Suturing Techniques

Sutures are used by your dentist to close wounds on the skin or other tissues. When the dentist sutures a wound, they’ll use a needle attached to a length of thread to stitch the wound. There are a variety of available materials that can be used for suturing which are discussed below. Your dentist will choose a material that’s appropriate for the wound or procedure depending on the type of wound.

Types of sutures #

The different types of sutures can be classified in many ways, some the classifications are mentioned below

• First, the suture material can be classified as either absorbable or non-absorbable. Absorbable sutures don’t require removal. This is because enzymes found in the tissues of the body naturally digest them and there is no need for suture removal. Non-absorbable sutures need to be removed by the dentist at a later date at least after a week or in some cases left in permanently.

• Second, the suture material can be classified according to the actual structure of the material or depending on the number of threads. Mono filament sutures consist of a single thread hence they are called as mono filament and this allows the suture to more easily pass through the tissues. Braided sutures on the other hand consist of several small threads braided together and this can lead to better security, but at the cost of increased potential for infection.

• Third, sutures can be classified as either being made from natural or synthetic material. However, since all suture material is sterilized, this distinction is not particularly useful and any of the one can be used.

Types of absorbable sutures #

• Gut

This is a natural mono filament suture which is used for repairing internal soft tissue wounds or lacerations. Gut sutures shouldn’t be used for cardiovascular or neurological procedures. The body has the strongest reaction to this suture and will often scar afterwards, and it is not commonly used outside gynecological surgery.

• Polydioxanone (PDS)

This is a synthetic mono filament suture that can be used for many types of soft tissue wound repair such as abdominal closures as well as for pediatric cardiac procedures, etc.

• Poliglecaprone (MONOCRYL)

This is a synthetic mono filament suture which is used for general use in soft tissue repair. This material shouldn’t be used for cardiovascular or neurological procedures and poliglecaprone suture is most commonly used to close skin in an invisible manner.

• Polyglactin (Vicryl)

This is a synthetic braided suture which is good for repairing hand or facial lacerations. It shouldn’t be used for cardiovascular or neurological procedures.

Types of non-absorbable sutures #

Some examples of non-absorbable sutures are mentioned below and these types of sutures can all be used generally for soft tissue repair, including for both cardiovascular and neurological procedures.

• Nylon - Is a natural mono filament suture.
• Polypropylene (Prolene) - Is a synthetic mono filament suture.
• Silk - Is a braided natural suture.
• Polyester (Ethibond) - Is a braided synthetic suture.

Suture selection and techniques #

Suture material is graded according to the diameter of the suture strand and the grading system uses the letter O preceded by a number to indicate material diameter. The higher the number, the smaller will be the diameter of the suture strand. Suture material is also attached to a needle. The needle has many features. It can be of various sizes and also have a cutting or non-cutting edges. The larger needles can close more tissue with each stitch while the smaller needles are more likely to reduce scarring.

Just like there are many types of sutures, there are many suture techniques also depending on type of wound and its site. Some of them are mentioned below

• Continuous sutures

This suturing technique involves a series of stitches that use a single strand of suture material. This type of suture can be placed rapidly and is also strong, since tension is distributed evenly throughout the continuous suture strand. This is most commonly used suturing technique.

• Interrupted sutures

This suturing technique uses several strands of suture material to close the wound and after the stitch is done, the material is cut and tied off. This technique leads to a securely closed wounds. If one of the stitches breaks, the remainder of the stitches will still hold the wound together preventing the wound from exposing to outer environment.

• Deep sutures

This type of suturing technique is placed under the layers of tissue deep below the skin, and they may either be continuous or interrupted. This suturing technique is often used to close fascial layers.

• Buried sutures

This type of suturing technique is applied so that the suture knot is found inside i.e. under or within the area that is to be closed off. In this suturing technique the suture is typically not removed and is useful when large sutures are used deeper in the body.

• Purse-string sutures

This is a type of continuous suturing technique that is placed around an area and tightened much like the drawstring on a bag for example, this type of suture would be used in the intestines in order to secure an intestinal stapling device.

• Subcutaneous sutures

The name itself states that these sutures are placed in the dermis, the layer of tissue that lies below the upper layer of the skin. Short stitches are placed in a line that is parallel to the wound. The stitches are then anchored at either end of the wound.

Suture removal #

When the sutures will be removed will depend on where they are on your body and also healing condition of the wound. According to American Family Physician, some general guidelines are as follows

• Scalp - Removal can be done within 7 to 10 days
• Face - Removal can be done within 3 to 5 days
• Chest - Removal can be done within 10 to 14 days
• Arms - Removal can be done within 7 to 10 days
• Legs - Removal can be done within 10 to 14 days
• Hands - Removal can be done within 10 to 14 days
• Palms of hands or soles of feet - Removal can be done within 14 to 21 days

To remove the sutures, your dentist will first sterilize the area, and they’ll pick up one end of your suture and cut it, trying to stay as close to your skin as possible. Then, they’ll gently pull out the suture strand which completes the process of suture removal.