How to close intraoral wounds and incisions - DVM
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How to close intraoral wounds and incisions
Best practices for choosing dental sutures, needles and suturing methods


DVM360 MAGAZINE



Photo 3: 4-0 Vicryl Rapide suture on a ⅜-in. cutting needle.
Vicryl Rapide (Ethicon/Novartis Animal Health), a braided, undyed, synthetic and absorbable polyglactin-910 suture that retains tensile strength for 10 to 14 days and is absorbed completely by phagocytosis in 35 days (Photo 3). I think this is an ideal suture for fast-healing wounds in the oral cavity where the suture actually falls off the wound by day 12. Additionally, this suture is soft, so it shouldn't irritate the animal as some monofilament sutures can.


Photo 4: 2-0 Monocryl Plus (active) suture on a ⅜-in. reverse cutting needle.
Monocryl (Ethicon/Novartis Animal Health), a monofilament, synthetic and absorbable poliglecaprone-25 suture noted for ease of handling, as well as knot security and strength (Photo 4). It retains 21 days of tensile strength and absorbs in 78 days. Monofilament suture materials are stiffer, making handling more difficult, and they may increase oral irritation.


Photo 5: Two different needle choices for Vicryl Rapide suture.
Coated Vicryl Rapide (Ethicon/Novartis Animal Health), a braided, synthetic and absorbable polyglactin-910 coated suture that retains tensile strength for 28 days and absorbs in 68 days (Photo 5).

PDS II (Ethicon/Novartis Animal Health), a monofilament, synthetic and absorbable polydioxanone suture that retains tensile strength for 56 days and absorbs in 180 days. Unfortunately, its slow absorption may cause wound complications (e.g., inflammation, infection, granuloma).

Antibacterial (active) suture material, which is treated with triclosan to create a zone of inhibition around the suture. These sutures are best used in at-risk patients, including those that are immunosuppressed because of feline immunodeficiency virus infection, feline leukemia infection, diabetes, hypothyroidism or neoplasia. Active suture materials include Monocryl Plus, Vicryl Plus and PDS Plus (Ethicon/Novartis Animal Health).

Suture size

The smaller the suture size, the less its tensile strength will be. Tension-free apposition of oral wound margins is important to allow healing. Sutured wounds in the mouth shouldn't be placed under high tension, so 3-0 to 6-0 suture material should be adequate to repair most oral wounds.

Needle selection

At times, closing oral surgical wounds can be difficult, especially in cats. Only swaged needles are recommended, where the suture and needle are a continuous unit, minimizing tissue trauma and increasing ease of use.

Unfortunately, in many cases veterinarians make do with the needle attached to the suture size they choose. Often this results in using a too-small needle that can barely be grasped by the needle holders and easily bends when the tissue is penetrated.

Curved needles should be used when working in the mouth. A ⅜-in. needle is the easiest to handle, allowing the surgeon to pass from the buccal to the lingual surface in one motion. For more inaccessible oral sites (e.g., oropharynx), a 0.5-in. or 5/8-in. circle needle is easier to use. The half-circle needle is routinely used for periosteal and mucogingival surgery. Unfortunately, there's no uniform needle labeling or coding among manufacturers. The sizing of Ethicon sutures for oral surgery ranges between 10.5 mm (P-1), 13 mm (P-3) and 19 mm (PS-2).


Photo 6: Needle options for placing sutures.
The surgeon has a choice between taper, spatula, regular cutting and reverse cutting types of needles (Photo 6). Cutting needles have a triangular shape with three cutting edges. Because the apex is located on the needle's concave surface, flap tear is common. The reverse cutting needle is preferred because there is less likelihood of flap tear since the apex is located on the needle's convex surface.

The best practice is to view the actual-size image of the needle on the package to ensure it's appropriate.


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Source: DVM360 MAGAZINE,
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