Suturing

Question 1

When were synthetic non-resorbable and resorbable suture fibres developed?

Answer 1

after the second world war

Question 2

What is the purpose of sutures?

Answer 2

• hold tissues in place to permit healing via primary intention
• control bleeding

Question 3

What suturing techniques should a GDP be familiar with?

Answer 3

• interrupted suturing
• continuous suturing
• vertical mattress suturing
• horizontal mattress suturing

Question 4

State the suittable thread diameter for use in dentistry

Answer 4

3-0 to 6-0

Question 5

The most commonly used suture needles are made from ___________. They vary in the shape of _________.

Answer 5

stainless steel

shape of curvature

Question 6

What type of suture is best placed in the oral mucosa?

Answer 6

absorbable

Question 7

What kind of suture is best placed in facial skin?

Answer 7

non- absorbable

Question 8

Give examples of absorbable sutures

Answer 8

• vicryl
• vicryl rapide
• serasynth
• serafast

Question 9

Give examples of non- absorbable sutures

Answer 9

• prolene
• sealene

Question 10

Absorbable sutures are all eliminated by the same process of degradation. True or false

Answer 10

false

Question 11

How does catgut degradation take place?

Answer 11

• a foreign body reaction with enzymatic involvement

Question 12

How does degradation of vicryl (synthetic) take place?

Answer 12

• it is absorbed by hydrolysis

Question 13

What are the characteristics of monofilament threads ?

Answer 13

• consists of a single thread
• have a closed interior
• smooth
• display no capillarity

Question 14

Monofilaments form _______ suture threads

Answer 14

thin suture threads

Question 15

How are multifilament threads produced?

Answer 15

they are produced by twisting or braiding many thin threads together

Question 16

State a major disadvantage of twisted threads

Answer 16

they display a high capillarity i.e. they act as bacterial reservoirs

Question 17

What is the consequence of using braided threads?

Answer 17

they impede the passage of fluids as the filaments are aligned obliquely to the longitudinal axis of the thread

Question 18

State an advantage and disadvantage of using multifilament sutures

Answer 18

Advantage:
* superior knot tying characteristics

Disadvantage:
* due to the process of production, they tend to be rough making their passage through tissue more difficult

Question 19

What helps reduce the friction and capillarity of sutures ?

Answer 19

coating them

Question 20

How long does coated vicryl offer wound support for?

Answer 20

28 days

Question 21

When does complete absorption of coated vicryl take place?

Answer 21

56-70 days

Question 22

How long does vicryl rapide offer wound support?

Answer 22

10 days

Question 23

When does total absorption of vicryl rapide occur?

Answer 23

42 days

Question 24

The wound support of vircyl rapide at 5 days is ___%

Answer 24

50%

Question 25

Vicryl plus has _______ properties. However, its use for intraoral wound closure has not been demonstrated yet.

Answer 25

anti-bacterial

Question 26

Suture thread diameter is described by ______.

Answer 26

gauge

Question 27

What is the gauge range of suture threads ?

Answer 27

1-0 to 11-0

Question 28

The greater the gauge of a suture the _______ the suture thread

Answer 28

thinner

Question 29

What is an important characteristic to recognise for suture threads with a higher gauge?

Answer 29

lower tensile strength

Question 30

What are the most commontly used shapes of suture needles? Which shape out of these is the least curved /

Answer 30

* 3/8 circle * 1/2 circle * 5/8 circle 3/8 circle is the least curved | learn to identify these

Question 31

What is an indication for use of a needle with a greater curve?

Answer 31

when access to an area with restricted space is needed

Question 32

What are the two ways in which needle types may be described?

Answer 32

* taper (smooth) - gradually taper to the point * cutting

Question 33

What types of tissues are taper needles used for? Give examples

Answer 33

used for tissues that are easy to penetrate e.g. blood vessels, bowel

Question 34

What kind of needle is required for closure of mucosa and mucoperiosteal flaps?

Answer 34

cutting needles

Question 35

Briefly describe the nature of cutting needles

Answer 35

* triangular in shape * the apex of the needle forms/is the cutting surface

Question 36

Why are taper needles contraindicated for tougher tissues such as the skin?

Answer 36

this is because of the trauma that is caused by the difficulty of penetration

Question 37

How do reverse cutting needles differ from conventional cutting needles?

Answer 37

the cutting edge faces down rather than up

Question 38

What is the major benefit assigned to the reverse cutting needle?

Answer 38

it reduces the chance of the suture pulling through the tissue (essentially of it falling out of the tissue)

Question 39

What are the main types of needle holders ?

Answer 39

* rachet needle holders non-rachet needle holders

Question 40

What is the purpose of a rachet on needle holders?

Answer 40

maintenance of grip on the needle

Question 41

Describe the ideal set up and hold for a needle/suture

Answer 41

* palm grip to allow mobility of the wrist * needle is grasped about 2/3 back from the needle tip; holding it closer may weaken or bend the needle (should be approximately 2mm from where the suture material joins the needle) * thumb and ring finger should not be placed too far into the rings of the holder

Question 42

State the use of the toothed tissue forceps

Answer 42

* used to position the edge of the tissue gently and facilitate perpendicular passage of the needle * used to grasp the needle when repositioning it in the needle holder to avoid touching it with fingers

Question 43

Describe the ideal position of the toothed tissue forcep in the hands

Answer 43

* they should be rested on the web space between the thumb and index finger so they (tissue forceps) can act as an extension of the thumb and index fingers The tissue forceps are essentially used as an extension of thumb and index finger

Question 44

The ideal suture should form a ________. How should the tissue be penetrated?

Answer 44

rectangle the tissue should be penetrated perpendicular to its surface

Question 45

When is a less perpendicular angulation accepted when placing a suture? What type of knot is accepted here?

Answer 45

* when closing mucosa that is bound down to bone in the gingival region * a square knot

Question 46

State an important requirement for the placement of a square knot

Answer 46

* the needle should be passed through a distance of at least 3mm from the free edge

Question 47

Describe how knot tying is achieved

Answer 47

wrapping/throwing the long end of the suture thread around the tip of the closed needle holder twice before grasping the short end with the needle holder

Question 48

What is the consequence of placing suture too tight?

Answer 48

they can cause oedematous swelling of the soft tissues

Question 49

What length of thread is appropriate to leave behind? What is the consequence if it is too short or too long ?

Answer 49

3-4mm too short: * knot may untie too long * uncomfortable for patient

Question 50

What type of scissors is appropriate for the removal of intra-oral sutures?

Answer 50

Iris-type scissors

Question 51

Why is a continuous suture considered to be more vulnerable?

Answer 51

this is because it relies on fewe knots

Question 52

What is the purpose of the vertical mattress suture?

Answer 52

* add additional wound edge eversion * decrease dead space within a wound

Question 53

What is the benefit of wound edge eversion?

Answer 53

allows a wound to lay flat as opposed to becoming depressed in the centre(inverting) | google images of wound edge eversion

Question 54

Briefly describe how a vertical mattress suture is placed

Answer 54

* needle introduced about 5-6mm from the wound edge * deep bite of tissue is taken before exiting in the tissue in the same position on the opposite side of the wound edge * needle position is then reversed in needle holder and reintroduced about 1-3mm from the second side of the wound * a smaller bite of tissue is taken before leaving the first side of the wound * a knot is placed

Question 55

When is the horizontal mattress suture indicated ?

Answer 55

when it is important to distribute wound tension across larger wounds

Question 56

What is the most commonly used type of intra-oral suture?

Answer 56

simple interrupted suture

Question 57

If a wound requires support longer than a 7 days, what suture should be used ?

Answer 57

vicryl (not vicryl rapide)

Question 58

Why would continuous suture not be suitable for the closure of a wound created following access for anterior mandibular bone harvesting? Suggest appropriate sutures that can be placed instead

Answer 58

* this is because this would would be under significant tension with the movement of the lower lip * A horizontal mattress sutre is ideal for apposing the mentalis muscle | Appose- side by side

Question 59

Wounds resulting from endodontic surgery require increased support. Give the "ideal" suture to be placed following endodontic surgery

Answer 59

* horizontal mattress (not simple interrupted) * vicryl (not vicryl rapide) this is the case when the incision is placed in the vestibule and is under great tension with movement of the lip

Question 60

What patient and clinical characteristics could potentially indicate the need for longer wound support and therefore the use of coated vicryl.

Answer 60

when wound healing is compromised due to * age * low body weight * general health condition that reduces immune response - poor local blood supply - local infection