HOW DO CHOOSE WHICH IS THE BEST SUTURING MATERIALS TO USE IN ONE'S SURGICAL CASE?
DMD cEnter has provided on its previous post certain guide of suturing techniques for success in your surgical treatments. Click this link: READ
And, a post you can share to your patients, Click this Link: READ
Now, we will discuss with you the guide for the materials you will use on suturing for even a successful treatment.
A suture is an artificial fibre used to keep wound together until they hold sufficiently well by themselves by natural fibre (collagen) which is synthesized and woven into a stronger scar. The main purpose of a suture is to hold severed tissues in close approximation until the healing process provides the wound with sufficient strength to withstand stress without the need for mechanical support. Since wounds do not gain strength until 4-6 days after injury, the tissues are approximated till then by sutures.
Regardless of suture composition, most of the time the body reacts as if it is a foreign body. Thus, the body responds by producing a reaction of varying degrees.
➢Easy to handle
➢Causes only minimal tissue injury or tissue reaction ( nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic)
➢Holds securely when knotted (no fraying or cutting)
➢High tensile strength
➢Favorable absorption profile
➢Resistant to infection
➢Can be used in any tissue
➢Can create good knot security
➢Minimal tissue reaction
CLASSIFICATION OF SUTURES:
Absorbable vs Non-Absorbable
I. Absorbable Sutures
- In general, as dentist we will place a gauze on the area where the extraction is done for you to bite after the treatment. We instruct our patient to let it stay for a few hours to allow the clot to form, so, we advice them that it is good to replace this as often as necessary.
Absorbable sutures are broken down by the body via enzymatic reactions or hydrolysis. The time in which this absorption takes place varies between material, location of suture, and patient factors.
Absorbable sutures are commonly used for deep tissues and tissues that heal rapidly; as a result, they may be used in small tissue anastomosis, suturing in the soft tissue on surgical flaps.
For the more commonly used absorbable sutures, complete absorption times will vary:
➢Vicryl rapide = 42 days
➢Vicryl = 60 days
➢Monocryl = ~100 days
➢PDS = ~200 days
II. Non-Absorbable Sutures
– Non-absorbable sutures are used if the surgical site requires long-term tissue support, remaining walled-off by the body’s inflammatory processes (until removed manually if required).
Uses include tissues that heal slowly, such as fascia or tendons, closure of extra oral flap, or vascular anastomoses.
Suture materials can be further categorised by their raw origin:
Synthetic vs Natural
– These are sutures made of natural materials (e.g. silk or catgut). They are less frequently used, as they tend to provoke a greater tissue reaction and suture antigenicity can lead to inflammatory reactions.
Should not be used in high acidic environment (reflux bulimia, esophagitis, Sjogern’s syndrome, radiation therapy).
– Comprised of man-made materials (e.g. PDS or nylon). They tend to be more predictable than the natural sutures, particularly in their loss of tensile strength and absorption.
Suture materials can also be sub-classified by their structure:
Monofilament vs Multifilament
I. Monofilament Suture
– A single stranded filament suture (e.g nylon, PDS*, or prolene). This structure is relatively more resistant in harboring microorganisms, meaning lower risk for infection but also have a poor knot security and ease of handling. These sutures also exhibit less resistance to passage through tissue than multifilament suture.
II. Multifilament Suture
– These sutures are made of several filaments that are twisted together (e.g braided silk or vicryl). Generally this type of suture has greater tensile strength, better pliability and flexibility than monofilament suture. They handle easier and hold their shape for good knot security. Because multifilament materials have increased capillarity, they tend to ‘‘wick’’ oral fluids along the suture to the underlying tissues. This wicking action can carry bacteria along with saliva thus it may act as a tract for the introduction of pathogens increasing risk of infection
The diameter of the suture will affect its handling properties and tensile strength. Diameter of surface material it is measured in sizes from 1-0 to 10-0.10-0 is the smallest diameter and least amount of tensile strength. Tensile strength of the suture should never exceed the tensile strength of the tissue. In oral surgery the size 3-0 has the appropriate amount of strength; the polyfilament (braided) nature of the silk makes it easy to tie and is well tolerated by the patient’s tongue in that the cut ends of the suture tend to lie flat and are not pointed. The color makes the suture easy to see when the patient returns for suture removal. Sutures that are holding mucosa together are usually left in place no longer than 5 to 7 days, so the wicking action is of little clinical importance. Many surgeons prefer 3-0 chromic sutures to avoid the need to later remove them.
In other procedures 4-0 is most commonly used in periodontal flap surgeries and 5-0 is mostly used for delicate tissues and for soft tissue graft surgery
The surgical needle allows the placement of the suture within the tissue, carrying the material through with minimal residual trauma.
The ideal surgical needle should be rigid enough to resist distortion, yet flexible enough to bend before breaking, be as slim as possible to minimise trauma, sharp enough to penetrate tissue with minimal resistance, and be stable within a needle holder to permit accurate placement.
Needles can be Classified as:
a. Straight (limited use in oral surgery) or curved Needle Body.
b. Swaged or eyed. Made up of either SS or carbon
Needle bodies can be round: cutting, or reverse cutting:
I. Round Bodied Needles
Commonly used in friable tissue such as liver and kidney.
II. Cutting Needles
Cutting needles are triangular in shape, and have 3 cutting edges to penetrate tough tissue such as the skin and sternum, and have a cutting surface on the concave edge.
III. Reverse Cutting Needles
Reverse cutting needles have a cutting surface on the convex edge, and are ideal for tough tissue such as tendon or subcuticular sutures, and have reduced risk of cutting through tissue.
The needle point acts to pierce the tissue, beginning at the maximal point of the body and running to the end of the needle, and can be either sharp or blunt:
Blunt needles are used for abdominal wall closure, and in friable tissue, and can potentially reduce the risk of blood borne virus infection from needlestick injuries.
Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where leakage must be prevented.
The needle shape vary in their curvature and are described as the proportion of a circle completed – the ¼, ⅜, ½, and ⅝ are the most common curvatures used. Different curvatures are required depending on the access to the area to suture.
Knowing the types of materials to use in any given situation, improves the competency and success of the procedure. It should be kept in mind that the materials reacts on tissue differently, thus being informed prevents complication and improves quality of care to our patient.
Dr. Bryan Anduiza - Writer
Dr. Mary Jean Villanueva – Editor | Writer