Suturing- Dr. Takkar Flashcards
1
Q
Needle Holder
A
- locking handle
- short, blunt beak
- shorter and stronger than hemostat beaks
- Crosshatched face= better grasp of suture needle
- intraoral sutures
- recommend at least a 6 inch holder
- Hold w/thumb and ringer finger
- allows index and middle fingers to control instrument
2
Q
Dean Scissors
A
- slight curved hand and serrated blades→ easier to cut sutures
- held same way as needle holder
- Thumb and ring finger
- Soft tissue scissors:
- straight or curved blades
- do not cut suture
- suture will dull blade→ less effective and more traumatic when cutting tissue
3
Q
Adson Forceps
A
- hold tissue while suturing and biopsy
- Tissue forceps with or without teeth at tip
- Toothed forceps= delicate grip
4
Q
Suture Needle
A
- close mucosal incisions
- small half circle or 3/8ths circle
- curved:
- pass through limited space
- w/out rotating wrist
- hold at ⅔ length of needle
- allows
- needle to be exposed to pass through tissue
- needle holder to grasp needle in strong portion to prevent bending needle
- allows
5
Q
Tapered vs Cutting Needle (Tips)
A
- Tapered needle tip:
- delicate tissues
- ocular or vascular surgery
- delicate tissues
- Cutting needle tip: (Triangle)
- passes through mucoperiosteum more easily
- cutting portion= ⅓ length
- Caution-cut tissues lateral to the needle if not used correctly/carefully
6
Q
How is suture material classified?
A
- Diameter
- Resorbable vs nonresorbable
- monofilament vs polyfilament
7
Q
Suture Diameter:
A
- smaller the number=larger the diameter
- 3-0=(000)
- most common
- large enough to withstand tension
- strong enough for easier knot tying
- 6-0
- very fine size
- face→less scaring
8
Q
Absorbable vs Non-Absorbable Sutures
A
- Non-absorbable
- silk (most common)
- nylon
- vinyl
- stainless steel
- Absorbable
- Plain gut
- 3-5 days
- Chromic Gut
- 7-10 Fays
- treated w/chromic salts
- minimizes tissue irritation: less reaction during early stages of wound healing
- Fast absorbing gut
- heat treated:
- accelerate tensile strength loss and absorption
- heat treated:
- Synthetic absorbables
- 4 weeks
- polyglycolic & Polylactic acid (Vicryl)
- muscle closures
- Plain gut
9
Q
Characteristics of an ideal absorbable suture?
A
- Low tissue reactivity
- high tensile strength
- slow absorption rates
- reliable knot security
10
Q
What are absorbable sutures primarily made of?
A
- Gut
- aka catgut
- serosal surface of sheep intestines
- submucosal layer of sheep intestines or serosal layer of beef intestines
- processed strands of highly purified collagen
11
Q
Absorbable vs Non-absorbable: Mechanism of Absorption
A
- Biological origin
- tissue enzymes
- manufactured from Synthetic polymer
- hydrolysis
- Nonabsorbable:
- encapsulated by fibroblasts
12
Q
Monofilament vs Polyfilament sutures
A
- Monofilament
- plain gut, chromic gut, nylon, stainless steel, polypropylene
- difficult to tie
- tend to come united
- stiff ends→irritate tongue & soft tissue
- Polyfilament
- silk, polyglycolic acid, pollylactic acid(Vicryl)
- Braided→ easier to handle & tie
- soft ends
- “wick” oral fluids along the suture to tissues
- carry bacteria
13
Q
Principles of Suturing:
A
- Hod the flap in position
- Hemostasis
- hold a soft tissue flap over bone
- return
- maintain blood clot
14
Q
Techniques for Suturing?
A
- Placed at the papilla
- wound edges are supported by sound bone
- passed from mobile tissue (flap was reflected)→attached tissue
- Needle enters mucosa at 90 degrees
- prevents tearing during passage or knot tying
- Follow the curvature of the needle when passing through tissue
- do not push needle through tissue
- Make sure adequate amount of tissue is taken to prevent needle or suture from pulling through
- minimal=3mm
15
Q
How to suture a 3 cornered flap
A
2 sutures required-to close vertical end
- Periosteal elevator elevate non-flap side of incision→ freeing margin for needle
- 1st suture
- placed across papilla
- where the vertical release incision was made
- placed across papilla
- 2nd:
- remainder of envelope flap is closed
- 3rd:
- Vertical End (Vertical Releasing incision)
- closed separately & last
- Vertical End (Vertical Releasing incision)
16
Q
What is the purpose of the suture?
A
- to relocate the tissue
17
Q
When tying the suture?
A
- Do not tie too tight
- ischemia of flap margin→tissue necrosis→wound dehiscence
- No blanching of wound edges
- Do not position Knot directly over incision line
- additional pressure on incision
- Position knot to the side of incision
18
Q
Interrupted Suture
A
- aka Simple Suture
- most common
- goes through one side of wound and comes up through the other side
- then tie knot
19
Q
Simple Interrupted Suture: Advantages:
A
- Quick
- Adjust tension individual
- if one suture is lost, remaining sutures stay in position
20
Q
Figure-of-Eight Suture
A
- Used for:
- suturing around an implant
- tooth extraction
- holds the 2 papilla in place
- cross over the top of socket→help holds blood clot in place
- Start at MB papilla→pass to ML papilla
- Then DB papilla→ pass to DL papilla
- Tie Knot at MB papilla
21
Q
Horizontal Mattress Suture
A
- Used for:
- Suture 2 adjacent papillae w/one suture
- fragile edges of papilla
- Decreases number of individual sutures that might be placed
- compresses wound together
- everts wound edges
- Start at MB papilla→pass to ML papilla
- then DL papilla→pass to DB papilla
- Tie at MB papilla
22
Q
Continuous Suture
A
- used for long incisions
- quicker
- fewer knots to collect debris
- Knot does not have to be made for each pass
- if one suture pulls through or knot becomes untied→entire suture is loose
23
Q
Continuous Non-Locking Suture
A
- aka Baseball Stitch
- most common continuous suture technique used
- Multiple interrupted sutures placed at consecutive papilla
- not tied off until complete
24
Q
Continuous Locking Suture
A
- locking
- places points of friction to reduce loose suture while being placed
- keeps earlier portions tight
- places points of friction to reduce loose suture while being placed
- Pass the long end of the suture underneath the loop before it is pulled through tissue
- Place suture on deep periosteal and mucosal surfaces directly across papilla
- more direct apposition of tissues
25
Q
Suture Removal
A
- Use tips of sharp, pointed suture scissors
- cut as closer to mucosa as possible
- prevent dragging debris into wound via long suture
- Removed by pulling toward incision line
- decreases tension on wound
26
Q
How long are non-resorbable sutures left in the mouth? why?
A
- 5-7 days
- no useful role after 7 days
- increase contamination of underlying submucosa
