Wound closure can be accomplished in diverse ways, but suturing remains the mainstay. A wide variety of materials are available for wound suturing. One has to choose the right material and technique depending on the wound type and closure needs. Alternate techniques such as staples, tapes and adhesives are fast gaining popularity.
The suture needles are usually curved as an arc of a circle. Straight needles, though available, have very limited practical applications. The curvature is described as the span of the arc, in terms of , 3/8, and 5/8 of a circle. Most of the regular suturing in oral and maxillofacial surgery is done with half circle needles. A smaller arc such as 3/8 can be used for suturing flat skin surfaces. Longer arc, i.e. 5/8 circle, needles are used in narrow tunnelled surgical fields such as in cleft palate or inside the nose (Fig. 11.2).
suturing techniques in oral surgery zip
It is beyond the purview of this chapter to go into the details of all the types of suture materials available in the market, chemical structure, method of resorption, qualities, indications, advantages, etc. Details of few suture materials widely used in oral and maxillofacial surgery are given below.
Silk is now not considered an appropriate material for cutaneous suturing, except on specific sites such as eyelids and lips. It is very often used for ligating blood vessels and for hitching drains. It is the most popular material used in dentistry. Its soft and pliable nature makes it suitable for use in oral mucosa which is mobile and wet.
The tissues and the surgical environment in the dentoalveolar region are different from other parts of the body. Consequently, the wound closure requirements also differ. Wound closure in dentoalveolar surgery involves suturing in situations such as
This is a two-dimensional suturing technique where the suture thread is spread in a horizontal fashion in the tissues. It is not very popular for general cutaneous suturing but is especially useful in dentoalveolar surgery.
In reverse-cutting needles, the third cutting edge is on the outer convex curvature of the needle (depth-seeking). These needles are stronger than conventional cutting needles and have a reduced risk of cutting out tissue. They are designed for tissue that is tough to penetrate (eg, skin, tendon sheaths, or oral mucosa). Reverse-cutting needles are also beneficial in cosmetic and ophthalmic surgery, causing minimal trauma.
The use of this technique facilitates extremely rapid oral and dental rehabilitation within a few weeks of resective surgery, providing rapid return to function and restoring appearance following low-level maxillary resection, even in cases where radiotherapy is required as an adjuvant treatment post-operatively. The ZIP flap technique has been adopted as a standard procedure in the unit for the management of low-level maxillary malignancy, and this report provides a detailed step-by-step approach to treatment and discusses modifications developed over the treatment of an initial cohort of patients.
The surgical management and prosthodontic rehabilitation of the maxillectomy patient is complex with a variety of options available to the head and neck cancer team ranging from simple prosthodontic obturation [1] to reconstruction using pre-fabricated or digitally planned composite flaps [2] with or without the placement of osseointegrated implants [3]. The primary aims of treatment include effective eradication of the primary tumour, closure of the resulting maxillary defect, preservation of facial form, and ideally, the restoration of the resected maxillary dentition. Whilst the techniques for surgical closure of the low-level maxillectomy defect are well established, it can be challenging to subsequently achieve effective dental rehabilitation. The use of an obturator is not without its difficulties in terms of fit, retention and comfort, as well as preventing the transgress of fluid from the mouth to the nose. Providing and maintaining an effective obturator is demanding on both the patient and prosthodontist. Although some patients are able to tolerate the use of a removable denture following treatment, depending on retention, many are unable due to the change in the oral anatomy, oral dryness and the fragility of the irradiated tissues. Sealing the defect and providing bone and soft tissue through the use of free tissue transfer has both advantages and disadvantages. Following free tissue transfer providing secondary rehabilitation might be delayed or not possible. The situation is made worse by the frequent requirement for post-operative radiotherapy, which ideally should start as soon as feasible following tumour ablation.
Atlas of Suturing Techniques: Approaches to Surgical Wound, Laceration, and Wound Repair presents the building blocks of suturing and wound repair in an at-a-glance, economical atlas format. In its pages, the author shares his vast expertise and it is his intention to help physicians across many specialties to improve outcomes for patients requiring repair of any wound. Starting with chapters on principles of wound management and wound repair, the atlas then moves on to equipment, positioning, and other key principles. The next section covers 75 suture techniques, providing detailed step-by-step instructions adjacent to drawings and photos of the techniques. Finally, the last section covers each area of anatomy, guiding you in what suture to use when, how to modify certain sutures in specific locations, and even how to prepare and execute skin grafts.
The 81st MDG is one of three Air Force medical facilities with formal clinical investigation programs specifically designated to facilitate clinical-based research and training that meets the needs of DOD medical readiness, force protection, clinical medicine, graduate medical education and homeland defense. The hospital's Institutional Review Board and Institutional Animal Care and Use Committee currently oversee 88 research and training protocols. Training areas include neonatal intubation, emergency procedures for non-physicians, Special Operations damage control surgery and suturing techniques for dental officers. The Clinical Research Lab is actively pursuing integrated research with the Gulf Coast Veterans Administration Health Care System.Furthermore, the medical group operates the only medical genetics center in the DoD. The USAF Medical Genetics Center provides laboratory and consultative support to military medical facilities around the world. Laboratory capabilities include chromosome, gene and DNA testing. Currently the laboratory performs 50,000 tests annually, a number that is growing rapidly.
Fotona's dental lasers are ideal for all hard- and soft-tissue treatments. Unlike conventional oral surgery techniques, dental lasers enable fast and effective treatments without the need for a scalpel or sutures. Surgical procedures are precise, and enable simultaneous coagulation effect that occurs during laser-tissue interaction.
Using a scanner, a beam of laser light can be swiftly and accurately moved across the surface of treated tissues. The LightWalker AT's Er:YAG scanner-ready technology will soon allow dental practitioners to perform a wide range of treatments more effectively, with levels of accuracy and precision that are unavailable with any other technology. This will offer tremendous value to treatments in oral surgery as well many other fields of dentistry.
Abstract:Wound closure is a key element of any procedure, especially aesthetic and reconstructive plastic surgery. Therefore, over the last decades, several devices have been developed in order to assist surgeons in achieving better results while saving valuable time. In this work, we give a concise review of the literature and present a biomechanical study of different suturing materials under mechanical load mimicking handling in the operating theatre. Nine different suture products, all of the same USP size (4-0), were subjected to a standardized crushing load by means of a needle holder. All materials were subjected to 0, 1, 3 and 5 crushing load cycles, respectively. The linear tensile strength was measured by means of a universal testing device. Attenuation of tensile strength was evaluated between materials and between crush cycles. In the pooled analysis, the linear tensile strength of the suture materials deteriorated significantly with every cycle (p
Including coverage of surgical instruments, wound management and suturing, and minor surgical procedures, it also explains how to use these essential surgical skills to make the most of a surgical placement. Healthcare students or junior professionals undertaking a placement in surgery or emergency medicine will feel confident and capable, and will be able to take an active role in surgical placements. Learning basic surgical skills is important for such placements, as well as for undertaking exams such as the Membership of the Royal College of Surgeons (MRCS). 2ff7e9595c
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