Suturing Techniques in Oral Surgery

247 Pages·0121.404 MB·English

by  Sandro Siervo

Sandro Siervo
SUTURING TECHNIQUES
IN ORAL SURGERY
Luisa Lorenzini
uh/itTQtKMuby
SUTURING TECHNIQUES
IN ORAL SURGERY
Quintessenza Edizioni S.r.l.
Milano, Berlino, Chicago, Tokyo, Barcellona, Istanbul, Londra, Mosca,
Nuova Delhi, Parigi, Pechino, Praga,
San Paolo, Seul,Varsavia
Sandra Sierva
SUTURING TECHNIQUES
IN ORAL SURGERY
illustratlonsbyLuisa Lorenzini
Quintessenza Edizioni S.r.l.
Milano, Berlino, Chicago, Tokyo, Barcellona, Istanbul, Londra, Mosca,
Nuova Delhi, Parigi, Pechino, Praga,
San Paolo, Seul,Varsavia
Copyright ©2008 by
QUINTESSENZAEDIZIONI s.r.1.
20017 Rho (MIl. via Ciro Menotti, 65
tel. [phone] fax [phone]
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ALL RIGHTSRESERVED
The book and all of its parts are covered by copyright.
Any unauthorized utilization or marketing of the material outside the limits of the copyright, without the publisher's consent, is
illegal and will be the subject of legal proceedings. This holds in particular for photostatic reproductions, copies, circulars, dupli-
cations, translations, microfilms, electronic processing and data collection.
ISBN978-88-7492-120-1
Graphics and paging up:Andrea Unali
Cover: Luisa Lorenzini
Illustrations: Luisa Lorenzini
English Translation: Frances Cooper
Printed by: Reggiani S.p.A.- Varese
Science isorganized knowledge.
(Immanuel Kant)
ToAlberto
Toshow that the journey has not been interrupted.
To Mario
Sandra and Luisa
Preface
Thegreat surgeon hasjust successfully completed adelicate operation' he removes hisgloves and gives a
few suggestions to his collaborators as they begin closing the access route. Having sutured the deeper
planes in their turn they leave the skin suturing to theyoungest member; who isstillspecializing. Thusa
phase ofsurgery that, insome branches, isafundamental one isleftin the least expert hands. Suturing the
access route has always been neglected, put inplace quickly and no more than adequately, while in oral
surgery, and obviously in facial surgery, itis of fundamental importance. Whereas in the latter field the
esthetic consequences of a badly executed suture can readily be understood, formany operations in oral
surgeryproper suturing determines success. How many bone grafts have become infected because the
suture dIdnotprovide aproper seal?Howmany exposed membranes orgingival recessions arelinked to a
technicaldefect insuturing?Forthese reasons Iparticularly appreciate the workofSiervoand co/taoorators,
who have tackled thesubject, andgiven thesuture the roleitdeserves.
Theargument is treated with a clear and rational approach, including the indispensable biological
aspects required to understand the various probterns. and with illustrations that make even the less
understandable details clear.Soitiswithgreat pleasure that Ipresent this book, the latest undertaking of
Sandro Siervo. whose seriousand committed approach toalltheproblems he has dealt with Ihave come to
appreciate greatly sinceIfirstmet him.
Iam sure that this book willhave great success. that itsreaders willappreciate itsmessage, and that it
wi/Ihave apositive influence on day-to-day surgicalpractice.
Roberto Brusati
with collaboration from:
Samuele Burastero Doctor of Medicine and Surgery,Specialist in Pneumology, Specialist in
Immunology, Researcherat the SanRaffaeleHospital, Milan
Cristian Coraini Doctor of Dentistry and Dental Prosthetics, Private Practitioner in Milan
EnricoCerri Doctor of Medicine and Surgery,Specialist in Dentistry, Private Practitioner in Milan
CarloMarchetti Doctor of Medicine and Surgery,Specialist in Dentistry, Private Practitioner
in Morbegno and Milan
Luigi Paglia Doctor of Medicine and Surgery,Specialist in Dentistry, Head of the Children's
Dentistry Department, Istituto Stomatologico Italiano
Massimo Radici Doctor of Dentistry and Dental Prosthetics, Private Practitioner in Morbegno
PaoloSiervo Doctor of Medicine and Surgery,Specialist in Maxillo-Facial Surgery,Private
Practitioner in Milan
RaffaeleSiervo Doctor of Medicine and Surgery,Specialist in Dentistry, Private Practitioner in Milan
Acknowled ements
...,
"_._-----------------------
Particularthanks goto mymentor,Prof.DrJakobWirz,who waspresent atthe birth ofthis ideaand supported
itenthusiastically from the start.Only thanks to hiscontribution and histirelessdedication to teaching have I
beenableto complete this book.Itwould havebeenimpossible to dosowithout the helpofmany people,who
contributed generously and with great professionalism to its different phases and who helped collecting
material,drawing up the text, and checking it.My heartfelt thanks go to them all:Gabriella Parlabene,Maria
TeresaQuaglia, Daniela Barbetta, RaffaellaTognoli, Anna Ciapponi, Marenza Loviso,Erika Onqaro, Marcella
Samarati.Mr Luciano Pasinikindly made available his premises and his microscopes for the photographic
sections.My thanks to Hu-Friedy,in the person of Dr FabioMolinaro and Dr Stefano Checchi,to Sweden &
Martina,inthe personof DrElisabettaZangiacomi, andto W.L.Gore,inthe person of DrAndrea Nicolisand Mr
FrancescoMartinelli,forthe materialsthey madeavailableto me.Theauthors herebystatethey havenoconflict
of interestswith anyofthe materialsorcommercial products presented inthe text.
tents _
Surgical wounds
2
«tntroduction 3
-Tissuehealing: general considerations and dinical aspects 4
-Tissuehealing: cellular and molecular mechanisms 11
Thephysiology of wound healing: an overview 11
Inflammatory phase (days 0-3) 12
Proliferation orfibroblast phase (days 3-72) 14
Theremodeling phase (days 6-74) 15
Wound healing:peculiarities of thegastroenteric tract 16
Theroleofgrowth factors in tissue healing 17
Sepsis and scarformation 18
Treatment ofinfected surgical wounds 20
Useofgrowth factors inclinicalpractice 20
Theroleofintegrins inre-epithelialization 23
-Classification of wounds 25
-Tissuereactions to sutures 27
Technological aspects 34
•Suture needles 35
Technological and commercial characteristics ofsuture needles 35
Suture needle anatomy 39
Opticalmicroscopic analysis ofsuture needles on the market 50
•Sutures: general characteristics and terminology 53
Monofilaments 58
Multifilaments 59
Resorbable sutures 60
Non-resoroabte sutures 63
Suture removal 64
Packaging 65
Opticalmicroscopic analysis of thejunction between needle and suture thread 67
Auxiliary materials 72
•Instruments for use inoral-surgery procedures 73
Needle holders 73
Forceps 75
Scissors 77
•Gripping needle holders and scissors 80