Suturing Techniques Iyad Abou Rabii DDS, OMFS, MRes, PhD
Suturing Techniques
Iyad Abou RabiiDDS, OMFS, MRes, PhD
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Suturing
Suturing of the surgical wound is necessary, aiming at – holding a flap over the wound,
– reapproximating the wound edges,
– protecting underlying tissues from infection or other irritating factors,
– and preventing postoperative hemorrhage.
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HISTORY
The origins of surgery can be traced back many centuries. Through the ages, practitioners have used a wide range of materials and techniques for closing tissue……..
1650 BC – 2000’s AD
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In the tenth century BC, the ant was held over the wound until it seized the wound edges in its
jaws. It was then decapitated and the ant's death grip kept the wound closed.
Ants
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Thorns
The thorn, used by African tribes to close tissue, was passed through the skin on either side of the wound.
A strip of vegetable fibre was then wound around the edge in a figure eight.
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Suturing Tools
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Surgical – Anatomic Forceps
Surgical forceps
Anatomic dissecting forceps
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Needle Holders
Surgical forceps
Anatomic dissecting forcepsa- Mayo–Hegar needle holder.b- Mathieu needle holder
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Needle Holders and hemostat
Surgical forceps
Anatomic dissecting forceps
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Scissors
a- Standard suture scissors.b- Goldman–Fox soft tissue scissors
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Needles
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Taper-Point•Suited to soft tissue•Dilates rather than cuts
Reverse cutting
•Very sharp•Ideal for skin•Cuts rather than dilates
Conventional Cutting
•Very sharp•Cuts rather than dilates•Creates weakness allowing suture tearout
Taper-cutting
•Ideal in tough or calcified tissues•Mainly used in Cardiac & Vascular procedures.
Tip: Needle Point Geometry
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Blunt•Also known as “Protect Point”•Mainly used to prevent needle stick injuries i.e. for abdominal wall closure.
Premium point spatula
•Ophthalmic Surgery
Spatula•Ophthalmic Surgery
DermaX*•NEW: ½ The Penetration force•½ The Penetration force•Superior Cosmetic Effect
Tip: Needle Point Geometry
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Body: Needle Curvature
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Eyed needles– More Traumatic– Only thread through once– Suture on a reel– Tends to unthread itself
easily
Swage
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Swaged-on needles
– Much less traumatic
– More expensive suture material
– Sterile
Swage
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The Right Needle Choice
The appropriate needle choice for any situation is…………….
……………The needle that will cause least possible trauma to the tissue being sutured
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Summary of Needles
1. Needles are made of steel alloy (Surgalloy) with a Nucoat coating so they stay sharp for multiple passes through tissue
2. Different needle points for different tissues
3. Choose the needle that will cause the least trauma
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A suture is a thread used for uniting wound edges
eg. Suture material
Nylon, Silk Catgut, Stainless still suture
Suture Material : Definition
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Adequate tensile strength
Functional strength
Non capillary
Non reactivity
Flexibility & elasticity
Easy to handle
Qualities of a suture material
Knotable
Easily sterlisable
Uniformity
Smooth surface
Monofilament
Absorbility
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Characteristics of Suture Material
According to their behavior in tissue: Absorbable Vs. Nonabsorbable
According to their structure: Monofilament Vs. Multifilament
According to their origin:Natural or Synthetic
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Suture Materials : Behavior
ABSORBABLE Those that are absorbed or digested by the body cells and tissue fluids in which they are embedded during and after the healing processes.
NON-ABSORBABLE: Those suture materials that can not be absorbed by the body cells or fluids. they are removed after healing is complete.
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Types of absorbable suture material
(i) Catgut
(ii) Collagen :
(iii) Kangaroo tendon
(iv) Fascia lata
(iv) Polyglycolic acid suture material :
(v) Polyglactin 910
(vii) Polydioxanone
(viii) Cargile membrane
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(i) Silk
(ii) Silkworm Gut :
(iii) Cotton :
(iv) Linen :
(v) Nylone :
(vi) Vetafil :
(vii) Stainless steel
(viii) Wires of tentallum and silver
(ix) Umbilical tape :
(x) Horse here
(xi) Pin sutures
(xii) Prolene
(xiii) Pagenstecher
(xiv) Dermal suture
Types of non absorbable suture material
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Absorbable Sutures
Caprosyn Biosyn Maxon Polysorb Dexon II
MATERIAL
60% Glycolide10% caprolactone10% Trimethylene carbonate10% Lactide
60% Glycolide26% Trimethylene carbonate14% Dioxanone
Poly-glyconate
90% Polyglycolic acid10% Polylactic Acid
100% Polyglycolic acid
STRUCTURE Monofilament MonofilamentMono-
filamentBraided Braided
COATING NA NA NA
Caprolactone / Glycolide, Calcium stearoyl lactilate
Polycaprolactone
SIGNIFICATE TENSILE STRENGTH
10 Days 21 days 42 Days 21 Days 21 Days
ABSORPTION PROFILE
56 Days 90-110 Days180-210
Days56-70 Days 60-90 Days
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Multifilament (braided)Monofilament
Suture Materials : Structure
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Has capillary action Increased infection
risk Less smooth
passage Less tensile
strength Better handling Better knot security.
No capillary action Less infection risk Smooth tissue
passage Higher tensile
strength Has memory More throws required
.
Comparison
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5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0
Thick Thin
USP (United States Pharmacopoeia)
Oral
General
Suture Materials : Suture Size
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The most commonly used suture sizes are • 4–0 and 3–0 for resorbable sutures, • 3–0 and 2–0 for nonresorbable sutures.
These kinds of sutures are sold in sterilized packages with pre attached atraumatic needles or in bundles without needles.
Suture Materials
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The Suture Packaging
STRAND SIZE
MATERIAL
STRAND LENGTH
PRODUCT CODE
NEEDLE CODE
WITH LIFE SIZE
PICTURE OF
NEEDLE
NEEDLE LENGTHCOLOUR
POINT TYPE
NEEDLE CIRCLE
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The Suture Packaging
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Suturing Techniques
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Beak of the needle holder grasps a suture needle.The needle holder’s beak face is crosshatched, ensuringstability of the needle during tissue penetration
Suturing Techniques : Tools Manipulation
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Correct position of the fingersfor holding the needle holder
Suturing Techniques : Tools Manipulation
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Scissors are held the same way as needle holders
Suturing Techniques : Tools Manipulation
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• The needle enters 2–3 mm away from the margin of the flap (mobile tissue) and exits at the same distance on the opposite side.
• The two ends of the suture are then tied in a knot and are cut 0.8 cm above the knot.
• To avoid tearing the flap, the needle must pass through the wound margins one at a time, and be at least 0.5 cm away from the edges.
• Over-tightening of the suture must also be avoided (risk of tissue necrosis), as well as overlapping of wound edges when positioning the knot.
Suturing Techniques : Tools Manipulation
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Suturing Techniques : Knots
Suture is initially wrappedtwice around the needle holder
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Suturing Techniques : Knots
The two ends of the suture are tightened to createa surgeon’s knot over thewound (double knot)
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Suturing Techniques : Knots
Safety knot, created by the single wrap of thesuture in the counterclockwise direction as opposed to the first one
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Suturing Techniques : Knots
Tightening of the safety knot over the initialsurgeon’s knot
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Suturing Techniques
• The main sutures used in oral surgery are the• interrupted,• continuous, • and mattress sutures.
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Suturing Techniques: Interrupted Suture.
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Suturing Techniques: Continuous Simple Suture.
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Suturing Techniques: Continuous Locking Suture.
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Mattress Suture
• This is a special type of suture and is described as• horizontal (interrupted and continuous)• and vertical
It is indicated in cases where strong and secure reapproximation of wound margins is required.
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Mattress Suture : Horizontal interrupted mattress
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Mattress Suture : Horizontal continuous mattress
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Mattress Suture : Vertical mattress
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Thank you for your attention!
Any Questions?
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Contact Details
Dr. Iyad Abou Rabiiwww.facebook.com/iarabii
www.Twitter.com/iarabiiwww.Scribd.com/iyad abou rabii
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