Suturing; principles, armamentarium and techniques

1. In the Name of Allah, the Most Beneficent, the Most Merciful And your Lord has decreed that you worship none but Him. And that you be dutiful to your parents. If one of them or both of them attain old age in your life, say not to them a word of disrespect, nor shout at them but address them in terms of honour (23) (And lower unto them the wing of submission and humility through mercy, and say: "My Lord! Bestow on them Your Mercy as they did bring me up when I was small." (24) Surat Al-'Isrā' Wounds, Wound Healing And Suturing ELHAWARY

2. Suturing Principles, Armamentarium And Techniques Assistant professor OMFS Cairo University MSA Univesity Umm Ql-Qura University Wounds, Wound Healing And Suturing ELHAWARY

3. Closure (Suturing) • Approximation of the soft tissue edges to cover the surgical field Wounds, Wound Healing And Suturing ELHAWARY

4. Closure (Suturing) • Approximation of the soft tissue edges to cover the surgical field • Advantages of suturing: – Promotes healing – Prevents complications • Infection • Hemorrhage • Tissue necrosis – Preserve the normal contour and shape of tissues Wounds, Wound Healing And Suturing ELHAWARY

5. Suturing Instruments • Suturing needle • Suturing material • Needle holder • Tissue forceps • Suture scissor Wounds, Wound Healing And Suturing ELHAWARY

7. Suturing Instruments • Suturing needle • Suturing material • Needle holder • Tissue forceps Point • Suture scissor Wounds, Wound Healing And Suturing ELHAWARY

8. Suturing Instruments • Suturing needle • Suturing material • Needle holder • Tissue forceps Body • Suture scissor Wounds, Wound Healing And Suturing ELHAWARY

9. Suturing Instruments • Suturing needle • Suturing material • Needle holder • Tissue forceps • Suture scissor Swaged end Wounds, Wound Healing And Suturing ELHAWARY

12. Suturing Instruments • Suturing needle • Suturing material • Needle holder • Tissue forceps • Suture scissor Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

14. Suturing Instruments Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 • Suturing needle • Suturing material • Needle holder • Tissue forceps • Suture scissor Wounds, Wound Healing And Suturing ELHAWARY

15. Wounds, Wound Healing And Suturing ELHAWARY

16. Wounds, Wound Healing And Suturing ELHAWARY

18. Suturing Instruments • Suturing needle • Suturing material • Needle holder • Tissue forceps • Suture scissor Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

19. Opening The Suture Material Wounds, Wound Healing And Suturing ELHAWARY

27. Grasping the needle holder Wounds, Wound Healing And Suturing ELHAWARY

31. Grasping the needle Wounds, Wound Healing And Suturing ELHAWARY

35. Principles of suturing Wounds, Wound Healing And Suturing ELHAWARY

36. Principles of suturing • Use suture needle of suitable shape and size Wounds, Wound Healing And Suturing ELHAWARY

37. Principles of suturing • Use suture needle of suitable shape and size • Use suture material that is of suitable type and size for the tissues being sutured Wounds, Wound Healing And Suturing ELHAWARY

38. Principles of suturing • Use suture needle of suitable shape and size • Use suture material that is of suitable type and size for the tissues being sutured • Good bite (2:3 mm from the free edge of the soft tissue) Wounds, Wound Healing And Suturing ELHAWARY

39. Principles of suturing • Use suture needle of suitable shape and size • Use suture material that is of suitable type and size for the tissues being sutured • Good bite (2:3 mm from the free edge of the soft tissue) • Sutures should not be placed under tension Wounds, Wound Healing And Suturing ELHAWARY

40. Principles of suturing • Use suture needle of suitable shape and size • Use suture material that is of suitable type and size for the tissues being sutured • Good bite (2:3 mm from the free edge of the soft tissue) • Sutures should not be placed under tension • Knots should be tied 2-3 mm away from the incision line Wounds, Wound Healing And Suturing ELHAWARY

41. Principles of suturing • Use suture needle of suitable shape and size • Use suture material that is of suitable type and size for the tissues being sutured • Good bite (2:3 mm from the free edge of the soft tissue) • Sutures should not be placed under tension • Knots should be tied 2-3 mm away from the incision line • Suture material is cut 4-5 mm away from the knot Wounds, Wound Healing And Suturing ELHAWARY

42. Principles of suturing • Use suture needle of suitable shape and size • Use suture material that is of suitable type and size for the tissues being sutured • Good bite (2:3 mm from the free edge of the soft tissue) • Sutures should not be placed under tension • Knots should be tied 2-3 mm away from the incision line • Suture material is cut 4-5 mm away from the knot • Superficial sutures must be removed 5 days after surgery to prevent infection / foreign body reaction Wounds, Wound Healing And Suturing ELHAWARY

43. Suture needles • Patterns of the suture needle according to accessibility: – Straight suture needles – Curved suture needles – Half circle suture needles http://www.burtons.uk.com/products.asp?recnumber=424 Wounds, Wound Healing And Suturing ELHAWARY

44. Suture needles • Patterns of the suture needle according to accessibility: – Straight suture needles • For skin closure – Curved suture needles • For intraoral suturing • For deep suturing – Half circle suture needles • For intraoral suturing http://www.burtons.uk.com/products.asp?recnumber=424 • For deep suturing Wounds, Wound Healing And Suturing ELHAWARY

45. Suture needles • Patterns of the suture needle according to cross section: – Round suture needles – Triangular suture needles • Cutting • Reverse cutting http://www.starmedix.com Wounds, Wound Healing And Suturing ELHAWARY

46. Suture needles • Patterns of suture needles according to cross section: – Round suture needles • Round cross section • May be straight, curved or half circle • Suturing of fragile and delicate tissues e.g. oral mucosa and mucous membranes Round needle http://www.starmedix.com Wounds, Wound Healing And Suturing ELHAWARY

47. Suture needles • Patterns of suture needles according to cross section: – Cutting / Reverse cutting (Atraumatic) suture needles • Triangular cross section • May be straight, curved or half circle • Suturing of dense tissues e.g. oral mucoperiosteum Reverse cutting needle Cutting needle http://www.starmedix.com http://www.starmedix.com Wounds, Wound Healing And Suturing ELHAWARY

48. Suture materials Wounds, Wound Healing And Suturing ELHAWARY

49. Suture materials • Types of suture material according to resorption: – Non-Absorbable suture materials – Absorbable suture material Wounds, Wound Healing And Suturing ELHAWARY

50. Suture materials • Types of suture material according to resorption: – Non-Absorbable suture materials – Absorbable suture material • Types of suture material according to nature: – Natural – Synthetic Wounds, Wound Healing And Suturing ELHAWARY

51. Suture materials • Types of suture material according to resorption: – Non-Absorbable suture materials – Absorbable suture material • Types of suture material according to nature: – Natural – Synthetic • Types of suture material according to gauge: – 0/00/000/0000/00000/000000 Wounds, Wound Healing And Suturing ELHAWARY

52. Suture materials • Types of suture material according to resorption: – Non-Absorbable suture materials – Absorbable suture material • Types of suture material according to nature: – Natural – Synthetic • Types of suture material according to gauge: – 0/00/000/0000/00000/000000 • Types of suture material according to filament – Monofilament – Multifilament Wounds, Wound Healing And Suturing ELHAWARY

53. Suture materials Wounds, Wound Healing And Suturing ELHAWARY

54. Suture materials Non-Absorbable Absorbable Wounds, Wound Healing And Suturing ELHAWARY

55. Suture materials Non-Absorbable Absorbable • Can’t be resorbed by the body • Used for suturing of: – Skin closure – Routine intraoral closure – Blood vessels ligation Wounds, Wound Healing And Suturing ELHAWARY

56. Suture materials Non-Absorbable Absorbable • Can’t be resorbed by • Can be resorbed by the body body • Used for suturing of: • Used for suturing of: – Skin closure – Deep tissues – Routine intraoral closure – Fascial layers – Blood vessels ligation – Intraoral closure in cases of: • Inability of the patient to return to remove the sutures • Mentally retarded patients • Epileptic patients • Sutures under surgical stents Wounds, Wound Healing And Suturing ELHAWARY

57. Suture materials • Non-Absorbable suture materials – Silk – Cotton – Nylon Wounds, Wound Healing And Suturing ELHAWARY

58. Suture materials • Non-Absorbable suture materials – Silk • Black or white • Tough suture material • Intraoral suturing – Cotton – Nylon Wounds, Wound Healing And Suturing ELHAWARY

59. Suture materials • Non-Absorbable suture materials – Silk – Cotton • Weak suture material • Intraoral suturing – Nylon Wounds, Wound Healing And Suturing ELHAWARY

60. Suture materials • Non-Absorbable suture materials – Silk – Cotton – Nylon • Very hard suture material • Used for skin closure • Cause mucosal irritation if used intraorally Wounds, Wound Healing And Suturing ELHAWARY

61. Suture materials • Absorbable suture materials – Plain catgut – Chromic catgut – Collagen sutures – Polyglycolic acids sutures (Dexon) – Polyglactin-910 (Vicryl) sutures Wounds, Wound Healing And Suturing ELHAWARY

62. Suture materials • Absorbable suture materials – Plain catgut • Resorbed 5-10 days • Used for suturing of deep fascia and muscles • Occasionally tissue irritant – Chromic catgut – Collagen sutures – Polyglycolic acids sutures (Dexon) – Polyglactin-910 (Vicryl) sutures Wounds, Wound Healing And Suturing ELHAWARY

63. Suture materials • Absorbable suture materials – Plain catgut – Chromic catgut • Resorbed completely after 10-15 days • Non irritant to the tissues • Sutures of ligaments, tendons and severed blood vessels – Collagen sutures – Polyglycolic acids sutures (Dexon) – Polyglactin-910 (Vicryl) sutures Wounds, Wound Healing And Suturing ELHAWARY

64. Suture materials • Absorbable suture materials – Plain catgut – Chromic catgut – Collagen sutures • More uniform physical properties • Prepared from tendons of cattle – Polyglycolic acids sutures (Dexon) – Polyglactin-910 (Vicryl) sutures Wounds, Wound Healing And Suturing ELHAWARY

65. Suture materials • Absorbable suture materials – Plain catgut – Chromic catgut – Collagen sutures – Polyglycolic acids sutures (Dexon) • Synthetic polymer • Resorbed by hydrolysis within 15-30 days – Polyglactin-910 (Vicryl) sutures Wounds, Wound Healing And Suturing ELHAWARY

66. Suture materials • Absorbable suture materials – Plain catgut – Chromic catgut – Collagen sutures – Polyglycolic acids sutures (Dexon) – Polyglactin-910 (Vicryl) sutures • Synthetic inert copolymer • The strongest absorbable suture material • Resorbed 60 – 90 days Wounds, Wound Healing And Suturing ELHAWARY

67. Factors affecting selection of suturing material • Area to be sutured – Deep layers Vs superficial layers – Intraoral surgeries Vs extraoral – Vascular anastomoses are performed with fine-bore non- absorbable materials • Strength of the sutures needed • Tissue reactivity toward suture material Wounds, Wound Healing And Suturing ELHAWARY

68. The suture packaging Wounds, Wound Healing And Suturing ELHAWARY

69. The suture packaging Wounds, Wound Healing And Suturing ELHAWARY

70. The suture packaging Material Wounds, Wound Healing And Suturing ELHAWARY

71. The suture packaging Material Size Wounds, Wound Healing And Suturing ELHAWARY

72. The suture packaging Material Size Color Wounds, Wound Healing And Suturing ELHAWARY

73. The suture packaging Material Size Color Sterile Wounds, Wound Healing And Suturing ELHAWARY

74. The suture packaging Material Size Color Single use Sterile Wounds, Wound Healing And Suturing ELHAWARY

75. The suture packaging Material Size Color Single use Needle code Sterile with life size picture Wounds, Wound Healing And Suturing ELHAWARY

76. The suture packaging Material Size Shape Color Single use Needle code Sterile with life size picture Wounds, Wound Healing And Suturing ELHAWARY

77. The suture packaging Material Size Shape Color Needle length Single use Needle code Sterile with life size picture Wounds, Wound Healing And Suturing ELHAWARY

78. The suture packaging Material Size Shape Color Needle length Cross-section Single use Needle code Sterile with life size picture Wounds, Wound Healing And Suturing ELHAWARY

79. The suture packaging Material Material length Size Shape Color Needle length Cross-section Single use Needle code Sterile with life size picture Wounds, Wound Healing And Suturing ELHAWARY

80. The suture packaging Material Material length Size Shape Color Needle length Cross-section Expiration date Single use Needle code Sterile with life size picture Wounds, Wound Healing And Suturing ELHAWARY

81. Suturing techniques Wounds, Wound Healing And Suturing ELHAWARY

82. Suturing techniques • Interrupted sutures • Continuous sutures • Continuous with lock suture • Horizontal mattress suture • Vertical mattress suture Wounds, Wound Healing And Suturing ELHAWARY

83. Suturing Materials & Techniques INTERRUPTED SUTURES Wounds, Wound Healing And Suturing ELHAWARY

84. Manual of Minor Oral Surgery for the General Dentist By Karl R. Koerner 2006 by Blackwell Munksgaard, Wounds, Wound Healing And Suturing ELHAWARY

85. Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 Wounds, Wound Healing And Suturing ELHAWARY

91. Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

94. Hesham El-Hawary www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

96. Oral Surgery by Fragiskos D. Fragiskos Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 Springer-Verlag Berlin Heidelberg 2007 Wounds, Wound Healing And Suturing ELHAWARY

97. Key suture Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

98. Key suture X Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

101. Key suture X Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

102. Rule of Halves X Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

103. Rule of Halves X X Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

104. Rule of Halves X X X Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

105. Suturing Materials & Techniques CONTINUOUS SUTURES Wounds, Wound Healing And Suturing ELHAWARY

106. Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 Wounds, Wound Healing And Suturing ELHAWARY

107. Suturing Materials & Techniques CONTINUOUS WITH LOCK SUTURES Wounds, Wound Healing And Suturing ELHAWARY

108. Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 Oral Surgery by Fragiskos D. Fragiskos Springer-Verlag Berlin Heidelberg 2007 Wounds, Wound Healing And Suturing ELHAWARY

109. Suturing Materials & Techniques HORIZONTAL MATTRESS SUTURE Wounds, Wound Healing And Suturing ELHAWARY

116. Eversion of the edges Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

117. Manual of Minor Oral Surgery for the General Dentist By Karl R. Koerner 2006 by Blackwell Munksgaard, Wounds, Wound Healing And Suturing ELHAWARY

118. Oral Surgery by Fragiskos D. Fragiskos © Springer-Verlag Berlin Heidelberg 2007 Oral Surgery by Fragiskos D. Fragiskos © Springer-Verlag Berlin Heidelberg 2007 Wounds, Wound Healing And Suturing ELHAWARY

119. Suturing Materials & Techniques VERTICAL MATTRESS SUTURES Wounds, Wound Healing And Suturing ELHAWARY

122. Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com 1 4 3 2 Wounds, Wound Healing And Suturing ELHAWARY

123. Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com 1 Wounds, Wound Healing And Suturing ELHAWARY

124. Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com 1 2 Wounds, Wound Healing And Suturing ELHAWARY

127. Dr. Hesham El-Hawary Ass. Prof OMFS www.elhawarydentalclinic.com 1 4 3 2 Wounds, Wound Healing And Suturing ELHAWARY

129. Dr. Hesham El-Hawary From the inner aspect Ass. Prof OMFS www.elhawarydentalclinic.com 1 4 2 3 Wounds, Wound Healing And Suturing ELHAWARY

130. Dr. Hesham El-Hawary From the inner aspect Ass. Prof OMFS www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

131. Thank you Dr. Hesham El-Hawary Ass. Professor OMFS Facebook: Hesham El-Hawary Twitter: @elhawary_hesham Email: hesham@elhawarydentalclinc.com Website: www.elhawarydentalclinic.com Wounds, Wound Healing And Suturing ELHAWARY

Suturing; principles, armamentarium and techniques

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