Upload
sanjukta-saha
View
136
Download
1
Tags:
Embed Size (px)
Citation preview
INCISION, SUTURE & SUTURE MATERIAL
INCISION
Definition :-a cut or wound deliberately made
by an operator in the skin or mucosa using a
sharp instrument such as a surgical blade
cautery, so that the underlying structures can
be exposed adequately for surgical access.(NB:- sound anatomical knowledge is essential in planing incision)
PRINCIPLES OF INCISION
Incision is placed parallel to the structures without causing damage to the vital structures .
Sharp bade of proper size & shape should be used.
Clean , single stroke incision without much tissue damage.
Incision is placed on the sound bone , or away from the surgical area to ensure the prevention of wound dehiscence
Pen grasp for intra oral incision & table knife grasp for extra oral incision is used.
Skin or mucosa to be incised , should be stabilized with finger pressure to guide the passage of the blade.
Long firm continuous stroke are used to minimise tissue damage.
No sharp angles are given instead curve are given to reduce slough due to poor circulation.
Incision through epithelial surfaces is made with blade perpendicular to the epithelial surface
INCISION IN THE ORAL CAVITY
It is desirable to incise
through attached gingiva
and over a healthy bone
.
Incision placed near the
teeth for extraction
should be made in the
gingival sulcus.
Integrity of the inter
dental papillae is
maintained as far as
possible.
Blood supply to
incision should be
adequate.
Incision should be at
right angle to mucosa
to prevent shelfing
edges, that might
cause necrosis of the
undermined part.
CONTRAINDICATION FOR PLACEMENT OF
INCISION LINES
Avoid placing incision :-
i. Over canine prominence – soft tissue defect will be created due to bony fenestration
ii. Vertical incision in the mental nerve region
iii. On the palate – near the greater palatine vessels
iv. Through incisive papillae
v. Over bony lesions – dehiscence
vi. Vertical incision on the lingual side of the mandibular arch
TYPES OF INCISION
Horizontal :- Seldom used. Incisions are directed along the gingival margin either mesially or distally. Generally used in periodontal flap surgery.
Vertical:- Most desirable . Aka releasing incision. Generally placed at obtuse angle to horizontal incision.
Semilunar :- This incision is used to keep attached gingivaintact around teeth & for endodontic surgery. A gap of 5mm is present from the base of the gingival slucus to the incision .
INSTRUMENT USED FOR INCISION Scalpel & dissecting
scissors
FLAP
Flap is a section of soft tissue that is outlined by a surgical incision , carries its own blood supply, allows surgical access to underlying tissue ; can be replaced in the original position , and can be maintained by sutures and is expected to heal.
COMPLICATION OF FLAP SURGERY Flap tearing:- Flap should be
large enough to prevent tearing
Flap necrosis:- side of flap should be parallel or convergent from base . Length of flap is not more than twice the width of the base . Axial blood supply should be included in base of the flap. Base of the flap is not excessively twisted , stretched, or grasped that might damage its blood supply.
Flap dehiscence:- Flap edges are approximated over healthy bone and not placing flap under tension.
TYPES OF FLAP
A Full thickness flap –
mucoperiosteal flap
Partial thickness
B Envelope flap
Two sided triangular flap
Three sided rhomboid flap
Semilunar flap
C Labial,buccal flap
Palatal, lingual flap
ENVELOPE FLAP
Most common type of flap.
Incision is made to any length intraorallyaround the necks of the teeth along the free gingival margin on the buccal or lingual aspect including the interdentalpapillae.
The entire mucoperiosteal flap is raised by using periosteal elevator to a point to the apical 1/3 of the tooth
This is mainly used for surgical extraction of tooth or root.
TWO SIDED TRIANGULAR FLAP Vertical releasing incision is
made to envelop flap on one side.
Gives better access.
Vertical incision is given in interproximal area as the tissue is thick.
To avoid periodontal defect , the incision should never lie directly on facial aspect of the tooth.
Flap is reflected towards base using periosteal elevator.
THREE SIDED RHOMBOID FLAP
Additional vertical incision is
given
Improves visibility and
access
Base of the flap is greater
than apes to ensure
adequate blood supply
SEMILUNAR FLAP This flap is designed whenever
periapical area is required to be exposed for periapicalsurgery
Base is border than apex
Incision is taken at least 5 cm away from free gingival margin.
Advantage:- This flap is useful to prevent damage to interdental papilla and periodontal post surgical defects.
In case of crowding , suture is not a problem.
Disadvantage :- It often lies on
SUTURE
Definition:-a suture is a strand or thread of
material used to approximate tissues and also
ligate blood vessels.
To suture is the act of swing or bringing
tissues or flap edges together and holding
them in apposition untill normal healing takes
place.
CLASSIFICATION
Based on diameter or thickness
• From 1-0 to 10-0
• Higher no of zeros corresponding to thinner
more delicate thread
• Most commonly used suture in suturing oral
mucosa is 3-0 thread
• Smaller size suture are used for suturing
conspicuous places on the skin such as face.
Based on resorbability
1. Absorbable :- All suture materials that are
digested by the body enzyme or are hydrolyzed
by the tissue fluids are absorbable
a. Synthetic
b. Natural
2. Non absorbable :- sutures that can not be
digested by tissue enzymes are encapsulated
or walled off are non absorbable
a. Natural
b. Metallic
c. synthetic
Based on type of filament
1. Monofilament type:- made of single strand , resist harbouring micro-organisms & ties smoothly. It has to be handled delicately.
2. Multifilament type :- several filaments are twisted or braided together into a single strand . It gives good handling & tying characteristics.
Based on coating
a. Coated :- polyester sutures are usually coating with biologically inert non resorbable compound . Coating is done to reduce friction of braid.
b. Non-coated
REQUISITES OF SUTURE MATERIALS
1. Tensile strength
2. Tissue biocompatibility, low tissue irritation
and reaction
3. Low capillarity
4. Good handling & knotting properties
5. Sterilization without detoriation of properties
.
SUTURE MATERIAL
SUTURE NEEDLES
Types
Eyed
Eyeless
PARTS OF NEEDEL
CLASSIFICATION BASED ON CURVATURE ,
RADIUS &SHAPE
PRINCIPLES OF SUTURING 1. The needle should be grasped at
approximately 1/3 rd the distance from the eye and 2/3 from the point
2. The needle should enter the tissue perpendicular to the tissue surface
3. The needle should be passed through the tissues along its curve
4. The suture should be passed at an equal depth and distance from the incision on both sides
5. The needle always passes from the movable tissue to fixed tissue
6. The needle always passes through the thinner tissue to the thicker tissue
7. The needle always passes from deeper tissue to superficial tissue
8. Tissues must never be closed under tension
9. Suture is tied only to approximate tissue not to blanch
10. Knot should not lie on incision line
11. Sutures should be placed at a greater depth than the distance from the incision , so as to evert the wound margins
12. Skin sutures are removed in 5 days & intra
SUTURING TECHNIQUE
Interrupted suture-sling suture Most commonly used
suture
The suture is passed through both the edges at an equal depth & distance from the incision
Needle penetration should be 3 mm from the wound edges
Continuous over and over
suture
Initially a simple interrupted
suture is placed
The needle is reinserted in a
continuous fashion such that
the suture passes
perpendicular to the incision
line below and obliquely
above.
The suture is ended by
passing a knot over the
untightened end of the suture.
It provide rapid technique for
closer and distribution of the
tension uniformly over the
suture line.
It offers a more water tight
closer.
Continuous locking suture
Similar to continuous suture
But locking is provided by
withdrawing the suture through
its own loop.
The suture passes
perpendicular to incision line.
Locking prevent excessive
tightening of the suture as the
wound closer progresses
MATTRESS SUTURE
Horizontal mattress suture The needle is passed from one edge
of the incision to another & again from the latter edge to the 1st edge in a horizontal manner & knot is tied.
The distance of needle penetration from the incision line & the depth of penetration of the needle is the same for each entry point
Horizontal distance of the points of penetration on the same side of the flap differs
This provide broad contact of the wound margins
Eg:- closer of extraction socket
Vertical mattress
suture
Similar to horizontal
suture
But depth of
penetration varies
When needle is
brought back from the
second flap to 1st flap ,
the depth of
penetration is more
superficial.
It is used for closing
deep wounds.
FIGURE OF 8 SUTURE
Used for the
extraction socket
closer and adaptation
of gingival papillae
around the teeth.
SUBCUTICULAR SUTURES The subcuticular layer of
tough connective tissue if sutured will hold the skin edges in close approximation when cosmetic results are desired
Continuous short lateral stiches are taken beneath the epithelial layer of the skin
Ends of the suture comes out at each end of the incision and are knotted.
This tye of suture leaves cosmetic scar.
KNOT
Definition :- A knot is an interwining of threads for the purpose of joining them.
Component of sutured knot
a. The loop created by the knot
b. The knot itself , which is composed of a number of tight throws , each throw represents a weave of two strands
c. The ears, which are the cut ends of the suture
TYPES OF KNOT
Square knot(sequre /
half hitch / Reef/ single
knot)
There are four throws
The 1st throw is placed in
precise position for the
knot , using a double
loop.
2nd throw is tied using
horizontal tension .
Additional 2 throws are
given
Ends are cut long.
SURGEON’S KNOT
It is formed by two
throws of the suture
around the needle
holder on the first tie
and one throw in the
opposite direction in
the second tie
Granny’’s knot / slip knot
It involves a tie in one direction followed by a
second tie in the same direction & a 3rd tie in the
opposite direction to square the knot and hold it
sequrely.
Used with silk , chromic catgut or plain catgut
suture material.
BIBLIOGRAPHY
SANJUKTA SAHA
FINAL YEAR
HIDSAR
THANK YOU