Download - Suturing Tools and Techniques

Suturing Techniques

Iyad Abou RabiiDDS, OMFS, MRes, PhD

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.

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

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

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.

Suturing Tools

Surgical – Anatomic Forceps

Surgical forceps

Anatomic dissecting forceps

Needle Holders

Surgical forceps

Anatomic dissecting forcepsa- Mayo–Hegar needle holder.b- Mathieu needle holder

Needle Holders and hemostat

Surgical forceps

Anatomic dissecting forceps

Scissors

a- Standard suture scissors.b- Goldman–Fox soft tissue scissors

Needles

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

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

Body: Needle Curvature

Eyed needles– More Traumatic– Only thread through once– Suture on a reel– Tends to unthread itself

easily

Swage

Swaged-on needles

– Much less traumatic

– More expensive suture material

– Sterile

Swage

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

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

A suture is a thread used for uniting wound edges

eg. Suture material

Nylon, Silk Catgut, Stainless still suture

Suture Material : Definition

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

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

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.

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

(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

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

Multifilament (braided)Monofilament

Suture Materials : Structure

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

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

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

The Suture Packaging

STRAND SIZE

MATERIAL

STRAND LENGTH

PRODUCT CODE

NEEDLE CODE

WITH LIFE SIZE

PICTURE OF

NEEDLE

NEEDLE LENGTHCOLOUR

POINT TYPE

NEEDLE CIRCLE

The Suture Packaging

Suturing Techniques

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

Correct position of the fingersfor holding the needle holder


Scissors are held the same way as needle holders


• 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 : Knots

Suture is initially wrappedtwice around the needle holder


The two ends of the suture are tightened to createa surgeon’s knot over thewound (double knot)


Safety knot, created by the single wrap of thesuture in the counterclockwise direction as opposed to the first one


Tightening of the safety knot over the initialsurgeon’s knot

Suturing Techniques

• The main sutures used in oral surgery are the• interrupted,• continuous, • and mattress sutures.

Suturing Techniques: Interrupted Suture.

Suturing Techniques: Continuous Simple Suture.

Suturing Techniques: Continuous Locking Suture.

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.

Mattress Suture : Horizontal interrupted mattress

Mattress Suture : Horizontal continuous mattress

Mattress Suture : Vertical mattress

Thank you for your attention!

Any Questions?

Contact Details

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