Suturing and its technique

Short Presentation

1. Suturing and its Technique Dr. Sarosh Hussain House Officer HUDH

2. Contents Introduction Goals of Suturing Suture Armamentarium Suture Materials Suturing Techniques

3. Introduction Suture means to ‘sew’ or ‘seam’. In surgery suture is the act of sewing or bringing tissue together and holding them in apposition until healing has taken place . A suture is a strand of material used to ligate blood vessels and to approximate tissues together.

4. Goals of Suturing Provide adequate tension. Maintain hemostasis. Provide support for tissue margins. Reduce post-operative pain. Prevent bone exposure. Permit proper flap position.

5. Suture Armamentarium Needle holder. Suture scissor. Adson forceps. Suture needle. Suture material.

6. Suture material Ideal Properties:- Easy to handle. Predictable behavior in tissues. Predictable tensile strength. Sterile . Secure knotting ability. Minimal tissue reaction. Non-allergenic, Non-carcinogenic, Non-shrinkage .

7. CLASSIFICATIONS OF SUTURE MATERIALS According to source:- Natural Synthetic Metallic

8. Natural SUTURE MATERIALS Absorbable Non-absorbable Catgut Silk Chromic catgut Silk worm gut Collagen Linen

9. Synthetic SUTURE MATERIALS Absorbable Non-absorbable Polyglycolic acid Nylon (polyamide) Polyglactic acid Polypropylene (Prolene) Polyglactin (vicryl) Polyesters

10. Metallic SUTURE MATERIALS Stainless Steel Tantalum Silver Gold Aluminium

11. Suturing techniques Interrupted suture. Simple Continuous suture. Horizontal Mattress Suture. Vertical Mattress Suture. Figure of 8 ( eight) suture.

12. Interrupted suture . Do the pass technique, two loops around the needle holder, then grab the tail and do the knot .

13. Indications:- Single tooth extraction, third molar extraction flap, biopsies, implants etc . Advantages:- It is the most commonly used technique, preferred in urgent situations and it is easy to remove. Failure of one is inconsequential of the others . Disadvantages :- It does not bring all surfaces into contact and less supportive for healing of the flap margins.

14. SIMPLE Continuous suture Start it with simple interrupted suture, then you cut the tail off and leave that last piece loose then you can do your loops .

15. Indications:- Bone graft, removal of mandibular tori, tuberosity reduction and where esthetics are not important . Advantages:- It is very easy to produce and offers a more water tight closure . Disadvantages:- if you cut one part of it, you lost all of it.

16. Horizontal Mattress Suture The strongest type of sutures , very far away ( 8 mm from the edge ).

17. Indications :- large distances between tissues, bone grafts and implants, and closure of extraction socket . Advantages :- Good for hemostasis, less prominent scarring . Disadvantages :- Leave a gap between flaps and it is difficult to remove.

18. Vertical Mattress Suture The far-far , near-near technique.

19. Indications :- where the wound edges tend to Evert. Advantages :- greater closure strength and better distribution of wound tension. Disadvantages :- Scar formation and the formation of edge necrosis.

20. Figure of 8 (eight) suture Pattern goes 1-2-3-4-1.

21. Indication:- Extraction socket closure, adaptation of gingival papilla around the tooth, and bone graft placement in socket. Advantages:- Rapid closure. Disadvantages:- Due to its orientation, it is difficult to remove and it leaves a significant amount of suture threads inside the socket.

22. THANK YOU