Suturing Flashcards

1
Q

When were synthetic non-resorbable and resorbable suture fibres developed?

A

after the second world war

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2
Q

What is the purpose of sutures?

A
  • hold tissues in place to permit healing via primary intention
  • control bleeding
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3
Q

What suturing techniques should a GDP be familiar with?

A
  • interrupted suturing
  • continuous suturing
  • vertical mattress suturing
  • horizontal mattress suturing
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4
Q

State the suittable thread diameter for use in dentistry

A

3-0 to 6-0

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5
Q

The most commonly used suture needles are made from ___________. They vary in the shape of _________.

A

stainless steel

shape of curvature

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6
Q

What type of suture is best placed in the oral mucosa?

A

absorbable

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7
Q

What kind of suture is best placed in facial skin?

A

non- absorbable

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8
Q

Give examples of absorbable sutures

A
  • vicryl
  • vicryl rapide
  • serasynth
  • serafast
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9
Q

Give examples of non- absorbable sutures

A
  • prolene
  • sealene
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10
Q

Absorbable sutures are all eliminated by the same process of degradation. True or false

A

false

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11
Q

How does catgut degradation take place?

A
  • a foreign body reaction with enzymatic involvement
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12
Q

How does degradation of vicryl (synthetic) take place?

A
  • it is absorbed by hydrolysis
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13
Q

What are the characteristics of monofilament threads ?

A
  • consists of a single thread
  • have a closed interior
  • smooth
  • display no capillarity
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14
Q

Monofilaments form _______ suture threads

A

thin suture threads

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15
Q

How are multifilament threads produced?

A

they are produced by twisting or braiding many thin threads together

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16
Q

State a major disadvantage of twisted threads

A

they display a high capillarity i.e. they act as bacterial reservoirs

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17
Q

What is the consequence of using braided threads?

A

they impede the passage of fluids as the filaments are aligned obliquely to the longitudinal axis of the thread

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18
Q

State an advantage and disadvantage of using multifilament sutures

A

Advantage:
* superior knot tying characteristics

Disadvantage:
* due to the process of production, they tend to be rough making their passage through tissue more difficult

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19
Q

What helps reduce the friction and capillarity of sutures ?

A

coating them

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20
Q

How long does coated vicryl offer wound support for?

A

28 days

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21
Q

When does complete absorption of coated vicryl take place?

A

56-70 days

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22
Q

How long does vicryl rapide offer wound support?

A

10 days

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23
Q

When does total absorption of vicryl rapide occur?

A

42 days

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24
Q

The wound support of vircyl rapide at 5 days is ___%

A

50%

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25
Q

Vicryl plus has _______ properties. However, its use for intraoral wound closure has not been demonstrated yet.

A

anti-bacterial

26
Q

Suture thread diameter is described by ______.

A

gauge

27
Q

What is the gauge range of suture threads ?

A

1-0 to 11-0

28
Q

The greater the gauge of a suture the _______ the suture thread

A

thinner

29
Q

What is an important characteristic to recognise for suture threads with a higher gauge?

A

lower tensile strength

30
Q

What are the most commontly used shapes of suture needles? Which shape out of these is the least curved /

A
  • 3/8 circle
  • 1/2 circle
  • 5/8 circle

3/8 circle is the least curved

learn to identify these

31
Q

What is an indication for use of a needle with a greater curve?

A

when access to an area with restricted space is needed

32
Q

What are the two ways in which needle types may be described?

A
  • taper (smooth) - gradually taper to the point
  • cutting
33
Q

What types of tissues are taper needles used for? Give examples

A

used for tissues that are easy to penetrate

e.g. blood vessels, bowel

34
Q

What kind of needle is required for closure of mucosa and mucoperiosteal flaps?

A

cutting needles

35
Q

Briefly describe the nature of cutting needles

A
  • triangular in shape
  • the apex of the needle forms/is the cutting surface
36
Q

Why are taper needles contraindicated for tougher tissues such as the skin?

A

this is because of the trauma that is caused by the difficulty of penetration

37
Q

How do reverse cutting needles differ from conventional cutting needles?

A

the cutting edge faces down rather than up

38
Q

What is the major benefit assigned to the reverse cutting needle?

A

it reduces the chance of the suture pulling through the tissue (essentially of it falling out of the tissue)

39
Q

What are the main types of needle holders ?

A
  • rachet needle holders
    non-rachet needle holders
40
Q

What is the purpose of a rachet on needle holders?

A

maintenance of grip on the needle

41
Q

Describe the ideal set up and hold for a needle/suture

A
  • palm grip to allow mobility of the wrist
  • needle is grasped about 2/3 back from the needle tip; holding it closer may weaken or bend the needle (should be approximately 2mm from where the suture material joins the needle)
  • thumb and ring finger should not be placed too far into the rings of the holder
42
Q

State the use of the toothed tissue forceps

A
  • used to position the edge of the tissue gently and facilitate perpendicular passage of the needle
  • used to grasp the needle when repositioning it in the needle holder to avoid touching it with fingers
43
Q

Describe the ideal position of the toothed tissue forcep in the hands

A
  • they should be rested on the web space between the thumb and index finger so they (tissue forceps) can act as an extension of the thumb and index fingers

The tissue forceps are essentially used as an extension of thumb and index finger

44
Q

The ideal suture should form a ________. How should the tissue be penetrated?

A

rectangle

the tissue should be penetrated perpendicular to its surface

45
Q

When is a less perpendicular angulation accepted when placing a suture? What type of knot is accepted here?

A
  • when closing mucosa that is bound down to bone in the gingival region
  • a square knot
46
Q

State an important requirement for the placement of a square knot

A
  • the needle should be passed through a distance of at least 3mm from the free edge
47
Q

Describe how knot tying is achieved

A

wrapping/throwing the long end of the suture thread around the tip of the closed needle holder twice before grasping the short end with the needle holder

48
Q

What is the consequence of placing suture too tight?

A

they can cause oedematous swelling of the soft tissues

49
Q

What length of thread is appropriate to leave behind? What is the consequence if it is too short or too long ?

A

3-4mm

too short:
* knot may untie

too long
* uncomfortable for patient

50
Q

What type of scissors is appropriate for the removal of intra-oral sutures?

A

Iris-type scissors

51
Q

Why is a continuous suture considered to be more vulnerable?

A

this is because it relies on fewe knots

52
Q

What is the purpose of the vertical mattress suture?

A
  • add additional wound edge eversion
  • decrease dead space within a wound
53
Q

What is the benefit of wound edge eversion?

A

allows a wound to lay flat as opposed to becoming depressed in the centre(inverting)

google images of wound edge eversion

54
Q

Briefly describe how a vertical mattress suture is placed

A
  • needle introduced about 5-6mm from the wound edge
  • deep bite of tissue is taken before exiting in the tissue in the same position on the opposite side of the wound edge
  • needle position is then reversed in needle holder and reintroduced about 1-3mm from the second side of the wound
  • a smaller bite of tissue is taken before leaving the first side of the wound
  • a knot is placed
55
Q

When is the horizontal mattress suture indicated ?

A

when it is important to distribute wound tension across larger wounds

56
Q

What is the most commonly used type of intra-oral suture?

A

simple interrupted suture

57
Q

If a wound requires support longer than a 7 days, what suture should be used ?

A

vicryl

(not vicryl rapide)

58
Q

Why would continuous suture not be suitable for the closure of a wound created following access for anterior mandibular bone harvesting? Suggest appropriate sutures that can be placed instead

A
  • this is because this would would be under significant tension with the movement of the lower lip
  • A horizontal mattress sutre is ideal for apposing the mentalis muscle

Appose- side by side

59
Q

Wounds resulting from endodontic surgery require increased support. Give the “ideal” suture to be placed following endodontic surgery

A
  • horizontal mattress (not simple interrupted)
  • vicryl (not vicryl rapide)

this is the case when the incision is placed in the vestibule and is under great tension with movement of the lip

60
Q

What patient and clinical characteristics could potentially indicate the need for longer wound support and therefore the use of coated vicryl.

A

when wound healing is compromised due to
* age
* low body weight
* general health condition that reduces immune response

  • poor local blood supply
  • local infection