Suturing Tools and Techniques

Suturing Techniques
Iyad Abou Rabii DDS, 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.
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HISTORY
1650 BC 2000s AD
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..
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Ants
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.
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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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Surgical Anatomic Forceps
Surgical forceps
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Anatomic dissecting forceps
Needle Holders
Surgical forceps
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a- MayoHegar needle holder. Anatomic dissecting forceps b- Mathieu needle holder
Needle Holders and hemostat
Surgical forceps
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Anatomic dissecting forceps
Scissors
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a- Standard suture scissors. b- GoldmanFox soft tissue scissors
Needles
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Tip: Needle Point Geometry
Taper-Point Reverse cutting Convention al Cutting Tapercutting

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Suited to soft tissue Dilates rather than cuts Very sharp Ideal for skin Cuts rather than dilates Very sharp Cuts rather than dilates Creates weakness allowing suture tearout Ideal in tough or calcified tissues Mainly used in Cardiac & Vascular procedures.
Tip: Needle Point Geometry
Blunt
Premium point spatula
Also known as Protect Point Mainly used to prevent needle stick injuries i.e. for abdominal wall closure. Ophthalmic Surgery
Ophthalmic Surgery
Spatula DermaX*
NEW: The Penetration force The Penetration force Superior Cosmetic Effect
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Body: Needle Curvature
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Swage
Eyed needles
More Traumatic Only thread through once Suture on a reel Tends to unthread itself easily
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Swage
Swaged-on needles
Much less traumatic More expensive suture material Sterile
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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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Suture Material : Definition

A suture is a thread used for uniting wound edges eg. Suture material
Nylon, Silk Catgut, Stainless still suture
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Qualities of a suture material

Knotable Easily sterlisable Uniformity Smooth surface Monofilament Absorbility
Adequate tensile strength Functional strength Non capillary Non reactivity Flexibility & elasticity Easy to handle
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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) (ii) (iii) (iv) (iv) (v) Catgut Collagen : Kangaroo tendon Fascia lata Polyglycolic acid suture material : Polyglactin 910
(vii) Polydioxanone (viii) Cargile membrane
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Types of non absorbable suture material

(i) (ii) (iii) (iv) (v) (vi) Silk Silkworm Gut : Cotton : Linen : Nylone : Vetafil : (xi) Pin sutures (xii) Prolene (xiii) Pagenstecher (xiv) Dermal suture
(vii) Stainless steel (viii) Wires of tentallum and silver (ix) (x)
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Umbilical tape : Horse here
Absorbable Sutures
Caprosyn
60% Glycolide 10% caprolactone 10% Trimethylene carbonate 10% Lactide Monofilament
Biosyn
60% Glycolide 26% Trimethylene carbonate 14% Dioxanone
Maxon
Polyglyconate
Polysorb
90% Polyglycolic acid 10% Polylactic Acid
Dexon II
100% Polyglycolic acid
MATERIAL
STRUCTURE
Monofilament
Monofilament
Braided Caprolactone / Glycolide, Calcium stearoyl lactilate 21 Days
Braided
COATING
NA
NA
NA
Polycaprolac tone
SIGNIFICATE TENSILE STRENGTH ABSORPTION Page 25 PROFILE
10 Days
21 days
42 Days 180-210 Days
21 Days
56 Days
90-110 Days
56-70 Days
60-90 Days
Suture Materials : Structure
Monofilament
Multifilament (braided)
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Comparison
No
capillary action Increased infection risk Less smooth passage Less tensile strength Better handling Better knot security
.
Has
capillary action Less infection risk Smooth tissue passage Higher tensile strength Has memory More throws required
.
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Suture Materials : Suture Size
USP (United States Pharmacopoeia) Oral

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
General
Thick
Thin
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Suture Materials
The most commonly used suture sizes are 40 and 30 for resorbable sutures, 30 and 20 for nonresorbable sutures. These kinds of sutures are sold in sterilized packages with pre attached atraumatic needles or in bundles without needles.
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The Suture Packaging
PRODUCT CODE
STRAND SIZE
MATERIAL
STRAND LENGTH
NEEDLE CODE WITH LIFE SIZE PICTURE OF NEEDLE
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COLOUR
NEEDLE CIRCLE
POINT TYPE
NEEDLE LENGTH
The Suture Packaging
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Suturing Techniques : Tools Manipulation
Beak of the needle holder grasps a suture needle. The needle holders beak face is crosshatched, ensuring stability of the needle during tissue penetration
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Correct position of the fingers for holding the needle holder
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Scissors are held the same way as needle holders
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The needle enters 23 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.
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Suturing Techniques : Knots
Suture is initially wrapped twice around the needle holder
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The two ends of the suture are tightened to create a surgeons knot over thewound (double knot)
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Safety knot, created by the single wrap of the suture in the counterclockwise direction as opposed to the first one
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Tightening of the safety knot over the initial surgeons 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 Rabii
www.facebook.com/iarabii www.Twitter.com/iarabii www.Scribd.com/iyad abou rabii
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Copyright notice
Feel free to use this PowerPoint presentation for your personal, educational and business. Do
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Suturing Techniques

Iyad Abou Rabii DDS, OMFS, MRes, PhD

 Suturing of the surgical wound is necessary, aiming at

Surgical Anatomic Forceps

Anatomic dissecting forceps

a- MayoHegar needle holder. Anatomic dissecting forceps b- Mathieu needle holder

Needle Holders and hemostat

Anatomic dissecting forceps

a- Standard suture scissors. b- GoldmanFox soft tissue scissors

Tip: Needle Point Geometry

Taper-Point Reverse cutting Convention al Cutting Tapercutting

Tip: Needle Point Geometry

Body: Needle Curvature

Much less traumatic More expensive suture material Sterile

The Right Needle Choice

Suture Material : Definition

Nylon, Silk Catgut, Stainless still suture

Qualities of a suture material

Characteristics of Suture Material

Suture Materials : Behavior

Types of absorbable suture material

(vii) Polydioxanone (viii) Cargile membrane

Types of non absorbable suture material

Umbilical tape : Horse here

Braided Caprolactone / Glycolide, Calcium stearoyl lactilate 21 Days

SIGNIFICATE TENSILE STRENGTH ABSORPTION Page  25 PROFILE

42 Days 180-210 Days

Suture Materials : Structure

Suture Materials : Suture Size

USP (United States Pharmacopoeia) Oral

The Suture Packaging

NEEDLE CODE WITH LIFE SIZE PICTURE OF NEEDLE

The Suture Packaging

Suturing Techniques : Tools Manipulation

Suturing Techniques : Tools Manipulation

Correct position of the fingers for holding the needle holder

Suturing Techniques : Tools Manipulation

Scissors are held the same way as needle holders

Suturing Techniques : Tools Manipulation

Suturing Techniques : Knots

Suture is initially wrapped twice around the needle holder

Suturing Techniques : Knots

Suturing Techniques : Knots

Suturing Techniques : Knots

Tightening of the safety knot over the initial surgeons knot

Suturing Techniques: Interrupted Suture.

Suturing Techniques: Continuous Simple Suture.

Suturing Techniques: Continuous Locking Suture.

Mattress Suture : Horizontal interrupted mattress

Mattress Suture : Horizontal continuous mattress

Mattress Suture : Vertical mattress

Thank you for your attention! Any Questions?

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Suturing of the surgical wound is necessary, aiming at

SIGNIFICATE TENSILE STRENGTH ABSORPTION Page 25 PROFILE