Goals of Sutures:
- Maintain & return the tissues to their original position.
- Haemostasis – It helps to prevent bleeding by allowing the tissues to clot. This is possible as the sutures provide; direct and indirect ligation, compression of the vessels and or by retaining a pack or dressing.
- Immobilise – Sutures help to stabilise at the tissue in place, further allow healing by primary intentions, reduce bleeding, help prevent the formation of a haematoma, reduce oedema, reduce discomfort and reduce the risk of infection.
- Reduce swelling – sutures may the ability to help reduce swelling.
- Sutures will help speed up the healing process
Classification of Sutures:
Absorbable vs Non-absorbable
Organic vs Synthetic
- As the name implies these sutures are broken down or absorbed over time. The time of breakdown is based on the material; but an average is 1-2 weeks.
- Catgut (Proteolytic) – Derived from animal collagen (Twisted multi-filament)
- Plain (5-7 days)
- Chromic – treated with chromic acid salts / for cross-linking / produces 2x stitch hold / increases tensile strength / less tissue reaction compared to plain gut / can produce inflammation due to bacterial contamination.
Synthetic (Hydrolytic) – lasts longer
- Polyglycolic acid (Polyglycolide) – Dexon (Braided multi-filament)
- Polyglactin 910- (Vicryl) – 2 weeks (Multifilament)
– Both are superior to catgut / biological and physical properties / ie less tissue reaction / greater tensile strength
– Less likely for infection / however contact hypersensitivity has been reported
– Hydrophobic properties / slows breakdown
Non-Absorbable Sutures – Tissue reaction is material dependent. The down-side with these sutures is they need to be retrieved, or removed at a later date.
- Silk (Can affect biological tissue / so waxed to reduce) / natural /multifilament / derived from silk worm larva.
- Typically incite more tissue reaction than synthetic counterparts / leads to encapsulation with fibrous tissue.
- Great handling characteristics.
- Generally can be absorbed after a substantial amount of time (proteolysis, 2yrs+).
- Nylon – (Monofilament) / polymer / good handling characteristics /
- Although high memory / stronger than silk + less tissue response
- Polypropylene (Monofilament) / isomer / has high memory / ie high recoil / does not adhere / good for a pull out suture / minimal tissue reaction
- Metallic / SS / Sliver / Staples
- Multifilament with sheath / Polyamide
* Generally, Non-absorbable are considered for slow healing tissues / whereas absorbable are considered for faster healing tissues / also in the oral cavity / retrievability is an issue
*Generally monofilaments produce less tissue reaction / ease of use / but have greater spring recoil / where as multi-filaments are a bit bulkier / but are better able to hold a knot / greater strength to hold tissues in place.
If you wish for more information on sutures please do not hesitate to contact Skygate Dental today on (07) 3114 1199 or 0406 579 197.