Suture and Suture Materials

Stress incontinence

Ans:B.)Polyester.

• Absorbable sutures are:Plain and Chromic Catgut,Polyglactin,Polyglyconate,Polyglycolic Acid,Polydiaxone,Polyglycaprone.
• Non-absorbable sutures are:Silk,Linen,Surgical Steel,Linen,Polyester,Polybutester,Polypropylene,polyethylene.

10% isopropyl alcohol is the routine packing fluid used in packing catgut sutures.

Catgut is available in glass tubes containing isopropyl alcohol and small quantity of water.

Catgut is prepared from the intestine of sheep.

Ref: Pharmaceutics By Dr. R. S. Gaud, Page 196; Veterinary Medicine/small animal clinician, Volume 72, Issues 1-6, Page 835.

• Polypropylene or Prolene is a synthetic non-absorbable suture.
• The advantages include minimal tissue reactivity and durability and the disadvantages include fragility, high plasticity, high expense, and difficulty of use compared to standard nylon sutures.
• They are dyed blue, which helps in easy visibility against the skin and when operating and is composed of a single filament.

Ans. is b i.e. Uterus

In case of massive haemorrhage if medical methods fail then either mechanical or surgical methods should be adopted.

Mechanical methods- include

• Bimanual compression
• Uterine packing under anesthesia
• Balloon tamponade with a sengstaken tube inserted into the uterus.

Surgical methods

If Family is not completed                                      

If family is completed Application of B lynch sutures (COGDT 10/ed Pg 482, William Obs 23/e, p 776)

Radiographic embolization of pelvic vesels (COGDT 10/ed p 481)                                                    

Hysterectomy Uterine and ovarian artery ligation

–             Internal iliac artery ligation fail

Hysterectomy

Details of Surgical method.

• B lynch Suture/ Brace suture is an alternative to vessel ligation technique in the surgical management of PPH. It involves the use of vertical brace sutures, which appose the anterior and posterior walls of the uterus, which leads to compression of the fundus and the lower uterine segment, thereby controlling the hemorrhage.
• The main advantage is that it is very easy to perform and may obviate the need for a hysterectomy.

It is commonly performed at cesarean section but can also be done after vaginal delivery.

Application of block sutures : The anterior and posterior uterine walls are approximated until no space is left in uterine cavity using block sutures I multiple squares.

Uterine and ovarian artery ligation : It is easier than internal iliac artery ligation and can be tried as the first resort .

Internal iliac artery ligation (anterior division) : It should be considered before hysterectomy, especially in nullipara. as the uterus can be preserved.

The artery is ligated about 3 cm from common iliac artery. It will ensure that posterior division is not included in the ligature, as it may lead to loss of lower limb sensation (femoral artery and dorsalis pedis artery are branches of posterior division.

Arterial embolisation : Done when patient is hemodynamically stable and good radiological facilities are available. Under fluoroscopic guidance femoral artery is catheterised, the bleeding vessel identified and embolisation is carried out using gel foam.

Hysterectomy : It is the most definative method of controlling PPH and should be the last resort.

Ans. is ‘c’ i.e. Non-synthetic absorbable 

Ans is (a ) ie., isopropyl alcohol

Ans. is ‘b’ i.e., 1 week 

Ans. is ‘A’ i.e. Polypropylene 

Ans. is C:Polyglycolic Acid.

• Absorbable sutures are:Plain and Chromic Catgut,Polyglactin,Polyglyconate,Polyglycolic Acid,Polydiaxone,Polyglycaprone.
• Non-absorbable sutures are:Silk,Linen,Surgical Steel,Linen,Polyester,Polybutester,Polypropylene.

Ans. is ‘a’ i.e., Polypropylene 

Ans. is ‘b’ i.e., Copolymer of glycolide and lactide 

Vicryl Suture is a synthetic absorbable sterile surgical suture composed of a copolymer made from 90% glycolide and 10% L-lactide.

Coated Vicryl Suture is indicated for use in general soft tissue approximation and/or ligation, including use in ophthalmic procedures, but not for use in neurological tissues.

Ans. is ‘b’ i.e., Vicryl 

Ans. is. ‘b’ i.e., Undergoes hydrolysis and complete absorption

Polydioxanone (PDS)

• Types- Monofilament dyed or undyed
• Raw material- Polyester polymer Approx
• Tensile strength- 70% remains at 2 weeks; 50% remains at 4 weeks; 14% remains at 8 weeks
• Absorption rate- Hydrolysis minimal at 90 days; Complete absorption 180 days

Ans. is ‘b’ i.e., Sero muscular sutures 

• Lembert described seromuscular suture technique for bowel anastomosis in 1826.
• Lembert suture group interrupted posterior seromuscular sutures were performed using 3-0 silk to approximate the gastric tube and esophagus with a 3 mm interval.
• Then, interrupted stitches with full-thickness of the esophagus and gastric tube were performed for patients undergoing thoracoscopic esophageal mobilization and lymphadenectomy, laparoscopic gastric mobilization, lymphadenectomy and gastric tube formation, and cervical anastomosis.

Ans. B i.e. 3-5 days