Lecture 6 - Sutures

what are the requirements for good sutures?

high uniform tensile strength, high tensile strength retention in vivo, sterile, ease of handling, knot security, freedom of irritating substances, tissue acceptance, limits/prevents bacterial adhesion and proliferation, uniform diameter, biologically inactive

what are the ideal characteristics of a suture?

optimal characteristics of application, minimal tissue trauma, high tear strength, complete resorption/removable

what are the advantages of monofilament sutures?

smooth surface, strong, low friction, lower resistance, less tissue trauma, no bacterial culture, no capillarity, no tumor cell transport

what are the disadvantages of monofilament sutures?

not very elastic, difficult handling and knotting

what are the advantages of multifilament sutures?

stronger, softer, more flexible, ease of use, knot safety

what are the disadvantages of multifilament sutures?

rough surface, bacterial cultures, capillarity, tumor cell transport, elongation, tissue trauma, tissue damage

what are the advantages of natural sutures?

easy to use and knot

what are the disadvantages of natural sutures?

enzymatic absorption, tissue reactions, unpredictable absorption

what are the advantages of synthetic sutures?

economic, similar to natural, hydrolytic absorption, calculable absorption, strength

what are the disadvantages of synthetic sutures?

difficult to handle the monofilaments

what is the main function of plain gut sutures?

subcuticular and mucosal closure

what are the advantages of plain gut sutures?

resorbs quickly, for noncritical wounds

what are the disadvantages of plain gut sutures?

can create sensitivity, does not hold knots well, unreliable for critical wounds, can bother tongue, weak

what is the main function of chromic gut sutures?

deep muscle closure

what are the advantages of chromic gut sutures?

resorbs slowly, dependable

what are the disadvantages of chromic gut sutures?

may create sensitivity, not for intraoral use, holds knots poorly, weak

what is the main function of nylon sutures?

skin closure

are nylon sutures resorbable?

no

what are the advantages of nylon sutures?

strongly discourages wicking

what are the disadvantages of nylon sutures?

holds knots poorly, plastic memory, requires removal

what is the main function of vicryl sutures?

deep suturing mucosal closure

what are the advantages of vicryl sutures?

strong, knots well, resorbs

what are the disadvantages of vicryl sutures?

causes some wicking, can require removal when used intraorally, does not slide or knot as well as silk when wet

what are two examples of multifilament, non-absorbable sutures?

silk, polyester

what are two examples of monofilament, non-absorbable sutures?

polypropylene, nylon

what are two examples of surgical gut, absorbable sutures?

chromic, plain gut

what are two examples of synthetic, absorbable sutures?

PGA, PGA-FA

can the tensile strength of a suture exceed the tensile strength of the tissue?

no

what are the most common diameters of sutures used in dentistry?

0.2 (3-0), 0.15 (4-0)

what are the requirements for a needle used for suturing?

sharp enough to penetrate tissue with minimal resistance, passes easily through tissue, stays sharp on every pass, minimal tissue trauma, thin diameter without compromising strength, non-bending for maximum control

what are the characteristics of a taper-point needle?

suited for soft and easily penetrated tissue, dilates instead of cuts, preferred when smallest hole or least cutting is desired

what are the characteristics of a reverse cutting needle?

very sharp, ideal for skin, cuts instead of dilates, designed for tough tissues like skin and mucosa, has three cutting edges and creates a triangular tissue hole

what are the characteristics of a conventional cutting needle?

very sharp, cuts instead of dilates, creates weakness allowing suture tear out

what are the characteristics of a taper cutting needle?

ideal in tough or calcified tissue, mainly used in cardiac and vascular procedures

what should be considered when selecting a needle for suturing?

type of tissue to be sutured, tissue accessibility, diameter of suture material

what are the characteristics of a perma sharp needle?

1:1 suture to needle ratio, no crimping where suture attaches, less tissue displacement, smooth passage through tissue, better surgical results and healing

how should the needle be held in relation to the tissue when initiating a suture?

perpendicular to tissue

should rotational or circular movements be used during suturing?

rotational