Polypropylene- Surgipro; Surgipro II- Prolene Braided Polyester (coated)- Ti Cron- Ethibond Silk-Sofsilk-Silk; Perma-Hand Braided Nylon- Surgilon- Nurolon
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