The document discusses suturing techniques and materials. It provides details on various suturing instruments including needles, needle holders, forceps and scissors. It explains the principles of suturing such as using the appropriate needle and suture size for the tissue. Different types of suture materials are also outlined, categorizing them based on absorbability, source and degradation time. Specific suture materials are described like catgut, collagen and synthetic absorbable sutures. The document serves as a guide for proper suturing methods and selection of instruments and materials.
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
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
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
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
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
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
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
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
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
86. Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
Wounds, Wound Healing And Suturing ELHAWARY
87. Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
Wounds, Wound Healing And Suturing ELHAWARY
88. Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
Wounds, Wound Healing And Suturing ELHAWARY
89. Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
Wounds, Wound Healing And Suturing ELHAWARY
90. 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
92. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
Wounds, Wound Healing And Suturing ELHAWARY
93. 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
95. Dr. Hesham El-Hawary
Ass. Prof OMFS
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
99. Key suture
Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
Wounds, Wound Healing And Suturing ELHAWARY
100. Key suture
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
106. Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
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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
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120. Oral Surgery by Fragiskos D. Fragiskos
Springer-Verlag Berlin Heidelberg 2007
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121. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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122. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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123. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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124. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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125. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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126. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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127. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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128. Dr. Hesham El-Hawary
Ass. Prof OMFS
www.elhawarydentalclinic.com
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129. Dr. Hesham El-Hawary
From the inner aspect Ass. Prof OMFS
www.elhawarydentalclinic.com
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130. Dr. Hesham El-Hawary
From the inner aspect Ass. Prof OMFS
www.elhawarydentalclinic.com
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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
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