Suturing Materials

Introduction

This is an area which is extremely poorly taught at dental school. It is often was felt that you use whatever suture was given to you, that should not be the case.

In the mouth we frequently get given cutting needles, which produce a diamond shaped hole, and in any inflammatory disease where the tissues are friable, surprise surprise the tissue doesn't hold the suture and tears.

The obvious solution is to use a round bodied needle.

When you are suturing skin however you need a cutting needle, a round body just simply won't do it.

Different materials

 in essence you need to think about a number of factors

-  the size of the suture, this is done in gauges -  The smaller the number the thicker the suture. Generally in the face we use 5/0 , 6/0  for skin. We use 4/0  for deeper sutures.

- The size and shape of the needle -  this is illustrated on the front of the suture packet. This is for surgical preference.

-  the taper of the needle -  this means round body, cutting which produces diamond shape holes, and reverse cutting which makes a triangular hole

.- The type of thread -  this means is it monofilament or braided. Braided sutures are much easier to tie, and don't slip easily. Monofilament are difficult tie, slip hence you need at least three or four throws.

 The advantage of monofilament is that they don't harbour bacteria as easily, and therefore better tolerated, reduce inflammation, and produce better scars. This may well be important in the current crisis as sutures may stay on for longer.

-  Dissolvable or non-dissolvable 

 we would advocate wherever possible the use of dissolvable sutures. 

Any deep suture is  almost invariably dissolvable. The most commonly used suture is polygalactin - vicryl  or equivalent.

 skin sutures are -  non-dissolvable e.g. proline - ethilon or equivalent -  dissolvable monocryl -  the problem with this suture is that it is usually clear, and therefore very difficult to tie.

 have a look at the videos -