210 Questions
What is the purpose of using needles with lateral cutting edges?
To reduce the risk of needlehole elongation during needle passage
Which type of needle is frequently used in ocular surgery?
Spatula-point needle
What should be the direction of introducing the needle tip to the tissue being sutured?
Perpendicular to the tissue
What is the point of the needle?
The area from the needle tip to the end of the taper
When are straight needles generally used?
Closer to the surface of the body, almost exclusively in skin
What dictates the ideal shape of the needle?
The size of the surgical field and working area
What are curved needles further defined by?
The fraction of a circle that they overlie
What is the preferred shape for intracorporeal endoscopic suturing?
Straight body with a curved point
Why are swaged needles used more commonly than nonswaged needles?
They are sharper and cause less tissue trauma
What is the advantage of laser-drilled swages over channel-swaged needles?
They enable the surgeon to grip farther back on the needle
In which types of surgery are swaged-on needles essential due to their significant reduction in tissue trauma?
Ocular, vascular, and urogenital surgery
Why are nonswaged needles less commonly employed in small-animal veterinary surgery?
They cause more tissue trauma during needle and suture passage
Why should suture be loaded from the concave surface when using nonswaged needles?
To prevent the suture from pulling out of the needle
Which type of needle is used for friable tissue but has poor handling characteristics in normal tissue?
Blunt needles
What is the direction of force applied during needle passage that may result in increased risk of suture pull-through?
Toward the convex surface
What does the point of the needle refer to?
The area from the needle tip to the end of the taper
What is the function of suture in wound healing?
To optimize tissue apposition
What does 'breaking strength' of a suture refer to?
The stress value at which suture acutely fails
When are straight needles generally used?
Closer to the surface of the body, almost exclusively in skin
How are curved needles further defined?
By the fraction of a circle that they overlie
What term describes the tendency of a suture to slowly and permanently deform under constant stress?
Creep
Which characteristic is necessary for consideration when choosing a suture material?
Nonirritating composition
What dictates the ideal shape of the needle?
The specific surgical task for which the needle is intended
How is suture size standardized according to the text?
United States Pharmacopeia (USP) standards
Why are swaged-on needles used more commonly than nonswaged needles?
Because of their significant reduction in tissue trauma
What is the main benefit of using barbed sutures in laparoscopic procedures?
Decreased tissue drag
What is the purpose of coating suture with a water-soluble compound?
To improve knot formation
What is the significant benefit of triclosan suture coating?
Decreased postoperative pain in pediatric patients
Which compound is commonly used for coating suture to increase pliability and reduce tissue drag?
Polyglactin 910
In what type of surgery were triclosan impregnated sutures found to not reduce the rate of incisional infection or inflammation in dogs?
Tibial plateau leveling osteotomies
How are natural sutures, such as catgut, absorbed in the body?
By enzymatic actions of cellular proteases and collagenases
What plays major enzymatic roles in the absorption of catgut suture?
Acid phosphatase and leucine aminopeptidase
What is a significant determinant of suture absorption qualities?
Environmental pH
How does exposure to urine influence the strength of polyglycolic acid (Dexon) suture?
It causes a loss of 64% of its initial breaking strength after 10 days
What happens to nylon suture in acidic conditions?
It loses 50% of its strength in 12 weeks
What is the main difference between monofilament and multifilament sutures?
Monofilament sutures are composed of a single strand of material, while multifilament sutures are made up of multiple strands braided or twisted together.
Why should multifilament suture be avoided in contaminated wounds?
Because multifilament suture has greater capillarity and an increased tendency for bacterial colonization.
What is the advantage of barbed suture over smooth knotted suture in endoscopic applications?
Barbed suture has very even distribution of tensile forces throughout the closure instead of focal areas of high tension associated with suture knots.
What is the downside of smooth suture compared to barbed suture?
Smooth suture tends to be less pliable and more susceptible to catastrophic damage from crushing or nicking.
What is the primary advantage of multifilament suture over monofilament suture?
Multifilament sutures have lower tissue drag because the surface is much smoother compared with monofilament suture.
What is the preferred shape for intracorporeal endoscopic suturing?
Straight body with a curved point
Why are swaged needles used most commonly?
They cause less tissue trauma than nonswaged needles
What distinguishes laser-drilled swages from channel-swaged needles?
The method of needle attachment to the suture
When are nonswaged needles less commonly employed in small-animal veterinary surgery?
When passing large suture in orthopedic surgery
What is the advantage of using tapercut needles?
They have a fine point that pierces and spreads tissue during needle passage
Which suture material is similar to polyglycolic acid in terms of mechanical and absorption characteristics?
Polyglactin 910
Which suture material has high initial breaking strength, being superior to chronic gut, polyglactin 910, and polydioxanone?
Poliglecaprone 25
Which suture material is completely absorbed in 90 to 120 days with mild tissue inflammation during the absorption period?
Poliglecaprone 25
Which suture material has approximately twice the initial loop strength of chronic gut suture and less tissue drag and knot security than chromic gut?
Polyglytone 6211
Which suture material was stronger than polyglactin 910 when compared and had greater first throw knot hold?
Glycomer 631
What is the impact of temperature on the ability of suture to withstand tensile load over time?
Higher or lower temperatures lead to more rapid suture degradation
Which factor enhances suture degradation?
Prestraining suture material
Which type of suture undergoes additional curing or tanning processes with chromium trioxide salts?
Catgut
In which surgery is catgut suture rapidly absorbed due to exposure to proteolytic enzymes?
Bladder surgery
Which synthetic suture material has been shown to have greater knot security compared with polyglactin 910?
Uncoated polyglycolic acid
What characteristic is essential for suture material to have when being chosen?
Ability to absorb fluid following immersion
What is the term used to describe the load required to break a suture deformed by a knot?
Knot strength
Why are curved needles essential in small or deep surgical fields?
To accommodate the limited size of the surgical field and working area
Which characteristic refers to the degree to which a suture will deform under stress or load and return to its original form when the load is removed?
Elasticity
What dictates the ideal shape of the needle?
The nature of the tissue being sutured
What is the main advantage of using straight needles in skin suturing?
Precise control over suture placement near the surface
What is the term used to describe the ability of suture to reduce stress under constant strain?
Stress relaxation
What is the degree to which a suture will absorb fluid following immersion known as?
Fluid absorption
What is the function of the point of the needle?
To provide an atraumatic tissue penetration
How are curved needles further defined?
By their curvature angle and taper ratio
Which type of suture coating will reduce knot security compared with similar uncoated suture?
Water-insoluble coating
In what animal model was a significant in vivo benefit of triclosan suture coating confirmed?
Dogs undergoing tibial plateau leveling osteotomies
What is the purpose of coating suture with growth factors, bioactive glass, stem cells, and matrix metalloproteinase inhibitors?
To improve wound healing
What distinguishes barbed suture from smooth suture in terms of biomechanical properties?
Barbed suture is significantly stiffer and has less elongation than smooth suture
Which type of sutures resulted in more rapid application with equivalent or improved strength when used in laparoscopic procedures?
Barbed sutures
Which enzyme plays a major role in the enzymatic absorption of catgut suture?
Leucine aminopeptidase
What is the main mode of absorption for synthetic absorbable sutures?
Random main-chain scission of ester linkages
Which factor has a dramatic influence on the strength of polydioxanone (PDS) and polyglycolic acid (Dexon) sutures over time?
Environmental pH
In what conditions will glycolide component sutures degrade more rapidly?
Alkaline environment
Which suture material is resistant to reduction in tensile strength regardless of pH?
Polypropylene suture
What is the benefit of using J-, ski-, or f-needles in intracorporeal endoscopic suturing?
The straight body is optimal for gripping with endoscopic needle drivers.
What distinguishes laser-drilled swage needles from channel-swaged needles?
The suture crimped in a depression vs. a hole drilled in the body of the needle.
What distinguishes tapercut needles from standard cutting needles?
Having a concave cutting surface vs. having a convex cutting surface.
Why are swaged-on needles recommended for routine clinical use?
They cause less tissue trauma than nonswaged needles.
What is the advantage of using reverse-cutting needles over standard cutting needles?
They have a flat edge parallel to the incision.
Which type of suture tends to be less pliable and more susceptible to catastrophic damage from crushing or nicking?
Multifilament suture
What results in greater strength and pliability compared with a monofilament of the same material and size?
Multifilament suture
Which type of suture should be avoided in contaminated wounds or in applications where wicking of bacteria is undesirable?
Multifilament suture
Which type of sutures are designed primarily for orthopedic applications and are extremely strong and resistant to failure, even when abraded or damaged?
Polyblend sutures
Which type of barbed suture has two needles, with half of the suture length having circumferential barbs in one direction pointing toward the midpoint of the suture, and the other half having circumferential barbs in the opposite direction?
Bidirectional barbed suture (Stratafix, Quill)
Which suture material has high initial breaking strength, being superior to chronic gut, polyglactin 910, and polydioxanone?
Polyglytone 6211
Which suture material has approximately twice the initial loop strength of chronic gut suture and less tissue drag and knot security than chromic gut?
Polyglytone 6211
Which suture material is completely absorbed in 90 to 120 days with mild tissue inflammation during the absorption period?
Poliglecaprone 25
Which suture material was stronger than polyglactin 910 when compared and had greater first throw knot hold?
Glycomer 631
Which suture material is similar in many ways to polydioxanone and retains approximately 50% of its strength after 4 to 5 weeks?
Polyglyconate
What impact does exposure to pancreatic secretions, bile, gastric secretions, or blood have on suture degradation?
It reduces the suture strength.
What is the impact of prestraining suture material on suture degradation?
It enhances suture degradation.
What impact does exposure to proteolytic enzymes have on the absorption of catgut suture?
It accelerates the absorption of catgut suture.
Which synthetic suture material has the highest breaking stress and greater knot security compared with polyglactin 910?
Polyglycolic acid
What is the duration of complete absorption for catgut suture in any environment?
60 to 90 days
Which type of needle is a flat, curved needle most frequently used in ocular surgery?
Spatula-point needle
What term describes the degree to which a suture will slowly and permanently deform under constant stress?
Creep
Which characteristic is essential for suture material to have when being chosen?
Pliability for ease of handling
What is the main mode of absorption for synthetic absorbable sutures?
Enzymatic absorption
What is the term for the stress value on the stress-strain curve at which suture acutely fails?
Breaking strength
What is the main purpose of selecting an appropriate suture needle?
To minimize the risk of tissue trauma and complications
How are curved needles different from straight needles in terms of usage?
Curved needles are used in small or deep surgical fields, while straight needles are used closer to the surface of the body.
What primarily dictates the ideal shape of a suture needle?
The surgical field and working area
What is the main distinction between straight needles and curved needles?
Straight needles are used for skin suturing, while curved needles are used for internal tissues.
What defines the specific surgical task for which a suture needle is intended?
The geometric shape of the needle body and the point
Which type of needles are essential for surgery in delicate settings such as ocular, vascular, urogenital, or intestinal procedures?
Nonswaged needles
What distinguishes tapercut needles from cutting needles?
Tapercut needles have a reverse-cutting point while cutting needles have a triangular point.
What is the purpose of using reverse-cutting needles over standard cutting needles?
To reduce the risk of suture pull-through
What are nonswaged needles primarily used for in small-animal veterinary surgery?
Passing large suture in orthopedic surgery
What is the distinguishing feature of laser-drilled swages compared to channel-swaged needles?
Laser-drilled swages enable gripping farther back on the needle and reduce tissue drag.
What distinguishes barbed suture from smooth suture in terms of biomechanical properties?
Barbed suture is significantly stiffer than smooth suture.
What is the purpose of using needles with lateral cutting edges?
To improve knot security
Which synthetic suture material has been shown to have greater knot security compared with polyglactin 910?
Polydioxanone (PDS)
What plays major enzymatic roles in the absorption of catgut suture?
Proteolytic enzymes
What distinguishes tapercut needles from standard cutting needles?
Tapercut needles are designed to improve knot security.
What is the primary reason that monofilament suture has lower tissue drag compared to multifilament suture?
The surface is much smoother.
In orthopedic applications, what makes composite or “polyblend” sutures extremely strong and resistant to failure?
They have a core of one polymer and a braided exterior composed of a different polymer.
What is the main disadvantage of barbed sutures compared to smooth knotted sutures?
They may harbor bacteria and tend to protrude through the incision.
Why should multifilament suture be avoided in contaminated wounds or in applications where wicking of bacteria is undesirable?
It has greater capillarity and an increased tendency for bacterial colonization.
What is the purpose of introducing barbed sutures in veterinary applications such as gastropexy, gastrotomy, and intestinal anastomosis?
To promote tissue ingrowth in high-tension applications.
What impact does exposure to pancreatic secretions, bile, gastric secretions, or blood have on suture degradation?
It reduces suture strength
Which suture material is completely absorbed in 60 to 90 days, with approximately 50% of its strength remaining at 2 to 3 weeks?
Polyglycolic acid
What is the primary impact of prestraining suture material on suture degradation?
It enhances suture degradation
In what conditions will catgut suture be completely absorbed in 2 to 3 weeks?
Regardless of the environment
Which factor has a dramatic influence on the rate of suture absorption?
All of the above
What is the impact of environmental pH on suture absorption?
Glycolide component sutures degrade more rapidly in an acidic environment.
In what conditions did polydioxanone (PDS) and polyglycolic acid (Dexon) show substantial loss of strength over time?
When infected with Escherichia coli or Proteus bacteria
What is the effect of infection with Escherichia coli or Proteus bacteria on suture absorption?
Increases the absorption rate of catgut suture
Which enzyme plays a major role in the enzymatic absorption of catgut suture?
Acid phosphatase
What is the impact of exposure to urine on polyglycolic acid (Dexon) suture strength?
Lost 50% of its initial breaking strength after 10 days when immersed in sterile urine
Which suture material has relatively rapid absorption with approximately 50% loss of tensile strength at 2 to 3 weeks and complete absorption at 90 to 110 days?
Glycomer 631
When compared with polyglactin 910, which suture material was observed to be stronger and had greater first throw knot hold?
Glycomer 631
Which suture material has high initial breaking strength, being superior to chronic gut, polyglactin 910, and polydioxanone (PDS II)?
Polyglytone 6211
Which suture material has identical knot performance to polyglactin 910, similar performance to polydioxanone, and lesser performance compared with polyglyconate and is also available with triclosan coating (Monocryl Plus)?
Poliglecaprone 25
Which suture material is similar to polyglycolic acid in terms of mechanical and absorption characteristics?
Polyglactin 910
Which suture material is known for its marked elasticity, especially at low loads?
Polybutester (Novafil)
Which suture material has been theorized to be advantageous when closing wounds that may swell postoperatively?
Polybutester (Novafil)
Which composite suture has significantly greater knot security and abrasion resistance compared with a braided polyester suture?
FiberWire
Which coated and braided polyethylene suture is described as impregnated with polytetrafluoroethylene?
Tevdek
Which type of suture has at least twice the strength of monofilament polyester or polydioxanone (PDS II) suture and 500 times the fray resistance?
Composite suture
What is the advantage of using stainless steel suture for musculoskeletal applications?
Increased resistance to corrosion
In what direction are the warp filaments aligned in woven mesh materials?
Course direction
What characterizes knitted mesh materials in terms of mechanical properties?
Anisotropy and different properties depending on force application direction
What is the major pore diameter of knitted polypropylene meshes?
0.6-0.9 mm
What is the impact of a very small pore size in synthetic mesh materials like ePTFE?
Decreased risk of encapsulation
Which suture material should be avoided in applications where excessive inflammation is undesirable?
Silk
Which suture material is commonly used in tendon, ligament, joint capsule, or fascia closures due to its prolonged strength and lack of tissue reactivity?
Polypropylene
Which suture material is susceptible to degradation due to hydration soon after implantation?
Nylon
Which suture material is not recommended for implantation in tissues due to the high incidence of sinus formation?
Polymerized Caprolactam
Which suture material has the highest energy to break point compared with silk, nylon, polyester, polyglycolic acid, and gut?
Polypropylene
What is the primary reason for using silk frequently for ligation of large vessels?
Excellent handling characteristics and good knot security
What characteristic of silk makes it advantageous when used to partially ligate portosystemic shunts in animals?
Foreign protein that incites tissue reaction
What is the result of partial ligation of canine femoral veins with silk ligatures after 6 weeks, according to an experimental model?
No change in vessel diameter
What is the primary reason for suggesting that foreign body reaction and associated inflammation are responsible for progressive occlusion of partially ligated vessels over time when using silk?
Silk is a foreign protein that incites a considerable tissue reaction
How long does it take for silk to be completely deteriorated?
2 years
What material demonstrated the best biomechanical properties in a study comparing suture pull-out, tensile strength, and push-through strength?
Allogenic frozen canine fascia lata
What is the recommended overlap with native tissue when mesh is under tension?
1 cm
What is the significant association of postoperative complications in dogs undergoing rib tumor resection?
Use of polypropylene mesh alone
What is one potential complication of surgical mesh?
Visceral adhesions
When should staple instruments not be used?
In necrotic tissue
What synthetic mesh material had an initial greater bursting strength and a smaller pore diameter?
Polypropylene
Which mesh material had significantly greater mature (type I) collagen ingrowth and 90-day wound strength?
Polypropylene
Which synthetic mesh material is unlikely to form adhesions to viscera?
ePTFE
Which biologic material is used most frequently in veterinary surgery as a multilaminate material and is marketed as a bioscaffold?
Porcine small intestinal submucosa
What material has been shown to have a modulatory effect on local cytokines involved in wound healing?
Porcine small intestinal submucosa
What is the most frequently used material for staples today?
Titanium
What are the advantages of skin stapling compared to suturing or gluing?
Increased wound oxygenation and blood flow
Which compound is used to compose absorbable, subcuticular staples?
Polyglycolic and polylactic acid
What makes titanium staples preferable to 316L stainless steel staples?
Radiographic and magnetic artifact
What is the purpose of instilling saline under pressure after stapling hollow organs?
To assess for anastomotic leaks
What is a potential clinical disadvantage of staples?
Difficulty during application
What wire diameters are typically associated with skin staples?
$0.5$ to $0.6$ mm
What is the approximate range for the closed width or crown of regular skin staples?
$4.8$ to $5.7$ mm
Which suture material is commonly used in tendon, ligament, joint capsule, or fascia closures due to its lack of tissue reactivity and resistance to degradation?
Polypropylene
Which suture material should be avoided in any application where excessive inflammation is undesirable?
Silk
Which suture material is susceptible to degradation, leading to disruption of hydrogen bonds and loss of tensile strength due to exposure to hydration and an acid environment?
Nylon
Which suture material is marketed as Vetafil and is recommended for use only in the skin due to the high incidence of sinus formation?
Polymerized caprolactam
Which suture material is very resistant to degradation due to a lack of hydrolyzable bonds?
Polypropylene
Why is stainless steel suture employed mostly for musculoskeletal applications?
It has high initial breaking strength
What is the primary purpose of using surgical mesh?
To serve as a buttress for primary tissue repair
What mechanical properties are observed in the warp and weft directions in woven mesh materials?
Similar properties in all directions
What are the major pore diameter and porosity of knitted polypropylene meshes?
Pore diameter roughly between 0.6 and 0.9 mm and porosity of 28% to 32%
Why are knitted materials considered to be more porous and flexible but less strong than woven meshes?
They have intermeshing loops of one continuous filament
What mesh material had a significantly greater mature (type I) collagen ingrowth and 90-day wound strength compared with polypropylene mesh?
ePTFE
What is the primary purpose of using composite meshes in veterinary surgery?
Maximizing early wound strength
Which biologic material is used most frequently in veterinary surgery as a bioscaffold due to the observed ingrowth of native tissues after placement?
Porcine small intestinal submucosa
What happens to the leukocyte inflammatory population after 1 month of implantation of porcine small intestinal submucosa in comparison to other materials?
It wanes dramatically
What is the impact of temporally using porcine small intestinal submucosa in a body wall defect model?
Initial degradation in bursting strength, followed by progressive increase
What material demonstrated the best biomechanical properties in a study comparing suture pull-out, tensile strength, and push-through strength?
Allogenic frozen canine fascia lata
What is recommended due to the poor performance of single-layer porcine small intestinal submucosa in high-strain environments?
Limiting the use of single-layer porcine small intestinal submucosa
Which surgical technique is recommended to prevent mesh fraying and pull-out on the margins?
Creating a hem by doubling over the edge of the mesh
What technique may reduce complications associated with the use of surgical mesh?
Using the smallest amount of mesh needed
When should staple instruments not be used?
In ischemic or necrotic tissue
Which suture material has been associated with significant adhesions when used to close mesenteric defects in people?
Surgidac
What is the distinguishing characteristic of polybutester suture?
Marked elasticity
Which composite suture has a core of multifilament ultra-high molecular weight polyethylene surrounded by a braided polyester and polyethylene exterior?
FiberWire
Which material demonstrated significantly greater knot security and abrasion resistance compared with a braided polyester suture in a study?
FiberWire
Which type of stainless steel is composed of 304, 316, or 316L?
316L stainless steel
What is the primary reason for using silk frequently for ligation of large vessels?
Silk provides excellent handling characteristics
Which characteristic of silk makes it advantageous when used to partially ligate portosystemic shunts in animals?
Considerable tissue reaction
What is responsible for the progressive occlusion of partially ligated vessels over time when silk is used?
Considerable tissue reaction
What is the crystalline structure of silk slowly degraded by?
Hydration
What occurs to silk after 2 years?
It completely deteriorates
What is the primary reason for using titanium staples in surgery?
They have a low risk of radiographic or magnetic artifacts
What is the advantage of using skin staples over sutures in wound closure?
They lead to better wound oxygenation and blood flow
What is the approximate closed width or crown of regular skin staples?
4.5 to 5.0 mm
Why are absorbable staples used in surgery?
They lead to less inflammation and postoperative infection-inflammation
What is a disadvantage of using staples in surgery?
They have a greater potential for postoperative infection-inflammation
What is the primary characteristic of skin staples that tends to differ from other wound closure methods?
They tend to evert the wound edge
What is the main reason for using single-use disposable skin stapling devices?
They reduce the risk of postoperative infection-inflammation
Test your knowledge on the selection of appropriate suture needles for surgical procedures. Understand the importance of needle choice, the anatomy of a suture needle, and its impact on tissue trauma and wound healing.
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