SUTURE DEFINITION MEANING AND METERIALS

The Suture definition meaning and meterials describes any strand of meterial ulitized to ligate blood vessels or approximate tissues. The primary objective of dental suturing is to position and secure surgical flaps in order to promote optimal healing.

THE GOALS OF SUTURING ARE AS FOLLOWS:

• Provide adequate tension for wound closure, but loose enough to prevent tissue ischemia and nercosis.
• Preventing postoperative hemorrhage.
• Reduce postoperative pain.
• Maintain hemostasis.
• Permit healing by primary intention.
• Prevent bone exposure resulting in delayed healing and bone resorption.
• Permit proper flap position.

SUTURE KIT INSTRUMENTS

A) Corn Suture Plies

B) Adson tissue pliers

C) Needle holder

D) Scissors

SUTURE KIT INSTRUMENTS

SUTURE MATERIAL DEFINITION

Suture is a thread used for uniting woudn edges. E.g. Suture Material

• Silk
• Catgut
• Nylon
• Stainless Steel Suture

QUALITIES OF SUTURE METERIAL

• Adequate tensile strength
• Functional Strength
• Easy to handle
• Flexibility & Elasticity
• Knotable
• Easily sterlisable
• Uniformity
• Non reactivity
• Absorbility
• Smooth surface

TYPES OF SUTURE MATERIAL

• According to their behavior in tissue: Absorbable and Nonabsorbable
• According to their structure: Monofilament and Multifilament
• According to their origin: Natural or Synthetic

SUTURING TECHNIQUES

Beak of the needle holder grasps a suture needle. The needle holder’s beak face is crosshatched, ensuring stability of the needle during tissue penetration.

The needle holder’s beak face is crosshatched, ensuring stability of the needle during tissue penetration.

Correct position of the fingers for holding the needle holder.

Scissors are held the same way as needle holders.

BASIC SUTURING TECHNIQUES

• Needle should be grasped with needle holder approximately 1/3rd distance from the eye and 2/3rd from the point.
• Needle should be placed perpendicular to surface being entered and pushed through tissues following curvature of needle, rotating wrist.
• Should not force through tissue may bend or break the needle.
• Suture end should be pulled together and tied to approximate wound edges.
• Never closed under tension.
• Knot should never lie on incision line.
• The needle enters 2-3 millimeters away from the margin of the flap (mobilie tissue) and exists at the same distance on the opposide side.
• The two ends of the suture are then tied in a knot and are cut 0.8 centimetres above the knot.
• To avoid tearing the flap, the needle must pass through the wound margins one at a time, and be atleast 0.5 centimetres away from the edges.
• Over tightening of the suture must also be avoided (risk of tissue necrosis) as well as overlapping of wound eges when positioning the knot.
• Tightly tied sutures canc ause ichemia and wound edge necrosis.
• Gentle but firm knots and minimal wound tension will minimize these factors.
• If wound becomes infected or there is an hematoma formation, removal of few sutures may offer satisfactory treatment.

BASIC SUTURING TECHNIQUES

• Needle should be grasped with needle holder approximately 1/3rd distance from the eye and 2/3rd from the point.
• Needle should be placed perpendicular to surface being entered and pushed through tissues following curvature of needle, rotating wrist.
• Should not force through tissue may bend or break the needle.
• Suture end should be pulled together and tied to approximate wound edges.
• Never closed under tension.
• Knot should never lie on incision line.
• The needle enters 2-3 millimeters away from the margin of the flap (mobilie tissue) and exists at the same distance on the opposide side.
• The two ends of the suture are then tied in a knot and are cut 0.8 centimetres above the knot.
• To avoid tearing the flap, the needle must pass through the wound margins one at a time, and be atleast 0.5 centimetres away from the edges.
• Over tightening of the suture must also be avoided (risk of tissue necrosis) as well as overlapping of wound eges when positioning the knot.
• Tightly tied sutures canc ause ichemia and wound edge necrosis.
• Gentle but firm knots and minimal wound tension will minimize these factors.
• If wound becomes infected or there is an hematoma formation, removal of few sutures may offer satisfactory treatment.

TYPES OF KNOTS

• Square knot
• Granny knot
• Surgeon’s knot

SQUARE KNOT OR REEF KNOT

Square knot formed by wrapping the suture around needle holder once in opposite directions b/w ties. 3 ties are recommended.

GRANNY’S KNOT OR SLIP KNOT

Granny’s knot involves a tie in one direction followed by tie in same direction and third tie in opposite direction to square the knot and hold it permanently.

SURGEON’S KNOT

Surgeon’s knots is formed by 2 throws of suture around the needle holder on the first tie and one throw opposite direction in 2nd tie.

HOW TO TIE A KNOT

• Suture is initially wrapped twice around the needle holder
• The two ends of the suture are tightened to create a surgeon’s knot over the wound (double knot)
• Safety knot, created by the single wrap of the suture in the counterclockwise direction as opposed to the first one.
• Tightening of the safety knot over the initial surgeon’s knot.