Suturing Flashcards
When were synthetic non-resorbable and resorbable suture fibres developed?
after the second world war
What is the purpose of sutures?
- hold tissues in place to permit healing via primary intention
- control bleeding
What suturing techniques should a GDP be familiar with?
- interrupted suturing
- continuous suturing
- vertical mattress suturing
- horizontal mattress suturing
State the suittable thread diameter for use in dentistry
3-0 to 6-0
The most commonly used suture needles are made from ___________. They vary in the shape of _________.
stainless steel
shape of curvature
What type of suture is best placed in the oral mucosa?
absorbable
What kind of suture is best placed in facial skin?
non- absorbable
Give examples of absorbable sutures
- vicryl
- vicryl rapide
- serasynth
- serafast
Give examples of non- absorbable sutures
- prolene
- sealene
Absorbable sutures are all eliminated by the same process of degradation. True or false
false
How does catgut degradation take place?
- a foreign body reaction with enzymatic involvement
How does degradation of vicryl (synthetic) take place?
- it is absorbed by hydrolysis
What are the characteristics of monofilament threads ?
- consists of a single thread
- have a closed interior
- smooth
- display no capillarity
Monofilaments form _______ suture threads
thin suture threads
How are multifilament threads produced?
they are produced by twisting or braiding many thin threads together
State a major disadvantage of twisted threads
they display a high capillarity i.e. they act as bacterial reservoirs
What is the consequence of using braided threads?
they impede the passage of fluids as the filaments are aligned obliquely to the longitudinal axis of the thread
State an advantage and disadvantage of using multifilament sutures
Advantage:
* superior knot tying characteristics
Disadvantage:
* due to the process of production, they tend to be rough making their passage through tissue more difficult
What helps reduce the friction and capillarity of sutures ?
coating them
How long does coated vicryl offer wound support for?
28 days
When does complete absorption of coated vicryl take place?
56-70 days
How long does vicryl rapide offer wound support?
10 days
When does total absorption of vicryl rapide occur?
42 days
The wound support of vircyl rapide at 5 days is ___%
50%
Vicryl plus has _______ properties. However, its use for intraoral wound closure has not been demonstrated yet.
anti-bacterial
Suture thread diameter is described by ______.
gauge
What is the gauge range of suture threads ?
1-0 to 11-0
The greater the gauge of a suture the _______ the suture thread
thinner
What is an important characteristic to recognise for suture threads with a higher gauge?
lower tensile strength
What are the most commontly used shapes of suture needles? Which shape out of these is the least curved /
- 3/8 circle
- 1/2 circle
- 5/8 circle
3/8 circle is the least curved
learn to identify these
What is an indication for use of a needle with a greater curve?
when access to an area with restricted space is needed
What are the two ways in which needle types may be described?
- taper (smooth) - gradually taper to the point
- cutting
What types of tissues are taper needles used for? Give examples
used for tissues that are easy to penetrate
e.g. blood vessels, bowel
What kind of needle is required for closure of mucosa and mucoperiosteal flaps?
cutting needles
Briefly describe the nature of cutting needles
- triangular in shape
- the apex of the needle forms/is the cutting surface
Why are taper needles contraindicated for tougher tissues such as the skin?
this is because of the trauma that is caused by the difficulty of penetration
How do reverse cutting needles differ from conventional cutting needles?
the cutting edge faces down rather than up
What is the major benefit assigned to the reverse cutting needle?
it reduces the chance of the suture pulling through the tissue (essentially of it falling out of the tissue)
What are the main types of needle holders ?
- rachet needle holders
non-rachet needle holders
What is the purpose of a rachet on needle holders?
maintenance of grip on the needle
Describe the ideal set up and hold for a needle/suture
- 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
State the use of the toothed tissue forceps
- 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
Describe the ideal position of the toothed tissue forcep in the hands
- 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
The ideal suture should form a ________. How should the tissue be penetrated?
rectangle
the tissue should be penetrated perpendicular to its surface
When is a less perpendicular angulation accepted when placing a suture? What type of knot is accepted here?
- when closing mucosa that is bound down to bone in the gingival region
- a square knot
State an important requirement for the placement of a square knot
- the needle should be passed through a distance of at least 3mm from the free edge
Describe how knot tying is achieved
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
What is the consequence of placing suture too tight?
they can cause oedematous swelling of the soft tissues
What length of thread is appropriate to leave behind? What is the consequence if it is too short or too long ?
3-4mm
too short:
* knot may untie
too long
* uncomfortable for patient
What type of scissors is appropriate for the removal of intra-oral sutures?
Iris-type scissors
Why is a continuous suture considered to be more vulnerable?
this is because it relies on fewe knots
What is the purpose of the vertical mattress suture?
- add additional wound edge eversion
- decrease dead space within a wound
What is the benefit of wound edge eversion?
allows a wound to lay flat as opposed to becoming depressed in the centre(inverting)
google images of wound edge eversion
Briefly describe how a vertical mattress suture is placed
- 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
When is the horizontal mattress suture indicated ?
when it is important to distribute wound tension across larger wounds
What is the most commonly used type of intra-oral suture?
simple interrupted suture
If a wound requires support longer than a 7 days, what suture should be used ?
vicryl
(not vicryl rapide)
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
- 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
Wounds resulting from endodontic surgery require increased support. Give the “ideal” suture to be placed following endodontic surgery
- 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
What patient and clinical characteristics could potentially indicate the need for longer wound support and therefore the use of coated vicryl.
when wound healing is compromised due to
* age
* low body weight
* general health condition that reduces immune response
- poor local blood supply
- local infection
