Suture materials and principles of suturing
Dr. Bara Sultan B.D.S,M.Sc,F.I.C.B.SSuturing
The purpose of suturing are :1 – to hold the wound margins together to promote wound healing by first intention. 2- to approximate the wound margin to minimize wound contamination with food debris 3 – to arrest hemorrhageNeedles
Needles are of 2 shapes : straight and curved. The straight needle require large spaces for manipulation and are of little importance to an oral surgeon. Curved needles are of round or cutting type ( according to the cross section of the needle). The curved cutting needle are a\conventional cutting type or b\ reverse cutting type.Surgical Needle
The conventional has one of its cutting edge on the curved inner surface. While reverse cutting has a flat inner surface.Principles of suturing
1- The needle is grasped with a needle holder at its 2\3 of its curvature .it never held by the eye or the point 2- the area to be sutured is dried with a sucker or cotton swab so that the cut edge are clearly visible . 3- suturing from the movable to the fixed wound margin 4- toothed dissecting tweezers are used to grip the flap and fix it .Needle Holder
Remember!!! Thumb & ring finger into needle holder’s rings (NOT your middle finger!)Index finger stabilizes the instrument by resting on the shaft.
Surgical Scissors5- the needle should pass at least 3 mm from the wound margin 6- the knots should be lied at one side of the wound margin. 7- the knots should be not too tight and not too loose .
suture removal
The suture should be remain in situ for up to 7 days They should be removed by grasping of the knots and cutting the suture where it enter the tissues . If the suture is cut at a distance from point of entry into the tissues contaminated suture material may be dragged through the healing wound thus infecting it .* * SUGGESTED REMOVAL TIME
Removal time (days)Area
3-5
Face
5-8
Neck
7-9
Scalp
8-14
Upper limb
10-14
Trunk
14
Ext. surface hand
14-28
Lower limb
Properties of suture materials
* * 1- CONFIGURATIONThe number of strands of material used to fabricate the suture:
Monofilament
Multifilament
* * 2- SIZE
Denotes the diameter of the material. Use the smallest suture size that will adequately hold the wounded tissue. Minimizes trauma. Minimum mass of the foreign material.* * SIZE
Diameter (mm)Metric scale
Size
0.5
5
2
0.4
4
1
0.35
3.5
0
0.3
3
2/0
0.2
2
3/0
0.15
1.5
4/0
0.1
1
5/0
* * 3- TENSILE STRENGTH
The weight required to break a suture divided by its cross-sectional area. The ability of suture material to keep tissues approximated. The rate of tensile strength loss is not the same as its absorption and varies among suture materials.* * 4- PLASTICITY
Ability of the suture to retain its new form and length after stretching. Allows a suture to accommodate wound swelling and therefore decreases the risk of strangulated tissue and crosshatch marks.* * 5- ELASTICITY
Ability of a suture to regain its original form and length after stretching. After the swelling of a wound recedes, the suture returns to its original length and keeps the wound well approximated. Most sutures are elastic; few are plastic.* * 6- MEMORY
The ability of a suture to return to its original shape after its deformation by tying. A suture with a high degree of memory, particularly a monofilament suture, is. Stiff. Difficult to handle. The knots are less secure. They may require an extra throw to prevent loosening of the knot.* * THE CHOICE OF PROPER SUTURE MATERIAL
The optimal suture has the following criteria: 1- Easy to handle. 2- Has high tensile strength and knot security. 3- Any tissue reaction should be minimal.* * THE CHOICE OF PROPER SUTURE MATERIAL
4- The material should resist infection 5- Have good elasticity and plasticity 6- A low cost is preferred* *
Suture Material
3 ways of classifying suture material: Natural or Synthetic Absorbable or Non-Absorbable Monofilament or Braided/TwistedSilk Catgut
Natural Silk, linen, catgut Synthetic polymer Polypropylene, polyester, polyamidePolypropylene Polyester
Absorbablecatgut, polydioxanone, polyglycolic acidUsed for deep tissues, membranes, & subcuticular skin closureNon-Absorbablepolyester, nylon, stainless steelUsed for skin (removed) & some deep structures (tendons, vessels, nerve repairs – not removed)
Monofilament Polypropylene Polydioxanone Nylon
Multifilament Catgut (twisted) Polyester Silk (braided)Suturing techniques
1-simple interrupted . 2- continuous . 3- continuous interlocking or blanket . 4- figure of eight. 5- Sling suture.SIMPLE INTERRUPTED suture
Simple interrupted suturesIn this type of suturing the needle is passed from one side to the other side of the incision and the knot- tied. If there is loosening or break of a stitch it does not affect the others. If for some reason like infection ,stitch is to be removed .it is not necessary to remove the complete suturing , the removal of only a few is sufficient.