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Goals of suturing
- Requisites of ideal suture
- Selection of suture material
- Absorption of suture material
- Biological response of body to suture.
Suture armamentarium- needles, needle holder,
Principles of suturing
Other methods of wound closure
Suture means to ‘sew’ or ‘seam’. In surgery suture
is the act of sewing or bringing tissue together and
holding them in apposition until healing has taken
A suture is a strand of material used to ligate blood
vessels and to approximate tissues together.
History of the Surgical Suture “I dress the wound, God heals it”.
-- Ambroise Pare, surgeon16th century
The act of sewing is probably older then Homo sapiens, because
Neanderthal man wore some sort of clothing.
Perhaps the world’s oldest suture was placed by an embalmer on
the body of a twenty first dynasty mummy about 1100 B.C.
A south American method of wound closure used large black ants
which bite the wound edges together and the ants body is then twisted
off leaving the head in place.
East African tribes ligated blood vessels with tendons and closed
wounds with acacia throns
The first detailed description of a wound suture and suture materials used in it is by the Indian,
physician Sushruta written in 500 BC.
Galen, the physician to Roman gladiators in the second century A.D. used silk for
Andreas Vesalius first advocated the suture of all fresh wounds as well as severed tendon and nerves.
Joseph Lister (1827-1912) discovered that bacteria present in suture strands cause wound
infection. He disinfected sutures with carbolic acid. He made sterile sutures possible to
bury it in clean wounds without infection.
Rhazes of Arabia was credited in 900 A.D. with first employing ‘kit gut’ to suture
abdominal wounds. The Arabic word ‘kit’ means a dancing master’s fiddle, the musical
strings of which ‘kit string’ were made up of sheep intestines. Over the years ‘kit’ was
confused with kitten or cat, and the misuse of the term was propagated.
suture material is an artificial fiber used to keep wound
together until they hold sufficiently well by themselves
by natural fiber (collagen) which is synthesized and woven
into a stronger scar
Suture is a Stitch/Series of Stitches made to secure
apposition of the edges of a Surgical/Traumatic wound
Any Strand of Material utilized to ligate blood vessels or
approximate Tissues (Silverstein L.H 1999)
GOALS OF SUTURING
Provide adequate tension
Provide support for
Reduce post-op pain
Prevent bone exposure
Permit proper flap
BASIC REQUISITE OF SUTURE MATERIALS
Good handling & knotting properties
Sterilization without deterioration of properties
Non allergic, non electrolytic and non carcinogènic
It should not fray, should slide through tissues readily & knot should not
slip after tying.
It should be readily visualized
On break down ,it should not release toxic agents
It should disappear without excessive reaction once its task is completed
ABSORBABLE – NATURAL
light milk, Derived from submucusa of
sheep intestine or serosa of beef
Used for ligating superficial bld vessels &
subcut fatty tissues
yellow,Treated with chromium salt.
Adv may be used in the presence of infection
Gut / cat gut
Oldest known absorbable suture.
Galen referred to gut suture as early as 175 A.D.
Derived from sheep intestinal sub mucosa or bovine
Submucosa of sheep has a rich elastic tissue
content which accounts for high tensile strength of
the catgut. It is monofilament and is available in
the plain form as well as “tanned” in chromic acid.
The tanning process delays the digestion by white
blood cell lysozymes.
Catgut should not be boiled or autoclaved as heat
destroys its tensile strength.
Catgut is sterilized during preparation and kept in a
preservative solution (isopropyl alcohol) inside spools
or foils. Unused and reusable catgut is hygroscopic so,
catgut will swell due to water absorption and its tensile
strength will be reduced .
Absorption :40-60 days
When placed intra orally sutures are digested in 3-
It is available pre-sterilized in
aluminium-coated sterile foil overwrap
pack with ethicon fluid as a
Colour: Plain catgut is yellow, while
chromic catgut is tan
Absorbtion: Catgut is absorbed by
proteolytic digestive enzymes released
from inflammatory cells collected
around the catgut. So, in the presence
of infection catgut is rapidly absorbed.
Coated with thin layer of chromium salt
solution to minimize tissue reaction,
increase TS, slow the absorption rate,
better knot security, and ease of handling.
TS – 10-14 days
Absorbed in 90 days
Uses : Opthalmic surgery (6-0)
Suture subcutaneous tissues
As it is an organic material and susceptible
to enzymatic degradation, packed in
isopropyl alcohol as a preservative. Also
condition or soften it.
Suture absorbs alcohol and swells. It is
combustible and is also irritating to
tissues. It is removed by a quick rinse in
saline prior to use.
Natural, absorbable, monofilament
Obtained by homogenous dispersion of pure
collagen fibrils from the flexor tendons of cattle.
Absorption – 56 days
TS - < 10% after 10 days.
Used in opthalmic surgery
Disadvantage of premature absorption.
ABSORBABLE - SYNTHETIC
Polyglactin (vicryl):cream, copolymer of
lactide & glycolide
Minimal tissue rxn
Used in general soft tissue approx,intestinal
anastomosis,vessels ligation in all surgical
Minimal tissue reactivity and can be used in
Available in purple and undyed. Undyed used
Coated with polyglactin 370 and calcium
stearate which allows easy passage through
tissues as well as easier knot placement.
On skin wounds, associated with delayed
absorption as well as increased inflammation.
Homo polymers of glycolide.
Avoid in adipose tissue
Losses tensile strength more rapidly
Other e.g Polyglyconate(maxon)
POLYDIOXANONE (PDS II)
Polyester derivative poly P dioxanone.
TS -14-42 days
Absorption – Hydrolysis in 6 months.
Passes through tissues easily.
Significant memory – compromises the
ease of knot-tying and knot security.
Minimal tissue reaction
For wounds under tension and
May extrude through the wound over time.
So used only in tissues deeper than
subcuticular layer. Or if in face 6-0 used.
It is braided synthetic absorbable suture
Colour : White.
It has a similar initial high tensile strength as
that of the normal vicryl suture.
It gives wound support upto 12 days. It shows
50% of the original tensile strength after 5 days
and all of its tensile strength is lost after 14
Its absorption is associated with minimal tissue
reaction facilitating improved cosmetics and
reduction of postoperative pain.
The absorption is essentially complete within 35-
Uses: Low tensile strength and Rapid absorption
rate --Ideal for intra-oral use (dental
VICRYL PLUS ANTIBACTERIAL SUTURE
Handles and performs
same as normal vicryl.
In vitro studies shown
that triclosan on
VICRYL plus creates a
zone of inhibition
around the suture.
Black, Derived from the cocoon of the silk
worm larvae, superior handling xtics,Trigger
inflam rxns,Undergo proteolysis &
undetected by 2yrs,Used in ligating maj bld
ves,tendon repair etc
Other e.g Virgin silk, cotton,
Surgical steel & wires
High tensile strength
Hold knots very well
Used in orthopaedic,Neurosurg,& Thoracic
OMFS- for suspension of splints or arch bars
and not as suture material
-Braided or twisted
-Made from the filament spun by silkworm larva to
form its cocoon. Each filament is processed to
remove the natural waxes and sericin gum. After
braiding, the strands are dyed, stretched and
impregnated with a mixture of waxes and
silicone. Dry silk suture is stronger than wet silk
Ease of handling – more for braided
Good knot security
made non capillary in order to withstand action of
body fluids & moisture.(wax or silicon coated)
Should not be used in presence of infection
Plastic surgery, ophthalmic and general
surgeries, ligating body tissues.
Although characterized as non-absorbable,
studies show that it loses most of their
TS after 1 yr. and cannot be detected in
tissues after 2 yrs.
Natural, multifilament, non absorbable
From stable Egyptian cotton fibers
good knot security
Not good in presence of contaminated
wounds or infection
Rarely used nowadays
Most body tissues for ligating and suturing
Natural, monofilament/multifilament, non
Alloy of iron, nickel and chromium
Good TS even in infection
Difficult to handle and tendency to cut through
tissues. Very hard to tie, and knot ends require
Potential to corrode or break at points
of twisting, bending or knotting.
Not to be used with a prosthesis of
Used in abdominal wall and skin closure,
sternal closure, retention, tendon
repair, orthopedic and neurosurgery.
OMFS- for suspension of splints or
arch bars and not as suture material.
1.Linear artifacts caused by substances with
high atomic number on CT images
2.Possible movement of metal suture during
3.Patch test for nickel sensitivity should be
NON-ABSORBABLE - SYNTHETIC
Is a polyamide polymer,blue
81% tensile strength at 1yr & 66% at 11yrs
Elicits minimal tissue rxn
Has good memory
Pliable when moist
Premoistened form is used cosmetic plastic
Its elasticity makes it useful for skin closure &
-Polymer of propylene.
-Inert and TS for 2 yrs
-Holds knots better than other synthetic sutures.
-Minimal suture reaction and so used in infected
and contaminated wounds.
-Do not adhere to tissues and is flexible. So used
for ‘pull-out’ type of sutures.
General, plastic, cardiovascular surgery, skin
From,expanded polytetrafluoroethylene (ePTFE)
Extremely low tissue reaction, good knot tensile strenghtand ease of
All type of soft tissue approximation and cardiovascular surgeries.
-New, monofilament, nonabsorbable, synthetic
-Made of polyglycol trephthate and polybutylene terephthalate and is
considered as a modified polyester suture.
-No significant memory compared to polypropylene and nylon. Easier to
manipulate and greater knot security.
-Unique feature is their ability to elongate or stretch with increasing
wound edema. When edema subsides, suture resumes original shape;
so it is an ideal suture for lacerations secondary to blunt trauma.
The condition of the
The tissues to be repaired,
The tensile strength of the
characteristics of the
The reaction of
surrounding tissues to the
Largest size 1 to extremely fine 11-0. Increasing
number of zeroes correlates with decreasing
suture diameter and strength.
Thicker sutures are used for approximation of
deeper layers, wounds in tension prone areas and
for ligation of blood vessels.
Thin sutures are used for closing delicate tissues
like conjunctiva and skin incisions of the face.
Size is chosen to correlate with the tensile
strength of the tissue being sutured.
UNITED STATES PHARMACOPEIA
Sized according to diameter with “0” as reference size
Numbers alone indicate progressively larger sutures
Numbers followed by a “0” indicate progressively
smaller sutures (“2-0”, “4-0”, etc)
METRIC GUAGE IMPERIAL GUAGE PRODUCT CODE
NEEDLE SIZE &
DO NOT REUSE
SEE INSTRUCTIONS FOR USE
EXPIRY DATE BATCH NO
STERILIZATION OF SUTURES
May affect suture properties to some extent
Ethylene oxide; poisonous gas is less
Sutures are usually stored in sterile pack by
the manufacturers , their integrity must be
checked before use
Surgical needles are designed to lead suture material
through tissue with minimal injury. Needles can be
- straight (GIT) or curved
- swaged or eyed
Made up of either SS or carbon steel.
Needle is selected according to:
-type of tissue to be sutured
-diameter of suture material.
CLASSIFICATION OF SURGICAL NEEDLES
1.According to eye -eye less needles
-needles with eye
2.According to shape -straight needles
. -curved needles
3.According to cutting edge
a) round body
b) cutting -conventional
4.According to its tip -triangular tip
5.Others -spatula needles
-micro point needles
Eyed require threading prior to use,
results in pulling a double strand
through tissue. Tying the suture to
the eye increases bulk of suture
material drawn through tissues. So
they are also called ‘traumatic
Most suture materials and needles
are difficult to sterilize. Needles
are also difficult to clean after
use and become blunt and
workhardened so that they snap.
Suture loop inserted through eye
Loop placed over tip
Loop drawn back
Suture tied on eyed needle
Swaged needles do not require threading and permit a
single strand of suture material to be drawn.
Suture attached to needle via a hole drilled through
the end of the needle, and the end is swaged during
It is atraumatic and
act as a single unit.
Prepacked and presterilized
by gamma radiation.
Length of needle
The linear distance
between eye and tip.
The distance between
eye and tip following
The distance of the
body of the needle from
the centre of the circle
Gauge or thickness of
the metal wire out of
which the needle is
RADIUS OF CURVATURE OF THE
Needle of choice for the skin
Limited use in oral surgery
May be used in surgery of the nose,
Needle of choice for microsurgery
associated with very fine sutures;
Oral surgery, flap surgery, wound closure
after placement of osseointegrated
implants and GTR procedures
May be used in all surgical wounds
Needle of choice in oral surgery
Wide range of uses in many surgical
Wounds of the urogenital tract
Point runs from tip to the max. cross sectional area
of the body.
Can be -triangular tip/cutting
Cutting needles are Ideal for suturing keratinized
tissues like skin, palatal mucosa, subcuticular layers
and for securing drains.
Round/tapered needles used for closing mesenchymal
layers such as muscle or fascia that are soft and
The conventional cutting
point has two opposing
cutting edges and third
edge on the inside
curvature of the needle.
The reverse cutting
point has two opposing
cutting edges and third
cutting edge on the
outer curvature of the
The tapered point is used primarily on soft,
easily penetrated tissues . it leaves small hole
and can be used in vascular surgery as well as
fascial soft tissue surgery.
The blunt point has a rounded end which does nt
cut through the tissue .it is used in friable
tissue suturing or to the parotid duct or lacrimal
Sharpened 12 times
Designated as C or FS
(CUTICULAR or FOR SKIN)
Sharpened an additional
Designated as P or PS or
(PREMIUM or PLASTIC
SURGERY or PRECISION
Needles in the PC series
are made up of stronger
SS alloy and have
flattened and conventional
Cuticular needles Plastic needles
The needle holder is used to
handle the suture needle and
thread while suturing the
If used properly it enables the
surgeon to perform
procedures correctly and with
GRIPPING OF NEEDLE HOLDER
The scissor grip
PRINCIPLES OF SUTURING
1.Needle grasped at 1/4th to half the distance from eye.
2.Needle should enter perpendicular to tissue surface
3.Needle passed along its curve
4.The bite should be equal on both sides of the wound margin and the point of
the entry of the needle should be closer to the wound edge than its point of
exit on the deep surface
5.The bite should be about 2-3 mm from the wound margin of the flap because
after wound closure the edge of the wound softens due to collagenolysis
and the holding power is impaired.
6. Usually the needle to be passed from mobile side to the fixed side but not
always(exception in lingual mucoperiosteum flap) and from thinner to thicker
& from deeper to superficial flap.
7.The tissues should not be closed under tension , since they will either tear or
necrose around the the suture
8.Tie to approximate; not to blanch
9.Knot must not lie on incision line
10.The distance b/w one suture to another should be about 3-4 mm apart to prevent strangulation of
the tissue & to allow escape of the serum or inflammatory exudate & to get more strength of the
11.Sutures placed at a greater depth than distance from the incision to evert wound margins
12.Close deep wounds in layers
13.Avoid retrieving needle by tip
14.Adequate tissue bite to prevent tearing
15.sutures should have correct tension while tying knot for provision of the slight edema post
operatively, more tensioned sutures cause ischemia of the edges of the incision
causes tearing of the tissues
may leave suture mark
edges may get overlapped
16.Occasionally extra tissue may be
present on one side of incision and
cause ”DOG EAR” to be formed in
the final phase of wound closure.
Simply extending the length of the
incision to hide the exists will
produce an unsatisfactory result.
Thus after undermining excess
tissue incision is made at approx.
300 to parent incision directed
towards undermined side. Extra
tissue is pulled over incision and
appropriate amount is excised.
Incision is closed in normal manner.
INTERRUPTED SIMPLE SUTURE
Most commonly used. Inserted singly through side
of the wound and tied with a surgeon’s knot.
Strong and can be used in areas of stress
Placed 4-8 mm apart to close large wounds, so that
tension is shared
Each is independent and loosening one will not
produce loosening of the other
Degree of eversion produced
In infection or hematoma, removal of few sutures
Free of interferences b/w each stitch and easy to clean
SIMPLE CONTINUOUS / RUNNING
A simple interrupted suture
placed and needle reinserted
in a continuous fashion such
that the suture passes
perpendicular to the incision
line below and obliquely
above. Ended by passing a
knot over the untightened
end of the suture.
Rapid technique and distributes tension
More water tight closure (Shoen, 1975)
Only 2 knots with associated tags
If cut at one point, suture slackens along the
whole length of the wound which will then
Similar to continuous but locking provided by
withdrawing the suture through its own loop.
Indicated in long edentulous areas, tuberosities or
Will avoid multiple knots
Distributes tension uniformly
Water tight closure
Prevents excessive tightening.
adjustment of tension over
suture line as tissue swelling
Specially designed for use in skin.
It passes at 2 levels, one deep to
provide support and adduction of
wound surfaces at a depth and
one superficial to draw the edges
together and evert them.
Used for closing deep wounds
This approximates subcutaneous
and skin edges
Needle passed from one edge to the other and again from
latter edge to the fist and knot tied.
When needle is brought back from second flap to the first,
depth of penetration is more superficial.
for better adaptation and maximum tissue approximation
To get eversion of wound margins slightly
Where healing is expected to be delayed for any reason, it is better to give
wound added support by vertical mattress. Used to control soft tissue
Runs parallel to the blood supply of the edge of the flap and therefore not
interfering with healing.
Uses: abdominal surgeries & closure of skin wounds.
It everts mucosal or skin margins, bringing greater
areas of raw tissue into contact. So used for closing
bony deficiencies such as oro-antral fistula or cystic
Disadvantage: constricts the blood supply to edges
Needle passed from one
edge to the other and
again from the latter to the
first and a knot is tied.
Distance of needle
penetration and depth of
penetration is same for
each entry point, but
horizontal distance of the
points of penetration on
the same side of the flap
Will evert mucosal or skin margins, bringing greater
areas of raw tissue into contact.
-So used for closing bony deficiencies such as oro-
antral fistula or cystic cavities, extraction socket
Prevents the flap from being inverted into the cavity.
To control post-operative hemorrhage from gingiva
around the tooth socket to tense the mucoperiosteum
over the underlying bone.
It does not cut through the tissue ,so used in
case of tissue under tension (inadequate
More trouble to insert
Constricts the blood supply to the incision if
improperly used, cause wound necrosis and
FIGURE OF “8” SUTURE
Used for extraction socket closure and for adaption
of gingival papilla around the tooth Suturing begun
on buccal surface 3-4mm from the tip of the papilla
so as to prevent tearing of papilla.
Needle first inserted into the
outer surface of the buccal flap
and then the lingual flap. Needle
again inserted in same fashion
at a horizontal distance and
then both ends tied.
Used to close deep wounds in layers. Knots will be
inverted or buried, so that the knot does not lie between
the skin margin and cause inflammation or infection.
To bury the knot, first pass of the needle should be from
within the wound and through the lower portion of the
dermal layer. Needle then passed through the dermal
layer and emerge through subcutaneous tissue and knot
CONTINUOUS SUBCUTICULAR SUTURE
Continuous short lateral
stitches are taken
beneath the epithelial
layer of the skin. The
ends of the suture come
out at each end of the
incision and are knotted.
Excellent cosmetic result
Useful in wounds with strong skin tension,
especially for patients prone to keloid formation.
Anchor suture in wound and, from apex, take
bites below the dermal-epidermal layer
Start next stitch directly opposite the one that
PURSE STRING SUTURE
A circular pattern that draws together the
tissue in the path of the suture when the
ends are brought together and tied.
Sutured knot has 3 components
1.Loop created by knot
2.Knot itself which is composed of a number of tight throws
3.Ears which are the cut ends of the suture
PRINCIPLE OF KNOT TYING
Use the simplest knot that will prevent slippage.
Tying the knot as small as possible and cutting the ends of the
suture as short as reasonable to minimize foreign body reaction.
Avoid friction or sawing
Avoid damage to suture material
Avoid excessive tension
Tying sutures too tightly strangulates the tissue
Placing the final throw as horizontally as possible to keep knot flat
Limiting extra throws to the knot, as they do not add strength to a
properly tied knot.
Square knot Formed by wrapping the
suture around the needle
holder once in opposite
directions between the ties.
Atleast 3 ties are
Best for gut, silk, cotton
Surgeons knot Formed by 2 throws on the
first tie and one throw in the
opposite direction in the
second tie. Recommended
for tying polyester suture
materials such as Vicryl and
Granny’s knot A tie in one direction
followed by a tie in the
same direction and a third
tie in the opposite direction
to square the knot and hold
Skin wounds regain TS slowly. It can
be removed in 3-10 days when the
wound gained 5%-10% of final TS.
Skin sutures on face removed
between 3-5 days. Alternate sutures
removed on 3rd day and remaining
sutures after 2 days.
Mucoperiosteal closure (without
tension) -- 5-7 days
Where there is tension on the suture
eg : Oro-antral fistula- 7-10
Back and legs where cosmesis is
less important – 10-14 days.
Continuous subcuticular can be left
for 3-4 weeks without formation of
A good guide is that as soon as they begin to get loose they should be taken out.
HOW TO REMOVE SUTURE
Suture area is first cleaned with normal saline.
The suture is grasped with non-tooth dissecting forceps and
lifted above the epithelial surface.
Scissors are then passed through one loop and then
transected close to the surface to avoid dragging
contaminated suture material through tissues.
The suture is then pulled out towards incision line to prevent
dehiscence. If suture entrapped in a scab, application of
hydrogen peroxide or saline solution is necessary.
If pieces of suture left, infection or granuloma formation can
POSSIBLE COMPLICATIONOF LEAVING SUTURE FOR MANY DAYS
2.Suture scarring or stitch mark
3.Implanted dermoid cyst
Suture marks are caused by 3 factors
1.Skin sutures left in place longer than 7 days,
resulting in epithelialisation of suture track
2.Tissue necrosis from sutures that were tied
too tightly or became tight due to tissue edema
3.Use of reactive sutures in the skin.
Sutures passing through mucous membrane or
skin provide a ‘wick’ or pathway through which
bacteria track down, and bacteria gain access to
The longer the suture remains, the deeper the
epithelial invasion of the underlying tissue. When
suture removed, epithelial tract remains.
These cells may eventually disappear or remain to
form keratin and epithelial inclusion cysts. The
epithelial pathway result in typical ‘railroad scar’
NEW ADVANCEMENT IN SUTURING
MECHANICAL WOUND CLOSURE DEVICES
Ligating clips :
can be resorbable or non resorbable.
Made up of SS,tantalum or titanium or
Designed for the ligation of tubular
Used for skin closure .
Made up of SS.
They are placed uniformly to span the
They have minimal tissue reaction .
Can be used for routine skin closure
any where in the body.
As the clips do not penetrate skin, yet give
apposition, the cosmetic result is excellent.
Speed and efficacy of stapling is more compared
Suturing causes more necrosis than stapling in
Most significant advance is the introduction of
absorbable staples (Lactomer).
Contra indicated when it is not possible
to maintain atleast 5mm distance from
the stapled skin to the underlying bone
and blood vessels.
Microporous tape is used alone or in conjugation with
skin sutures to decrease tension at the wound margins.
The surgical tapes have a backing of viscous rayon
fibers coated with an adhesive copolymer and they are
pervious to sweat but not to blood or purulent material.
Comes in 1/8, 1/4, and 1/2 inch wide strips. Skin
margin is prepared with tincture of benzoin to provide
better adhesiveness for tape.
Used to decrease skin tension on cheek,forehead,chin.
Minimizes wound dehiscence and allows earlier suture
Provides continuous support for the wound and
minimizes scar expansion
Avoids the ordeal of suture replacement and removal
Less inflammatory reaction, lower rate of wound
infection, greater TS and better cosmetic results.
No needle puncture marks and suture canals
Strangulation and necrosis of tissue are eliminated
Sterile paper tape is non expensive
Do not evert edges of the wound, and readily loosen
when wet by blood or serum.
Prior to placement, a thin coat of antibiotic ointment is
placed on wound margin to protect wound from skin oils
While removing, to avoid epithelial margin separation,
the ends should be lifted equally towards the wound
margin and then lifted evenly from the wound.
- n-butyl cyanoacrylate is the active ingredient.
Strong bonding to tissues in presence of moisture
Biodegradable, bacteriostatic & hemostatic.
Reduced post operative pain & facilitates healing.
Good shelf life.
Produces little or no heat during polymerisation.
Bonding is by secondary intermolecular forces aided by
mechanical interlocking of irregular forces.
Quick, atraumatic and cost effective with good cosmesis
No injection, suturing and post-op suture removal.
1.When applied for skin closure, the polymer acts as
barrier, prevents wound apposition, delays healing, and
increases the infection rate.
2.Should not be allowed to come in contact with tissue
under skin as it causes necrosis.
A sterile, liquid topical skin
Reacts with moisture on skin
surface to form a strong, flexible
Only for easily approximated
skin edges of wounds
punctures from minimally
simple, thoroughly cleansed,
Standard surgical wound prep and dry
Crack ampule or applicator tip up; invert
Hold skin edges approximated horizontally
Gently and evenly apply at least two thin
layers on the surface of the edges with a
brushing motion with at least 30 s between
each layer, hold for 60 s after last layer until
Degraded either by enzymatic process as in gut
sutures, or by hydrolysis, as in many of the synthetic
materials like glycolic acid, ployglactin910 or
Non absorbable sutures are walled off or
In infected tissues or in a patient who is febrile or
protein deficient, suture breakdown may be
If the loss of TS outpaces the healing phase, failure
of the wound results.
Absorbable sutures must be placed well into the
ABSORPTION OF SUTURE MATERIALS
The initial body response to sutures is almost identical
in the first 4-7 days, regardless of the suture
The early response is a generalized acute aseptic
inflammation, involving primarily polymorphonuclear
After few days mononuclear cells, fibroblasts &
histiocytes become evident.
Capillary formation occurs at the end of this initial
BIOLOGIC RESPONSE OF BODY TO SUTURE MATERIALS
Human body is very delicate & important.
When surgeries are needed to improve our
health is very important to select a suitable
suture. Today we know allots of biomaterials
to select, but is important to always think of
Suturing techniques in oral surgery –Sandro Siervo
Oral & Maxillofacial Surgery Vol 1- W. Harry Archer
Textbook of oral & maxillofacial surgery- Neelima Anil Malik
Minor Oral Surgery- Goeffrey L.Howe
Text book of surgery: Sabiston