Suturing Materials and Techniques

Introduction

• Suturing is a critical step in surgical procedures aimed at:
  
  

  • Promoting healing
    
    

  • Reducing wound dehiscence
    
    

  • Preventing infection
    
    

  • Achieving hemostasis
    
    

• Proper selection of suture material, needle, and technique ensures optimal wound closure.
  
  

Historical Background

• Ancient materials used: linen, silk, hair, animal gut.
  
  

• Modern materials introduced include synthetic absorbable and nonabsorbable sutures.
  
  

• Ideal suture characteristics:
  
  

  • Biocompatible
    
    

  • Adequate tensile strength
    
    

  • Minimal tissue reaction
    
    

  • Easy handling and knot security
    
    

Classification of Suture Materials

A. Based on Absorption

1. Absorbable Sutures: Broken down by body enzymes or hydrolysis.
   
   

2. Nonabsorbable Sutures: Remain intact and may need removal or become encapsulated.
   
   

B. Based on Origin

1. Natural: Gut, silk, cotton (more tissue reaction).
   
   

2. Synthetic: Vicryl, Dexon, Nylon (less reaction).
   
   

C. Based on Filament Structure

1. Monofilament: Single strand; less infection risk, more memory.
   
   

2. Multifilament (Braided): Multiple strands; better handling, higher infection risk.
   
   

Nonabsorbable Sutures

• Silk:
  
  

  • Natural, braided, soft, easy handling
    
    

  • Causes significant tissue reaction
    
    

• Nylon (Ethilon):
  
  

  • Synthetic, monofilament, minimal reaction
    
    

  • Requires multiple knots for security
    
    

• Polypropylene (Prolene):
  
  

  • Synthetic, inert, monofilament
    
    

  • Used in areas needing long-term support
    
    

• Polyester (Mersilene):
  
  

  • Braided, nonabsorbable, high tensile strength
    
    

• Stainless Steel Wire:
  
  

  • Used in bone fixation
    
    

  • Highest tensile strength, difficult to handle
    
    

Natural Absorbable Sutures

• Plain Catgut:
  
  

  • Derived from sheep intestine
    
    

  • Absorption within 7–10 days
    
    

  • Rapid tissue reaction
    
    

• Chromic Catgut:
  
  

  • Treated with chromic salts to delay absorption
    
    

  • Lasts 14–21 days
    
    

  • Moderate tissue reaction
    
    

Synthetic Absorbable Sutures

• Polyglycolic Acid (Dexon) and Polyglactin 910 (Vicryl):
  
  

  • Braided, absorbed by hydrolysis
    
    

  • Less tissue reaction than catgut
    
    

  • Used in mucosal closures
    
    

• Polydioxanone (PDS) and Polyglyconate (Maxon):
  
  

  • Monofilament, long-term absorbable
    
    

  • High tensile strength
    
    

  • Used in slow-healing tissues
    
    

Coated Vicryl: Polyglactin-910

• Features:
  
  

  • Braided, synthetic, absorbable
    
    

  • Coated for smoother passage through tissues
    
    

  • Absorbed by hydrolysis in ~60–90 days
    
    

  • Widely used in oral surgery due to its strength and handling
    
    

Suture Needles

Parts of a Surgical Needle

1. Swage (eye): Where suture attaches
   
   

2. Body: Main shaft, grasped by needle holder
   
   

3. Point: Cutting or tapering end
   
   

Types of Needle Points

• Cutting Needle:
  
  

  • Triangular cross-section
    
    

  • Cuts through tough tissues (e.g., skin)
    
    

• Reverse Cutting Needle:
  
  

  • Less tearing, more strength; ideal for oral mucosa
    
    

• Taper Point:
  
  

  • Smooth; used in soft tissues and deep closures
    
    

• Blunt Needle:
  
  

  • Used for friable tissues (e.g., liver)
    
    

Needle Curvature

• 1/4, 3/8, 1/2, or 5/8 circles
  
  

• 3/8 circle most commonly used in oral surgery
  
  

Suturing Techniques

A. Interrupted Sutures

• Each stitch is tied separately
  
  

• Advantages:
  
  

  • Precise tension control
    
    

  • If one suture fails, others remain intact
    
    

• Disadvantages:
  
  

  • Time-consuming
    
    

B. Continuous Sutures

• Single strand used for multiple stitches
  
  

• Quicker and distributes tension evenly
  
  

• Disadvantage: if one part breaks, entire closure may fail
  
  

C. Mattress Sutures

1. Vertical Mattress:
   
   

   • Provides deep and superficial closure
     
     

   • Good for gaping wounds
     
     

2. Horizontal Mattress:
   
   

   • Spreads tension along wound edges
     
     

   • Used in fragile or mobile tissues
     
     

D. Figure-of-Eight Sutures

• Commonly used after tooth extraction
  
  

• Excellent hemostasis
  
  

E. Subcuticular and Submucosal Sutures

• Cosmetic closure; hidden sutures
  
  

• Used in esthetic areas
  
  

Suture Removal

• Typically done after:
  
  

  • 5–7 days in oral mucosa
    
    

  • Delayed up to 10–14 days in slow-healing areas
    
    

• Use suture scissors and forceps
  
  

• Prevent contamination by avoiding dragging external suture material through tissue
  
  

Mechanical Wound Closure Devices

• Tissue Adhesives (e.g., cyanoacrylates):
  
  

  • Quick, painless, bacteriostatic
    
    

• Surgical Staples:
  
  

  • Rapid closure, mainly in extraoral procedures
    
    

• Adhesive Strips:
  
  

  • Temporary closure or for minor skin injuries