This document defines surgical sutures and suturing, and discusses the goals and armamentarium of suturing. It describes various suturing tools like needle holders, tissue forceps, and scissors. It also covers suture needles, materials, sizes, properties and selection criteria. The principles of suturing and different suturing techniques like interrupted, mattress, figure-of-eight and continuous sutures are explained. Knot tying and removal of sutures are also summarized.

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Dr. Timur Alazazi

2. Defination
• A surgical suture:- is a material that
approximates the adjacent cut surfaces or
compresses blood vessels.
• Suturing:- is the act of bringing tissues
together and holding them in apposition until
healing takes place.
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3. GOALS OF SUTURING
• Wound edge apposition.
• Provide adequate tension.
• Maintain hemostasis.
• Aid in wound healing.
• Avoid wound infection.
• Produce aesthetically pleasing scare by
approximating skin edges.
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4. Armamentarium
1. Needle holder
2. Tissue Forceps
3. Scissors
4. Suture needle
5. Suture material
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5. Needle holder
Parts:
• Working tip/jaws
• Joint
• Shank/body
• Catch mechanism/ratchet
• Grip area/Ring
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6-in. (15-cm) needle holder is usually recommended

6. Needle holder
How to hold
It is held with thumb & ring
finger through the rings &
with the index finger along
the length of needle holder
to provide stability &
control.
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7. Needle holder
Difference between neddle
holder and hemostate
• A hemostat has a longer, thinner
beak compared with the needle
holder
• The faces of the beaks of the needle
holder are cross-hatched to ensure
a positive grip on the needle while
The faces of the hemostat have
parallel grooves that do not allow a
firm grip on the needle.
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8. Tissue forceps
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9. Scissors
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Dean scissors is the most used one
These scissors have slightly curved
handles and offset serrated blades
that make cutting sutures
easier. Suture scissors usually have
long handles and thumb and finger
rings. The scissors are held in the
same way as are needle holders.

10. Suture needle
Parts:
• tip/point
• body/shaft
• eye/swaged end
Made up :
• Stanless steel “StSt”
• Carbon steel
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11. Suture neddle
How to hold
• The needle holder grasps
the curved needle about
two thirds of the distance
away from the tip of the
needle
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12. Suture neddle
Shape of needle:
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13. Suture neddle
Classification of needle
According to Shape:
 Straight
 Curved
According to eye:
 Eyed needle/Traumatic
 Eyeless needle/Atraumatic
According to cutting edge
 Round body
 Cutting body “Traingular”:-
A. Conventional
B. Reverse cutting
“used mostly in dentistry”
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15. Suture material
Ideal requirements of suture materials
 Easy to handle.
 Predictable behaviour in tissues.
 Predictable tensile strength(Won’t tear through tissues).
 Sterile.
 Good knot security.
 Minimal tissue reaction.
 Non-alergenic,non carcinogenic,non-shrinkage.
Cheap
Can be used in any tissue
Unfriendly to bacteria
Strong yet small
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16. Suture material
Classification of suture materials
According to source :
 Natural
 Synthetic
According to stracture:
 Monofilament
 Multifilament
According to fate:-
 Absorbable
 Non-absorbable
According to Coating:-
 Coated
 Uncoated
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17. Suture material
Monofilament:-
1. Has no capillary action
2. Less infection risk
3. Smooth tissue passage
4. Higher tensile strength
5. More throws required
Multifilament:-
1. Has capillary action
2. Increased infection risk
3. Less smooth passage
4. Less tensile strength
5. Better knot security
Absorbable :-
1. Degraded by
enzymes,hydrolysis or
phagocytosis
2. Used to hold the edges in
approximation temporarily
until the wound is heal
NonAbsorbable :-
1. Encapsulated or walled off
by fibrosis
2. Used to suture at sites
where tensile strength
need to be maintained
CHARACTERISTICS
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18. Suture material
“multi”
“Mono”
“Mono”
“Mono”
“Mono”
“Mono”
“Multi”
“Mono”
“Mono”
“Mono”
“Multi”
“Multi”
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19. Suture material
Sizes of suture materials
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20. Suture material
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22. Suture material
Suture Descriptions
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23. Suture material
Selection of suture materials
 Condition of the wound.
 Tissues to be repaired.
 Tensile strength.
 Knot holding characteristics.
 Reaction of surrounding tissues.
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24. Suture material
Selection of suture materials
 Do not use dyed sutures on the
skin
 Dyed sutures are best visualized in
oral cavity.
 Use monofilament on the skin as
multifilament harbor BACTERIA
 Non-absorbable cause less
scarring but must be removed
 Location and layer, patient factors,
strength, healing, site and
availability all also should be
considered
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25. Suture material
Selection of suture materials
 The most commonly used suture needles in dentistry are the 3/8 and 1/2 circle needles.
 The 3/8 needle allows the clinician to pass from the buccal surface to the lingual surface in
one motion.
 The 1/2 circle needle is traditionally used in more restricted areas; for instance, in the buccal
of the maxillary molars and the facial aspect of the maxillary and mandibular incisors.
 Generally in dentistry, the 3/8 reverse cutting needle with a 3-0 or 4-0 thread diameter and
the 1/2 reverse cutting needle with the thinner and more delicate 5-0 or 6-0 thread diameter
are the most commonly used needle and thread combinations,
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26. Suture material
Principle of suturing
 The needle should be grasped at
approximately 1/3 of the distance
from the eye & 2/3 from point.
 The needle should be pierced the
tissue perpendicular to its
surface(right angle)to make the
smallest possible hole in the
mucosal flap .If the needle passes
through the tissue obliquely, the
suture will tear
The needle should be placed
equidistant (2-3mm) from the
incision line.
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27. Suture material
Principle of suturing
 The depth of penetration should
be equal on both side of incision
line.
 The needle always passes from –
A. The movable tissue to the
fixed tissue.
B. Thinner tissue to the thicker
tissue.
C. Deeper tissue to the
superficial tissue.
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28. Suture material
Principle of suturing
 When placing multiple adjacent
interrupted sutures, they can
usually be spaced about 1 to 1.5 cm
apart.
The tissue never be closed under
tension (The flaps should not be
blanched and there is no ischemia
at the edges when tying a suture)
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29. Suture material
Principle of suturing
Only the long end that is pulled
during knoting and to the opposite
direction . The short end should be
1.5-2 cm long
The knot should be positioned so
that it does not fall directly over the
incision line, because this causes
additional pressure on the wound.
Therefore, the knot should be
positioned to the side of the
incision line.(3-4 mm apart from the
incision line)
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30. Suture material
Principle of suturing
The ends of the suture should be
left no longer than 1 cm.
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31. SUTURING TECHNIQUES
 Interrupted suture.
1. Simple (Routine) interrupted suture
2. Mattress suture:-
A. Horizontal mattress
B. Vertical mattress
 Continuous suture.
Figure of 8(eight) suture.
 Subcuticular suture.
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Interrupted :- Simple Interrupted

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FIGURE II-14. An example of placing a
single routine suture after an implant
procedure. A, The needle placed
through the facial papilla, taking care to
engage enough tissue so the suture is
less likely to pull through during
knotting. B, The second pass of the
needle through the undersurface of the
lingual papilla, attempting to engage
the same amount of tissue as engaged in
the facial papilla. If 2 sides of papilla are
lying well positioned before
suturing, many surgeons with make a
single pass with the needle through both
sides, rather than using a second
pass. C, The needle has been brought
through the lingual papilla to the facial
side to allow for knotting. D, Note
that the knot has been positioned to the
facial side of the wound before it is cut.
This keeps it off the wound edge,
to keep it from irritating the patient’s
tongue and, for nonresorbable sutures, in
a position making it easier to
remove.

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Interrupted :- Simple Interrupted
Number of stitches according to the type of flap
1. Envelope flap:- it is held in place with sutures that are
placed through the papillae only. Sutures are not placed
across the empty tooth socket because the edges of the
wound would not be supported over sound bone.
2. If a three-cornered flap :-the vertical end of the incision
must be closed separately. Two sutures are
usually required to close the vertical end properly. Before
the sutures are inserted, a periosteal elevator should be
used to slightly elevate the non–flap side of the incision,
freeing the margin to facilitate passage of the needle
through the tissue .The first suture is placed across the
papilla where the vertical release incision was made. The
remainder of the envelope portion of the incision is then
closed.

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Interrupted :- Horizontal Mattress

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Interrupted :- Horizontal Mattress

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Figure 8 suture

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Continuous suture

39. Kont tie Suture material
1. secure/square knot.
2. Surgeons knot.
3. Granny’s knot/slip knot.
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42. Removal of the sutures
 Skin sutures are removed as soon as tissue healing allows.
 Non-absorbable sutures are best removed from the face
after a period of 5-6 days.Tissues such as the scalp may
require a longer period(7-10 days).
 Use a disinfecting mouthwash to clean the wound of all
debris.
 The suture knot is elevated off the tissue utilizing cotton
pliers.
 The suture is cut as close to the tissue as possible in order
to avoid dragging bacteria through the wound.
 The suture is then pulled towards the incision line to
prevent dehiscence.
 When removing continuous sutures, each section should
be cut and pulled out individually.
 If pieces of suture left infection may occur.
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