Wound Closure Part 2: Sutures, Materials and Techniques
In part 2 of this presentation series on wound closure, Dr. Keyvan Abbaszadeh, oral maxillofacial surgeon from London ON, unpacks the art of suturing. In conversation with Dr. John O’Keefe, Director of Knowledge Networks CDA, Dr. Abbaszadeh introduces the different types of sutures and needles common to oral surgery, and walks through the principles and techniques behind effective wound closure in a variety of scenarios.
Here are the key takeaways from the presentation:
Types of Sutures
- Plain gut (lasts ~ 5 days)
- Chromic gut (lasts 10-21 days)
- Vicryl (lasts ~ 4 weeks)
- Round bodied
- Reversed cutting
- The purpose of suturing is tissue approximation, not strangulation.
- Needle should be kept at right angles to the instrument.
- Grab needle as close to the eye, but not at the eye itself.
- Do not want to have fingers inside the holes of the needle holder when putting sutures through.
Principles of Suturing
- Principles do not change regardless of the needle or suture material used.
- All sutures need to enter the tissue at right angles and exit at right angles.
- Sutures should be equidistant.
- Evert tissue edge to ensure that epithelial tissue is aligned with epithelial tissue and connective tissue is aligned with connective tissue.
- Knots – the first knot usually has two throws and locks the suture in place. The following knots are usually single throws to ensure the suture does not unravel.
- Running Suture – a single “baseball stitch” suture that closes everything. Very quick and provides watertight closure.
- Horizontal Mattress – no tie along the incision line means that you do not get inflammatory changes along the incision edge. Protects from tearing if tissue is flimsy and may fall apart.
- Vertical Mattress – similar idea to horizontal mattress.
- Figure of 8 – interrupted running suture. Preferred suture for extraction sockets.
- Simple Interrupted Suture
We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.
Until next time!
CDA Oasis Team