RU2842550C1 - Method of butt suture application in surgical dentistry - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention refers to medicine, namely to surgical dentistry. Needle is perpendicular to a surface of flap A, which can be represented by a free epithelial autograft or an incision edge of attached keratinised gingiva. Needle is inserted into the flap A at 1 mm from the wound edge. Needle is delivered through flap A, through a periosteal layer. Needle is rested against the bone surface. Needle is turned 90 degrees and advanced towards flap B which can be presented by an incision edge of the attached keratinised gingiva. Needle is pricked out at 2-3 mm from the edge of flap B with the suture wound to penetrate the connectable tissues at the same height. Needle is pricked into flap B at 1.5-2 mm from the prick-out point. Needle is delivered in the thickness of flap B and brought out in the middle of a thickness of an end face. Needle is delivered above the surface of flap A. Reef interrupted sutures are tightened. Wound surface is closed.

EFFECT: method enables to apply the joint suture in surgical dentistry, to reduce the number of tissue needle punctures required for the wound closure, to ensure the accurate positioning of the wound edges.

1 cl, 15 dwg, 1 ex

Description

The invention relates to medicine, namely to surgical dentistry, and is intended for use in applying sutures in the oral cavity.

Any surgical intervention in the oral cavity, as a rule, ends with suturing of surgical wounds. The main principles of wound suturing in dentistry are: atraumatic application, uniform connection of all layers in depth and width, the need for consistency of surgical sutures, creation of optimal tension force in tissues. In addition, when applying sutures to the wound surface It is necessary to pay special attention to matching the edges of the wound so that there are no free cavities or pockets along the entire depth of the wound along the suture line. Errors in suturing can cause various complications, such as bleeding in the postoperative area, long-term swelling of soft tissues, etc.

In surgical dentistry and periodontology, sutures are used that must meet the following requirements in the oral cavity: do not turn the edges of the wound outward (unnecessarily); do not overtighten the tissues so that ischemia with subsequent necrosis does not occur; close the wound tightly to avoid infection or secondary bleeding; do not rub the edges of the wound; firmly hold the flap if the latter was previously mobilized.

Currently, one of the most common methods of suturing in surgical interventions in the oral cavity in an outpatient setting is a simple interrupted suture (Sutures in surgical dentistry: a tutorial / A. M. Panin, A. M. Tsitsiashvili, A. V. Shishkanov, A. I. Potapova. - Moscow: GEOTAR-Media, 2022. - 32 p. (Series "Higher professional education") - ISBN 978-5-9704-6914-9). The suturing technique is as follows: the needle is inserted from the vestibular side of one of the wound flaps to be connected at a distance of 1-2 mm from its edge, then the needle is pulled out from the lingual side of the second flap. When suturing, the punctures and exits should be located on the same line, strictly perpendicular to the wound. Then the surgical knot is tightened. The knot should be tightened only until the edges of the wound are aligned; excessive force is highly likely to disrupt the trophism of the tissues being connected and increase the wound healing time. The tied knot should be located at the puncture or puncture points, but not above the wound itself. The knot suture has a number of advantages: precision of matching the tissues being connected, the ability to model the stitch parameters depending on the wound shape; high-quality joining of the edges of wounds of complex shapes (arcuate, angular, polygonal, etc.); ensuring strong fixation of the wound edges if it is necessary to remove one or more sutures in a row according to appropriate indications; maintaining blood supply to the wound edges; hemostatic properties. The disadvantages include, in particular: the need for precise additional matching of the wound edges before applying each subsequent suture; duration of the manipulation: a lot of time is spent on forming the loops of each suture. (Sibirskaya E.V., Vasilyeva M.D. Suture materials and methods of applying skin sutures in obstetric and gynecological practice. Effective pharmacotherapy. 2023; 19 (23): 64-71. DOI 10.33978/2307-3586-2023-19-23-64-71).

Vertical and horizontal mattress sutures are also often used in dental practice. The vertical mattress suture, when used in the interdental space, results in good papillae alignment. Similar to the figure-of-eight suture, when applying this suture, the flap at the site of the first puncture is folded slightly more than the flap at the site of the second puncture. It is used to close membranes in the interdental spaces. The technique for applying it: the needle is inserted from the vestibular side of one of the wound flaps at a distance of 2-4 mm from the wound edge, after which the needle is brought out from the lingual side of the second flap, then a puncture is made with the needle, but from the lingual side and 2-3 mm more vertically, then the needle is brought out to the vestibular side of the first flap 2-3 mm more vertically. A surgical knot is tied. A horizontal mattress suture is used in the presence of a thick interdental papilla (i.e., in the presence of a large thickness of tissue in the interdental space). It is applied as follows: the needle is inserted from the vestibular side of the first flap of the wound at a distance of 2-4 mm from the edge of the wound, then the needle is removed from the lingual side of the second flap, after which the needle is punctured again, but from the lingual side and 3-5 mm more horizontally. Finally, the needle is removed from the vestibular side.

As a prototype of the claimed invention the McMillan-Donati suture was chosen, which is one of the varieties of the interrupted vertical U-shaped suture and is used in general surgery. (Burykh M.P. General principles of surgical technology // Handbook for surgeons. - Rostov n / D .: Phoenix Publishing House, 1999. - 544 p. - P. - 427-432.) 2) (Egiev V.N., Buyanov V.M., Udotov O.A. Surgical suture. - M .: Medpraktika-M, 2001, 112 p. (p. 50-51)). The needle is inserted at a distance of 2-3 cm from the edge of the wound and passed outward. Having reached the base of the wound, the needle is turned toward the midline of the wound and brought out at its deepest point. The other edge of the wound is symmetrically punctured. The needle insertion and withdrawal sites should be equidistant from the wound edges. Then, on the side where the needle is inserted, a few millimeters from the wound edge, the needle is inserted again so that it comes out in the middle of the dermis layer. On the opposite side of the wound edge, the needle is inserted so that it comes out in the middle of the dermis layer. On the opposite side of the wound edge, the needle is inserted in the opposite direction. The knot is tied closer to the first needle insertion site, and the wound edges are slightly raised, which improves their alignment. This method avoids the need for subcutaneous sutures and the need for an assistant to help with the adaptation of the wound edges. However, along with the above advantages, the McMillan-Donati suture has some disadvantages. This method requires a sufficiently high tension of the suture thread, which leads to excessive pressure of the thread on the tissues, and, as a result, causes their ischemia and leaving rough suture marks on the already healed postoperative wound surface. In addition, in the postoperative period, if there is excessive pressure of the thread on the tissue and signs of aseptic inflammation appear under the thread, the supracutaneous part of the suture may sink below the skin surface with the loss of mutual adaptation of the wound edges. Another disadvantage is that with a wound deeper than 3 cm, a cavity containing blood and tissue discharge may remain in the center of the suture loop, which, in turn, causes the risk of suppuration and increases the time of tissue regeneration in the postoperative area.

The objective of the claimed method is to eliminate the above-described shortcomings, as well as to optimize the processes of tissue regeneration in the postoperative zone by reducing the number of tissue punctures with a needle required for wound suturing and achieving the most accurate matching of the wound edges.

The technical result of the proposed method of suturing is minimal trauma to the soft tissues of the postoperative area during wound suturing due to the fact that this method reduces the number of necessary tissue and node punctures. The technical result is achieved as follows: the needle is inserted into flap A (the first flap) at a distance of 1 mm from the wound edge, which helps reduce the risk of tissue ischemia due to increased pressure exerted on them. The needle is positioned perpendicular to the surface of flap A, passed through flap A, through the periosteal layer, after which the needle is pressed against the bone surface, turned 90 degrees and advanced in the direction of flap B (the second flap) at a distance of 2-3 mm from its edge. A puncture is made in the area of flap B. At this stage of wound suturing, special attention should be paid to ensuring that the suture tour penetrates the tissues being connected at the same height. Then, stepping back 1.5-2 mm from the needle puncture, the needle is inserted into flap B, passed through its thickness and brought out in the middle of the thickness of the end of the cut, passed over the surface of flap A, which allows to avoid an additional puncture of flap A, which is present in the description of the technique for performing the suture according to McMillan-Donati. After this, the surgical knot is tightened. Thus, the first suture, as it were, pulls flap A to the end of flap B, and the second suture presses it to the periosteum, preventing the surface of flap A from creeping onto the surface of flap B, which allows to ensure the most accurate anatomical reconstruction of tissues and their precise comparison.

The method is most effective in surgical interventions aimed at creating a zone of attached keratinized gum in the peri-implant area at the stage of fixation to the attached gum in the recipient zone, the coronal part of the free epithelial autograft obtained from the donor zone of the hard palate, as well as when suturing vertical incisions in the area of the attached gum of the upper and lower jaws.

The method is illustrated by figures with a detailed description of the sequence of actions for implementing the claimed suture application technique.

Fig. 1 shows a schematic representation of the application of a docking suture. A - flap A, B - flap B.

In Fig. 2, the needle is positioned perpendicular to the tissue, 1 mm away from the edge of the wound.

In Fig. 3, the needle is inserted through flap A, through the periosteum, after which the needle is pressed against the surface of the bone and turned 90 degrees.

In Fig. 4, the needle is advanced under the periosteum and flap B at a distance of 2-3 mm from its edge and the needle is removed.

In Fig. 5, at a distance of 1.5-2 mm from the needle puncture, the needle is inserted into flap B and passed through its thickness.

In Fig. 6, the needle is brought out in the middle of the thickness of the end of the cut of flap B.

In Fig. 7, 8, the needle is passed over the surface of flap A.

In Fig. 9, 10, the surgical knot is tightened.

In Fig. 11-14, stitches are applied to completely close the wound surface on one side.

Fig. 15 shows the final appearance of the wound surface after suturing one side.

The implementation of the method is demonstrated using a clinical example.

Female patient, 42 years old, vestibuloplasty of free epithelial autograft fixation in the recipient zone during surgery to create an attached gingiva zone. The graft is placed in the recipient zone in a pre-planned position. The needle is inserted into the graft at a distance of 1 mm from the edge of the graft facing the edge of the incision of the attached keratinized gingiva. The needle is positioned perpendicular to the graft surface, passes through the graft, through the periosteal layer, then rests against the bone surface, turns 90 degrees and advances in the direction of the attached gingiva at a distance of 2-3 mm from the edge of the attached gingiva. A puncture is made in the area of the attached gingiva. Then, stepping back approximately 1.5-2 mm from the needle puncture, the needle is injected into the area of the attached gum, carried through its thickness and comes out in the middle of the thickness of the end of the cut, carried over the surface of the transplant and sea knot sutures are tied. The wound surface is sutured.

References

1. Application 2013153067 dated November 28, 2013. Patent No. 2547699 dated 04/10/2015.

2. Sibirskaya E.V., Vasilyeva M.D. Suture materials and methods of applying skin sutures in obstetrics and gynecology. Effective pharmacotherapy. 2023; 19 (23): 64-71. DOI 10.33978/2307-3586-2023-19-23-64-71.

3. Burykh M.P. General principles of surgical technology // Manual for surgeons. - Rostov n / D.: Phoenix Publishing House, 1999. - 544 p. - P. - 427-432.

4. https://djvu.online/file/QGpRFfQQ596cq Egiev V.N., Buyanov V.M., Udotov O.A. Surgical suture. - M.: Medpraktika-M, 2001, 112 p. (pp. 50-51).

5. Application 2004129650 dated 10/11/2004. Patent No. 2296516 dated April 10, 2007.

6. Sutures in surgical dentistry: a tutorial / A. M. Panin, A. M. Tsitsiashvili, A. V. Shishkanov, A. I. Potapova. - Moscow: GEOTAR-Media, 2022. - 32 p. (Series "Higher professional education") - ISBN 978-5-9704-6914-9.

Claims (1)

A method of applying a docking suture in surgical dentistry, which consists in placing a needle perpendicular to the surface of flap A, which may be represented by a free epithelial autograft or the edge of an incision of attached keratinized gum, inserting the needle into flap A at a distance of 1 mm from the edge of the wound, passing the needle through flap A, through the periosteal layer, after which the needle is rested against the surface of the bone, turned 90 degrees and advanced in the direction of flap B, which may be represented by the edge of an incision of attached keratinized gum, and performing a puncture at a distance of 2-3 mm from the edge of flap B, while the suture tour should penetrate the tissues being connected at the same height; then, stepping back 1.5-2 mm from the puncture site, insert the needle into flap B, pass it through its thickness and bring it out in the middle of the thickness of the end of the cut, pass it over the surface of flap A, after which the sea knot sutures are tightened; the wound surface is sutured.