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What are sutures?
any material that hold tissues together until they heal.
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What are some uses for suture material?
- appose tissue edges
- stabilize joints
- strenthen weat tissue (hernia)
- ligate blood vessels
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What are the ideal characteristics of suture material?
- non-reactive in tissue
- easy to handle
- monofilament
- able to be sterilized
- high tensile strength
- inexpensive
- maintain know without slipping
- hold tissue until healing occurs
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How long does it typically take for tissue to heal together?
30 - 60 days
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Does the ideal suture material that meets all the characteristics exist?
no
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How is suture material supplied?
- individually packaged with swaged on needle
- bulk containers
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Is the knot the weakest point of the stitch?
yes
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What are the different classifications of suture materials?
- absorbable/nonabsorbable
- multifilament/monofilament
- natural/synthetic
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How long does it take for absorbable sutures to break down?
60 days
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Do non-absorbable sutures weaken over time?
no
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Do non-absorbable sutures have to be removed?
yes
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What is multifilament?
made of many strands (braided or twisted together)
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What are some advantages to multifilament?
- strong
- handles well
- holds knots well
- easy to work with
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What are some disadvantages to multifilament?
- tissue reactions
- more "drag" through tissue (traumatic)
- prone to infections
- harbor bacteria in crevices
- capillary action can pull bacteria along crevices
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What is monofilament?
one single smooth strand
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What are some advantages to monofilament?
- less "drag" - pulls through tissue easily (less traumatic)
- less bacterial hiding places
- less prone to infections
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What are some disadvantages to monofilament?
- does not handle well
- has "memory" - tries to return to its original shape - package shape
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Does monofilament hold knots well?
- no
- takes many "throws"
- big bulky knots
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What are some natural materials used for sutures?
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Are natural materials more likely to cause tissue reactions?
yes
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What does synthetic suture material avoid?
variations in strength, absorption rates, and tissue reactions
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What are the different types of suture materials?
- surgical gut
- Vicryl
- silk, cotton, linen
- nylon
- Prolene
- Vetafil, Braunamid
- stainless steel
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What is another name for surgial gut?
catgut
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Is surgical gut abosrbable?
yes
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Is "Catgut" really made from cat guts? How did it get its name?
- no
- name comes from "kit gut" - fiddle strings
- or "kid gut" - young goat
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What part of the gut is used and what animals does it come from?
- intestinal submucosa, collagen
- cattle, hogs, sheep
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What are the two types of gut?
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Does plain gut break down more quickly than chromic gut?
yes
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How long does it take for the body to absorb plain gut?
3 - 5 days
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What does chromic gut look like?
tanned with chromic acid salts
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Chomic gut decreases what?
tissue inflammatory reaction
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How long does it take for chromic gut to resorb?
10 - 15 days
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How does infected tissue affect the use of gut?
- breaks down gut faster - especially plain gut
- causes dehiscence
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What is Vicryl?
synthetic absorbable multifilament
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What is PDS/PDS II?
synthetic absorbable monofilament
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How long does it take PDS/PDS II to fully absorb?
6 months
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What kind of tissue reaction does PDS/PDS II have?
mild tissue reaction
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What is Dexon/Maxxon?
braided absorbable
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What is silk?
natural non-absorbable multifilament
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Does silk cause tissue reaction?
yes
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Is silk commonly used now?
no
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Is silk easy to handle?
yes
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What is cotton and linen?
natural non-absorbable multifilament
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What is nylon?
synthetic non-absorbable monofilament or multifilament
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Does nylon cause a tissue reaction?
no
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Is nylon easy to handle? Why or why not?
no - slippery and springy
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What is prolene?
synthetic non-absorbable plastic - similar to nylon
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Is prolene easy to handle?
no
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Does prolene weaken? What is it good for?
- no it does not weaken
- good for permanent support
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What is Vetafil and Braunamid?
synthetic nonabsorbable fibers coated with plastic?
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Can we use Vetafil or Braunamid in the body? Why or why not?
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What is stainless steel?
non-absorbable monofilament or multifilament
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What is stainless steel good for?
infected, stressed, slow healing tissue
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What are the different suture sizes?
- 9-0 to 3
- small to large diameter
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What does "ought" mean?
zero
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The higher the "ought" number, the ______ the diameter.
smaller
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The higher the number without an "ought", the _____ the diameter?
larger
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What size suture should we use for weaker tissue?
smaller size
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What size suture should we use for stronger tissue?
larger size
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What happens if the suture size is too big?
- may overtighten and strangulate tissue
- has less secure knots
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What happens if the suture size is too small?
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What does dehiscence mean?
to burst open
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How do you bury knots?
cut ends as short as possible without unraveling
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The more suture material is buried, the more _____.
tissue reaction
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When we are doing skin sutures, how much should be left for easy removal?
0.5 to 1.0 cm
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Why should skin sutures be uniform in length?
owners judge by appearance
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What does an inflammatory reaction look like caused by sutures?
- general swelling around incision
- tiny bumps where suture passes through skin
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What is the ranking from the most to least reactive suture materials?
- 1. plain gut
- 2. chromic gut
- 3. natural multifilaments (silk, cotton, linen)
- 4. synthetic multifilaments (Vicryl)
- 5. synthetic monofilaments (nylon, Prolene, PDS)
- 6. stainless steel
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Will the precense of an infection cause the sutures to break down faster?
yes
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What are the different parts to a needle?
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What are the different needle shapes?
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What are the different point designs?
- cutting
- reverse cutting
- taper
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What does the cutting point look like?
- triangular cross section
- point of triangle on inside of curve
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What does the cutting point do?
leaves hole in tussue larger than suture material
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What does the reverse cutting point look like?
- triangular cross section
- point of triangle is on outside of curve
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What does the reverse cutting point do?
leaves hole in tissue larger than suture material
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What does the taper point look like?
- round in cross section
- hole is not larger than suture material
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What is the taper point more commonly used on?
internal structures, organs
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What is the cutting and reverse cutting points used for?
skin
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How do we thread the suture material through the eye?
pass suture through once, from inside the curve
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What are swaged needles?
- eyeless
- disposable
- individually packaged
- more expensive
- less traumatic
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When can swaged needles become a problem?
if you accidently cut the suture, you can not thread it back through
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What are the different needle sizes?
- sizes 0, 1, 2 (large coarse needles)
- sizes 17, 18, 19 (small coarse needles)
- sizes 14, 15, 16 (commonly used in SA surgery)
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