This document discusses suturing techniques used in surgery. It begins by defining a suture as sewing or bringing tissue together to hold it in place until healing. The goals of suturing are then outlined, such as providing tension and hemostasis. Common suturing tools and various suture materials are described, including natural, synthetic, and metallic options. The document concludes by explaining five suturing techniques - interrupted, continuous, horizontal mattress, vertical mattress, and figure of eight - detailing their indications, advantages, and disadvantages.

1. SUTURING AND ITS
TECHNIQUE
Dr. Sarosh Hussain
House Officer HUDH

2. CONTENTS
• Introduction
• Goals of Suturing
• Suture Armamentarium
• Suture Materials
• Suturing Techniques

3. INTRODUCTION
• Suture means to ‘sew’ or ‘seam’. In surgery suture is the act of
sewing or bringing tissue together and holding them in
apposition until healing has taken place.
• A suture is a strand of material used to ligate blood vessels and
to approximate tissues together.

4. GOALS OF SUTURING
• Provide adequate tension.
• Maintain hemostasis.
• Provide support for tissue margins.
• Reduce post-operative pain.
• Prevent bone exposure.
• Permit proper flap position.

5. SUTURE ARMAMENTARIUM
1. Needle holder.
2. Suture scissor.
3. Adson forceps.
4. Suture needle.
5. Suture material.

6. SUTURE MATERIAL
Ideal Properties:-
1. Easy to handle.
2. Predictable behavior in tissues.
3. Predictable tensile strength.
4. Sterile.
5. Secure knotting ability.
6. Minimal tissue reaction.
7. Non-allergenic, Non-carcinogenic, Non-shrinkage.

7. CLASSIFICATIONS OF SUTURE
MATERIALS
• According to source:-
1. Natural
2. Synthetic
3. Metallic

8. 1. NATURAL SUTURE MATERIALS
Absorbable Non-absorbable
Catgut Silk
Chromic catgut Silk worm gut
Collagen Linen

9. 2. SYNTHETIC SUTURE MATERIALS
Absorbable Non-absorbable
Polyglycolic acid Nylon (polyamide)
Polyglactic acid Polypropylene (Prolene)
Polyglactin (vicryl) Polyesters

10. 3. METALLIC SUTURE MATERIALS
1. Stainless Steel
2. Tantalum
3. Silver
4. Gold
5. Aluminium

11. SUTURING TECHNIQUES
1. Interrupted suture.
2. Simple Continuous
suture.
3. Horizontal Mattress
Suture.
4. Vertical Mattress
Suture.
5. Figure of 8 (eight)
suture.

12. 1. INTERRUPTED SUTURE.
• Do the pass technique, two loops around the needle holder, then
grab the tail and do the knot.

13. • Indications:- Single tooth extraction, third molar extraction flap,
biopsies, implants etc.
• Advantages:- It is the most commonly used technique, preferred
in urgent situations and it is easy to remove. Failure of one is
inconsequential of the others.
• Disadvantages:- It does not bring all surfaces into contact and
less supportive for healing of the flap margins.

14. 2. SIMPLE CONTINUOUS SUTURE
• Start it with simple interrupted suture, then you cut the tail off
and leave that last piece loose then you can do your loops.

15. • Indications:- Bone graft, removal of mandibular tori, tuberosity
reduction and where esthetics are not important.
• Advantages:- It is very easy to produce and offers a more water
tight closure.
• Disadvantages:- if you cut one part of it, you lost all of it.

16. 3. HORIZONTAL MATTRESS SUTURE
• The strongest type of sutures, very far away (8 mm from the
edge).

17. • Indications:- large distances between tissues, bone grafts and
implants, and closure of extraction socket.
• Advantages:- Good for hemostasis, less prominent scarring.
• Disadvantages:- Leave a gap between flaps and it is difficult to
remove.

18. 4. VERTICAL MATTRESS SUTURE
• The far-far, near-near technique.

19. • Indications:- where the wound edges tend to Evert.
• Advantages:- greater closure strength and better distribution of
wound tension.
• Disadvantages:- Scar formation and the formation of edge
necrosis.

20. 5. FIGURE OF 8 (EIGHT) SUTURE
• Pattern goes 1-2-3-4-1.

21. • Indication:- Extraction socket closure, adaptation of gingival
papilla around the tooth, and bone graft placement in socket.
• Advantages:- Rapid closure.
• Disadvantages:- Due to its orientation, it is difficult to remove
and it leaves a significant amount of suture threads inside the
socket.