Suturing materials power point presentation.pptx

For Oral and Maxillofacial surgery students

1. dr Suturing materials

2. Classification: Surgical Sutures can be broadly divided into: Absorbable : All suture materials that are digested by the body enzymes or are hydrolyzed by the tissue fluids are absorbable. They can be further classified into natural and synthetic. E.g. surgical gut, vicryl , polydiaxonone (polyesters) etc . 2. Norabsorbable : Sutures that cannot be digested by tissue enzymes and are encapsulated or walled off are nonabsorbable . Nonabsorbable suture materials can also be classsified into natural, metallic and synthetic. e.g. linen, surgical cotton, surgical silk,nylon,prolene , polyamide, polyesters,surgical steel.

3. These can be further divided into monofilament and multifilament type in each category. a. Monofilament type: It is made up of a single strand, resists harboring micro-organisms and soak up tissue fluid ties smoothly. It is to be handled delicately without any damage to the strands to avoid breakage postoperatively. e .g. surgical gut, prolene . b. Multifilament type: It consists of several filaments twisted or braided together into a and a thread type th single strand. This gives good handling and page also influence tying characteristics. As this type of suture can harbor bacteria, it is not suitable in the presence of of contamination and infection. e.g. surgical silk, nylon, vicryl , surgical cotton,

4. 3.Coated or Non-coated: Some sutures like polyester sutures are usually coated with a biologically inert nonresorbable compound. This highly effective lubricant provides a thin coating, which dramatically reduces the surface friction of the braid, which aids the thread in passing more easily through the tissues. This coating, however, makes and biological knot security an issue, as the material will easily untie if not secured with a surgeon's knot. 4. Surgical threads are also classified by the thread diameter. Thread materials range in diameter or thickness from 1-0 to 10-0, with the higher number of zeros, corresponding to the thinner, more delicate thread. In dentistry, a 3-0 thread diameter is usually used to secure flaps, when a mattress suturing technique is used and then a 4-0 thread is used closer to the flap edges.

5. natural: surgical gut, linen , surgical silk, surgical cotton, collagen, surgical steel. synthetic: vicryl , prolene , nylon , natural absorvable : surgical gut synthetic absorvable : polymers , vicryl , polyesters

6. Principles of Suturing 1. The needle should be grasped at approximately 1/3rd the distance from the eye and 2/3rd from the point. 2. The needle should enter the tissues perpendicular to the tissue surface. 3. The needle should be passed through the tissues along its curve . 4. The suture should be passed at an equal depth and distance from the incision on both sides. 5. The needle always passes from the movable tissue to the fixed tissue.

7. 6. The needle always passes through the thinner tissue to the thicker tissue. 7. The needle always passes from the deeper tissue to the superficial tissue. 8. Tissues must never be closed under tension.Undermining the tissues must be done prior to suturing in such cases. 9. The suture should be tied only to approximate thetissues , not to blanch. 10. The knot should never lie on the incision line. 11. Sutures should be placed at a greater depth than the distance from the incision, so as to evert the wound margins . 12 Sutures on the skin are usually removed in 5 days and intraoral sutures in 7 days. If there is tension while suturing, the sutures may be kept for 10 days.

8. SUTURE NEEDLES: the surgical needles are of two types: a. Eyed Eyeless Suture needles are usually also classified according to their curvature , radius and shape . The surgical needle comprises of three parts needle eye, needle body,needle point.

9. Needle Eye: The eye can be closed or swaged. The closed eye is similar to the eye of the household needle. The shape of the eye may be round, oblong or square. Eyed needles must be threaded and present the disadvantage of pulling a double thread through the tissues and therefore are also known as traumatic needles. When the suture is attached to the needle via a hole drilled through the end of the needle, and the end is swagged during manufacture, it is called a swaged suture. These are also known as atraumatic needles. Advantages of Eyeless Needles: 1. Less trauma to the tissues, since a single strand of suture material has to be drawn through the tissues and this creates a smaller hole 2. Each patient has the benefit of a new, sharp, guaranteed sterile needle. 3. No chances of accidental unthreading of the needle and losing it

10. 3. No chances of accidental unthreading of the needle and losing it while suturing. 4. Faster and more efficient procedure. 5. Needles are made up of high quality steel 6. Tru -tempering process gives uniform strength. 7. By merely quoting the Code Number, the surgeon indicates the type, size, length of the suture as well as the details of the needle. 8. Nurse working hours are saved-no need of ordering, cleaning, sterilizing and threading the eyed needles.

11. Needle Body The body or the shaft section is usually referred to as the needle grasping area. The cross-sectional configuration of the body may be round, oval, side flattened rectangular, triangular or trapezoidal. The longitudinal shape of the body may be (I)Straight (II) Half curved, (III)curved _ One-fourth(1/4) Half circle(1/2),three-eight(3/8),Five-eight circle(5/8).

12. Needle Point The tip can be cutting, round or blunt .Cutting needles have at least two opposite cutting edges. They are ideal for suturing keratinized tissues like the skin, palatal mucosa, buccal and alveolar mucosa. Cutting edges can be conventional, reverse or side cutting. They are triangular in cross-section. Round/tapered needles are used for suturing soft and nonkeratinized tissues like muscle, fascia, and neural sheath.