Suture materials /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Suture materials /certified fixed orthodontic courses by Indian dental academy

  1. 1. Principles of Surgery SUTURES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. • In surgery, the choice of suture materials has been largely empirical. One learns the art and craft of surgery from once chief and the tendency is to follow the suture materials used by him or her. Thus the choice of suture material has not always been scientific. www.indiandentalacademy.com
  3. 3. • History – Used in closure of wounds – 50,000 B.C – Large black ants used – Made from Flax, Bark, Hemp and Fiber – Metal clips www.indiandentalacademy.com
  4. 4. • SUTURE : Any thread or strand which brings into opposition two surfaces or tissues • LIGATURE : Any thread or strand which obliterates lumen of ductular structures www.indiandentalacademy.com
  5. 5. Properties : • Absorbable materials – digested by tissue enzymes • Eg. Catgut – hydrolysis • Eg. Polyglactin (Vicryl) • Non-absorbable materials – Eg. Silk, Nylon etc… www.indiandentalacademy.com
  6. 6. • Tensile strength – Straight pull – to break the filaments – Knot pull – to break the knot • Smoothness – Smooth material  Easy passage  Least trauma • Eg. Monofilament www.indiandentalacademy.com
  7. 7. • Monofilament : • Polyfilament : – single filament – Multiple filaments – Eg. Prolene – Eg. Cotton, Silk – smooth – rough – open up – knot secure – not easy to handle – easy to handle – impede bacterial harbour – promotes bacterial harbour – no fraying – fraying www.indiandentalacademy.com
  8. 8. Classification : SUTURE MATERIALS Absorbable Natural Synthetic Non-absorbable Natural Synthetic Metals www.indiandentalacademy.com
  9. 9. Absorbable • Natural : • Synthetic : – Catgut • Plain – Polyglactin 910 • Chromic – Fascia lata – Kangaroo tendon – Cargile membrane – Collagen – Polyglycolic acid – Monocryl – Polydioxanone www.indiandentalacademy.com
  10. 10. Non-absorbable Natural : Synthetic : Metals : Silk Polyamide Stainless steel Cotton Polyester Platinum Linen Polypropelene Tantalum Polybutester Silver wire Others : Tapes Tissue adhesives Staples www.indiandentalacademy.com
  11. 11. Catgut : • • • • • • • • • Kitgut Sub-mucosa of sheep’s intestine Monofilament Plain – tensile strength 15 days Chromic  30 days Kept in preservative solution – Ethicion fluid Hygroscopic Absorption by proteolytic digestive enzymes In infection  rapidly absorbed www.indiandentalacademy.com
  12. 12. • Uses : • Plain Catgut – – – – Subcutaneous suturing For wounds in lip and oral cavity Ligation of smoother blood vessels Not used in tissues deeper to subcutaneous • Chromic – 1-0 / 2-0 : ligation of medium sized vessels – 3-0 / 4-0 : for cleft lip muscle layer closure – 5-0 / 6-0 : plastic surgery www.indiandentalacademy.com
  13. 13. • Fascia lata : – Thigh muscles of beef cattle – Was used to repair hernia • Kangaroo tendon : – Tail tendon of small kangaroos – High tensile strength www.indiandentalacademy.com
  14. 14. Synthetic absorbable sutures : • • • • Polyglycolic acid – Dexon Non-protein polymer of glycolic acid Absorption – esterase enzyme system (100 days) Characteristics – – White, polyfilament, braided • Advantages – – – – – – Minimum tissue reaction Uniform absorption Used even in presence of infection Knot security better Fraying is less www.indiandentalacademy.com
  15. 15. • Polyglactin 910 : – – – – – Co-polymer of Glycolin and Lactide Violet colour Coated with Calcium stearate Absorption – hydrolysis Advantages – • Unique molecular structure – retain strength for long • Minimum tissue reaction • Excellent handling characters – Not usedwww.indiandentalacademy.com of stress under the areas
  16. 16. • Vicryl Rapide – Irradiated polyglactin 910 • Absorption – 35- 40 days  Gamma radiation • Supports wound upto 12 days • Less force is used for tying knots • Ideal for intra-oral use • • • • Polydioxanone Unique feature of Flexibility Support wound beyond 4 week period Recommended in orthopedic surgery www.indiandentalacademy.com
  17. 17. • • • • • Polyglecaprone 25 – Monocryl co-polymer of Glycolide and Caprolactone tensile strength double of chromic Absorption – Hydrolysis Advantages – – – – – inert, used in infection, memory free, smooth surface • Indications – – subcutaneous www.indiandentalacademy.com
  18. 18. Non-absorbable suture materials : • Silk : – Natural – obtained from cocoon – Advantages – • natural elasticity • does not soak up fluids • ties smoothly & securely – Disadvantages • stitch granuloma • infection - high • tissue reaction - high www.indiandentalacademy.com
  19. 19. • Types – Prema hand surgical silk – Virgin silk suture • Uses – – – – ligate blood vessels & pedicles suture nerves, tendons skin & grafts wound over the face www.indiandentalacademy.com
  20. 20. • Cotton – vegetable origin ; polyfilament  disadvantage – advantage • economical • secure knotting • easily handled    absorbs fluid more tissue reaction low tensile strength • Linen – obtained from flax ; polyfilament – advantage • easily handled • tie is secure – uses • tying pedicles • ligatures www.indiandentalacademy.com
  21. 21. • Polyamide : • – Nylon – thickness – 1-8N – advantage • less irritant • high tensile strength • economical • smooth passage through tissues – disadvantage • has memory Polyester : – Terylene – Dacron – advantage • high tensile strength • low tissue reactivity • retained longer – C.V.S – disadvantage • cut through tissue – Teflon coat – better handling properties but diameter of suture increased – Polybutylate coated • infection www.indiandentalacademy.com
  22. 22. • Polypropylene : – Prolene – advantage • inert • monofilament • smooth • easily handled • knot secure • least thrombogenic • more tensile strength • unwetted by blood & tissue enzymes • elastic – indications • vascular surgery • chest & abdominal www.indiandentalacademy.com wall defects
  23. 23. • Stainless steel wire : – advantage • very little tissue reaction – disadvantage • tear of tissue • necrosis if tight • cutaneous discomfort • breaking sterile technique www.indiandentalacademy.com
  24. 24. Principles of suture selection : • knowldege of the tissues • physical and biological properties of suture • condition of the wound • post-operative course of the patient • skin, fascia & tendon – healing slow • peritoneum, liver & muscle – healing rapid • multifilament sutures avoided in contaminated wounds www.indiandentalacademy.com
  25. 25. • C.V.S – prolene and polyester are used • Microvascular surgery – 10-0 polyamide monofialment used • Irradiated patients – closure in layers • Cancer patients – non-absorbable sutures used • Intra-oral – silk, PGA used but absorbable preferred www.indiandentalacademy.com
  26. 26. Needle holder: www.indiandentalacademy.com
  27. 27. Needles : • sharp, pointed instruments are used for puncturing the tissue and guiding the thread to suture or pass a ligature around vessels • carbon steel or stainless steel www.indiandentalacademy.com
  28. 28. • Classifications : – Eye • eyeless • needles with eye – Shape • straight • curved – Cutting edge • round body • cutting body – Tip • tirangular • round tipped • blunt point www.indiandentalacademy.com
  29. 29. • Eyeless needle : – suture material is attached to the swage of the needle during manufacture – advantages • • • • • less trauma new sterile needle for each patient faster time saving no chance of needle loosing • Needles with eye : – can be reused – economical www.indiandentalacademy.com
  30. 30. • Straight – Eye – Eyeless – round body – blunt tip – suturing with hand – for fascia & skin – for passage of • Circum-zygomatic • Circum-mandibular wires • Curved – Eye – Eyeless – round body – cutting needle – facilitates working in depth – more confined operated site – greater curvature required www.indiandentalacademy.com
  31. 31. • Round body needles : used to separate tissue fibers & for soft tissues • Mayo’s needle : to penetrate periosteum • Blunt point suture needle : for friable tissues • Conventional cutting needle : keratinized mucosa & skin • Reverse cutting needle : triangular in cross-section; apex cutting edge on outside of needle curvature www.indiandentalacademy.com
  32. 32. • Slim blade needle : plastic and cosmetic surgery • Trocar point needle : in dense tissues • Taper cut needle : Cardiovascular surgery • Micropoint : for Opthalmic www.indiandentalacademy.com
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  36. 36. Principles of suturing : • grasp the needle at apporximately 3/4th the distance from the point • enter the tissue perpendicular to the surface • should follow the curvature of the needle • from free to the fixed tissue • thinner to the thicker • deeper to superficial • tissues should not close under tension • knot should not be placed on incision line www.indiandentalacademy.com
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  40. 40. • sutures placed 4mm apart • sutures should be tied so that edges are everted • dog ear should be eliminated • suture should be placed at an equal distance from the incision on both the sides & at an equal depth www.indiandentalacademy.com
  41. 41. Tapes : • Advantage – excellent cosmetic results – low infection rate – can be used in contaminated wounds – easy & quick • Disadvantage & Adhesives : • Cyanoacrylates • Advantage – quick to use – do not delay wound healing • Disadvantage – perfect hemostasis required – expensive – not used in contaminated wounds – blistering of skin – perfect hemostasis should be ensured www.indiandentalacademy.com
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  43. 43. Staples & Tissue Glues • Types – • Indications – – Linear – for hemostasis of liver – Side by side – End to end & spleen • Advantages – dural tears – quick – accurate closure – E.N.T surgeries – easy to remove – acceptable scars – access to difficult areas – to attach skin grafts www.indiandentalacademy.com
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  47. 47. Knots : • A knot, is an interwining of threads for purpose of joining them • Knot tying – one hand / two hand – instrument tie • Instrument tie is more convenient in closed areas www.indiandentalacademy.com
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  49. 49. Square knot • formed by wrapping ties around needle holder once in opposite direction www.indiandentalacademy.com
  50. 50. Surgeon’s knot • formed by two throws of suture around needle on first tie & one throw in opposite direction on second tie • Advantage – reduced slippage ofwww.indiandentalacademy.com first
  51. 51. Granny knot • involves a tie in one direction followed by single tie in same direction as first • a third tie is then squared on the second to hold the knot permanently www.indiandentalacademy.com
  52. 52. Suture method • Interrupted – used in areas of tension – Advantage • strong • independent • infection – selected sutures can be removed www.indiandentalacademy.com
  53. 53. • Continuous – simple interrupted suture is placed, a needle is then reinserted in continuous fashion The suture passes perpendiuclar to incision line underneath tissue & diagonally on surface & ended tying www.indiandentalacademy.com
  54. 54. • Advantage – rapid technique – even distribution of tension – water tight closure • Disadvantage – infection – whole suture should be removed – impedes blood supply to wound edges www.indiandentalacademy.com
  55. 55. • Locking continuous suture Degree of locking is provided by withdrawing the suture through its own loop • Advantage – suture will align perpendicular to its incision – prevents continuous tightening of suture as wound closure progresses www.indiandentalacademy.com
  56. 56. • Figure of 8 – – used in extraction sites – provides protection to socket – as well as adaptation of gingival papilla around adjacent tooth www.indiandentalacademy.com
  57. 57. • Sub-cuticular suture : – absorbable 4-0 suture materials used – knot should be inverted – a continuous suture can be used with no knots by having the ends exit at a short distance from wound www.indiandentalacademy.com
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  59. 59. • Tension suture – to prevent wound dehiscence – non-absorbable nylon prolene used with plastic tubing – to reduce tension www.indiandentalacademy.com
  60. 60. • Mattress suture – Vertical – Horizontal • Vertical – needle is passed close to the incision line on both sides & then engages tissue deep to the first pass when returning to the original site – Advantage • run parallel to the blood supply of the flap – not interfere with healing www.indiandentalacademy.com
  61. 61. • Horizontal : – passes perpendicular to incision line underneath tissue & parallel to it on the surface & then again perpendicular to incision line underneath tissue to be knotted on that side – Interrupted – produces broad contact of wound margins – Continuous – intra-oral bone grafting www.indiandentalacademy.com
  62. 62. • Dog ear elimination : – excess tissue is undermined & incision is made at 30 to the parent incision directed towards undermined side – excising the excess tissue with elliptical incision followed by closure www.indiandentalacademy.com
  63. 63. Suture removal : • Suture should be grasped with an instrument & elevated above epithelial surface • Scissors should be used to transect one side of the loop as close to the epithelial surface as possible www.indiandentalacademy.com
  64. 64. Conclusion : • Every surgeon should be in a position to make a logical decision regarding which suture material / technique to use in a given clinical situation, because the choice of wound closure material & technique may make a difference in www.indiandentalacademy.com
  65. 65. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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