SUTURES AND SUTURING TECHNIQUES (Class)
SUTURES AND SUTURING TECHNIQUES (Class)
SUTURES AND SUTURING TECHNIQUES (Class)
A SEMINAR BY
SAUMYA SHARMA
Contents
Provide adequate tension of wound closure without dead space…but loose enough
Maintain Haemostasis.
ABSORBABLE NON-ABSORBABLE
Multifilament
Absorbabale Sutures
Surgical Gut
Oldest known absorbable suture material.
Consists of several piles that have been twisted slightly & then machine
Childers 1963)
’s
Organic & highly susceptible to enzymatic degradation….isopropyl alcohol.
Rapid loss of tensile strength…
Absorbed by proteolytic action…inflammation and tissue reaction.
Absorbed in 3-5 days.
Stiff and insecure knot holding characteristics.
Chromic Gut
Plain gut tanned with solution of chromium salts…
Slightly increased strength, lesser tissue reaction and prolonged rate of
absorption…
Degraded by 7 days when used intraorally ( Wallace, Maxwell & Cavalaris 1970).
Much variability exists.
Collagen
’s
Loss of tensile strength extremely rapid.
Difficulty in tying suture material.
Expensive.
Polyglactin 910 (Vicryl)
Braided configuration.
Copolymer of glycolide and lactide which are derived from hydroxyacetic acid and
lactic acid respectively. … coated with polyglactin 370 & calcium stearate.
’s
Strongest of absorbable materials.
’s
Potential for scar formation.
Polydioxanone (PDS)
Polyester monofilament suture.
Absorbed in 120-180 days.
Minimal tissue reaction and maintains breakin strength for 6 wks.
Polyglyconate ( Maxon)
Monofilament
Absorbed in 180 days.
Maintains breaking strength for 3 weeks.
Monocryl
Polyglecaprone 25 copolymer of glycolide & caprolactone.
Absorbed in 90-120 days.
Very good tensile strength and minimal tissue reaction.
Non-Absorbable Sutures
Silk
Organic and undergoes slow proteolysis when implanted ( Douglas 1949)
Most popular for intra oral use.
’s
Braided…excellent handling.
Does not irritate adjacent mucous membrane.
Inexpensive.
’s
Moderate tissue reaction.
One of the lowest tensile strengths …….just above that of collagen and
gut.
Lowest knot holding ability….
Nylon
“Memory” property…..
Stiffness.
non-keratinised tissue.
Cotton and Linen
Stiff & do not conform to the suture pathway during host movement.
Usually used for suspension of splints and revision of keloid scars …….not intra
orally.
Dacron polyester, Polypropylene, Polyethylene, Teflon-
coated or impregnated Dacron polyester, Silicon coated
Dacron polyester.
Braided with great tensile strength & knot holding ability ( Herrmann 1971)
Possesses high co-efficient of friction…interferes with the ties being slipped into
place.
No difference in infection is seen with regards to both the uncoated and coated
versions.
Polypropylene
Gore-Tex
Wound closure and healing is affected by the initial injury caused by the
by the surgeon.
Ideal properties of Needles
Should be sharp.
Anatomy of a Needle
Tapered
1. Force should always be applied in the direction that follows the curvature
of the needle.
7. Grasp the needle in the body 1/4th to half of the length from the swaged area.
9. Avoid excessive tissue bites with small needles, as it will be difficult to retrieve
them
Needle Holder
2. Needles should be grasped 1/4th to half the distance from the eye or the
swaged area.
3. The tips of the jaws of the needle holder must meet before the remaining
4. The needle should be placed securely in the tips of the jaws and should
Dean Scissors…
Knots
Suture Securing : Ability of the knot & the materials to maintain tissue
2. Suture diameter.
3. Type of knot.
Monofilament & coated sutures (Teflon)
Square Knot :
Surgeons Knot :
Granny Knot :
Knot tying…Ethicon 1985.
1. Knot must be firm ….no slippage.
7. After the first loop is tied it is necessary to maintain traction at one end
of the strand to avoid loosening of the throw.
3. Tissue eversion.
Skin……..3-5 days
Intra-oral………7 days
Grasp the knot with the tweezers & cut very close to the mucosa….
Classification of Suture Techniques
INTERRUPTED CONTINUOUS
VERTICAL / HORIZONTAL
HORIZONTAL MATTRESS MATTRESS
INTRA-PAPILLARY
Interrupted Sutures
Advantages :
1. Distance between each suture and between that of the suture and the
incision line can be pre-decided or determined.
2. They are stronger & loosening of any one suture will not cause the others
to loosen.
3. In areas of tension when strong closure is required…interrupted sutures
are preferred.
4. Incase of infection….removal of infected sutures is sufficient.
Indications
Osseointegrated implants.
Direct Loop Suture
Indications
1. Need for coverage of interdental bone with interdental papilla.
2. Incase of bone graft usage.
When flaps are not in close apposition because of apical flap displacement.
5. Allows independent placement & tension of buccal & lingual/ palatal flaps….
7. Simple.
Disadvantages
Independent Sling Sutures
Continued through next interproximal embrassure such that the suture encircles the
Needle can then be passed, either over the papilla or underneath through the
Repeat procedure.
Vertical & Horizontal Mattress Sutures.
Continuous Locking Suture
Usually used in long edentulous areas.
Technique :
2. Needle is inserted from outer surface of buccal flap & inner aspect of the
lingual flap.
3. Needle then passed through the remaining loop of the suture & pulled
tight.
1. Holding sutures
2. Closing sutures
Technique
The needle point is perpendicular to the tissue surface…..Penetration.
Body of the needle is now rotated….Rotation.
The needle point is permitted to glide against the bone….Glide.
As it glides, it is rotated about the body……Rotation.
Exit.
Other Methods of Wound Closure
Cyanoacrylates
- n-butyl cyanoacrylate is the active ingredient.
Advantages :
irregular forces.
Ligating Clips
Usually made up of stainless steel, tantalum or titanium.
Can be resorbable or non-resorbable
Tubular structures are ligated.
Surgical Staples