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- -Surgical gut, chromic (treated with chromium salt):
- -Tensile strength =10-14 days.
- -Absorption rate slowed by chromium salt (90 d).
- -Tissue reaction due to the non collagenous material present.
- -Patient factors affect rates of absorption, making tensile strength somewhat unpredictable.
Chemical polymers are absorbed by hydrolysis and cause a lesser degree of tissue reaction following placement
What is Polyglactin? (Vicryl)
- Braided multiflament suture coated with a copolymer of lactide and glycolide (polyglactin 370)
- -Water repellant of lactide= loss of tensile strength
- -bulkiness of lactide= rapid absorption
- coated with Ca+ stearate= easy tissue passage, precise knots, smooth tie down
- Tensile strength= 65% at 14 days
- Absorption= 40 days. complete @ 56-70 days
- Minimal tissue reaction
What is Polyglactin considered?
What is Poliglecaprone 25 (Monocryl)?
- Synthetic monofilament suture
- Glycolides and e-caprolactone
What is an advantage of Poliglecaprone 25 (Monocryl)?
Superior pliability, leading to ease in handling and tying
What is the tensile strength for Poliglecaprone 25 (Monocryl)?
- High initially. 50-60% at 7 days
- Lost strength at 21 days
What is the absorption for Poliglecaprone 25 (Monocryl)?
Complete at 91-119 days
What is Polydioxanone(PDSIII)?
- absorbable synthetic Polyester suturemonofilament
- made of polydioxanone
What is the use of Polydioxanone(PDSIII)?
- Provides extended wound support and elicits only a slight tissue reaction
- Has low affinity for microorganisms like other monofilaments
What is the tensile strength for Polydioxanone(PDSIII)?
- 70% at 14 days
- 25% at 42 days
wound supper remains for 6 weeks
What is the absorption of Polydioxanone (PDSIII)?
- minimal for the first 90 days
- essentially complete within 6 months
What is surgical silk?
made of raw silk spun by silkworms
What is surgical silk usually coated with?
beeswax or silicone
What are some characteristics of surgical silk?
Surgeons consider silk suture the standard of performance (superior handling characteristics).
-a non absorbable material
-becomes absorbed by proteolysis
-undetectable in the wound site by 2 years.
How is surgical silk absorbed?
- absorbed by proteolysis
- often undetectable in the wound site by 2 years
What is the tensile strength of surgical silk?
decreases with moisture absorption and is lost by 1 year
What is the problem with surgical silk?
- acute inflammatory reaction
-host reaction leads to encapsulation by fibrous connective tissue
What is surgical steel?
- Non absorbable suture made of stainless steel.
- Iron chromium-nickel-molybdenum alloy
- monofilment and twisted multifilament
- can be made with flexibility, fine size, and the absence of toxic elements
What is the tensile strength of surgical steel?
- high tensile strecnth with little loss over time and low tissue reactivity
- holds knots well
What is unique about surgical steel?
**Least reactive suture material?***
What is Nylon?
Polyamide polymer suture material available in monofilament(ethilon/monosof) and braid forms(nurolon/surgilon)
What is useful with using nylon?
- Elasticity of this material makes it useful in retention and skin closure
- pliable when moist
- braided forms are coated with silicone
- good handling
How does a synthetic material like nylon work?
Memory tends to return the material to its original straight form
What is the tensile strength of Nylon?
- 81% tensile strength at 1 year
- 72% at 2 years
- 66% at 11 years
What is an advantage to Nylon?
The material is stronger than silk suture and elicits minimal acute inflammatory reaction
What is the absorption of Nylon?
- Nylon is hydrolyzed slowly, but remaining
- suture material is stable at 2 years, due to gradual encapsulation by fibrous
- connective tissue.
What is Polypropylene (Prolene)?
- monofilament suture
- isostatic crystalline stereoisomer of a liner polyprolene polymer
- little or NOT saturation
What is an advantage of polyprolene?
- doeS NOT adhere to tissues
- useful as a pull-out suture
- Holds knots better than other monofilaments
- NOT subject to degradation
What is the tensile strength of polyprolene?
up to 2 years
What is polyprolene useful in?
- Contaminated and infected wounds
- minimizing later sinus formation and suture extrusion
Conventional cutting needle
- This type of needle has 3 cutting edges
- (triangular cross-section that changes to a flattened body).
Reverse Cutting needle
- -The third cutting edge is on the outer convex curvature of the needle
- Stronger than conventional!
When are reverse cutting needles used?
-Designed for tissue that is tough to penetrate (eg, skin, tendon sheaths, oral mucosa).
- -Reverse-cutting needles are also beneficial in
- cosmetic surgery, causing minimal trauma.
Side- cutting (spatula) needle:
- -Flat on the top and bottom surfaces to reduce
- tissue injury.
- -Allow maximum ease of penetration and control
- as they pass between and through tissue layers.
Simple interrupted stitches
Horizontal Mattress stitches
- everts the skin edges.
- No skin burrying within the wound.
- Allows vascular portions of the layer side to side
Vertical Mattress Stitches
Running Interlocking Stitches
Stitches – Running Subcuticular