Thank you for your interest in this continuing education course. The content related to this CE lesson is drawn from "The Suture Book," by Lee H. Silverstein, DDS, MS. While Dr. Silverstein's work is not currently available in a digital format, you may purchase the book by visiting store.dentalaegis.com or calling 215-504-1275 x 207. If you already own Dr. Silverstein's book, please log in using the prompt to the right and click "Take the Quiz." You will be redirected to the quiz page.
The Suture Book Silverstein Pdf
My aphakic eye continued to be a nagging problem. Finally, in 1991, I had a secondary lens implant. I did well for a few months, but unfortunately, the 1975 eye surgeon had removed most of the posterior capsule behind the original lens, leaving almost nothing to hold the artificial lens in place. I blinked one day, and the intraocular lens implant simply flipped back into the posterior chamber. I ended up having a vitrectomy by a retina surgeon. The displaced lens was fished out of the posterior chamber and sutured back into the anterior chamber. I experienced postoperative optic nerve edema and could not see for 3 to 4 weeks. I was worried that I would never operate again. But my vision slowly returned, and I finally got back to work. I now had binocular vision without a contact lens.
My eye was fine until 2014, when the sutures holding the lens in place finally disintegrated. The lens once again fell back into the posterior chamber, this time straight down. The first retina surgeon I saw wanted to operate immediately. The surgery to fish the lens out and suture it back into place was complicated and fraught with the possibility of failure, particularly now that I was older and had undergone multiple prior surgeries on that eye.
We started collecting data in Van Nuys on an Apple II computer shortly after we opened in 1979. By the time we had been there for 20 years, we had published 90 peer-reviewed papers, 80 abstracts, 14 book chapters, and two textbooks, including the first textbook completely devoted to ductal carcinoma in situ of the breast.10
In 1994, the Northridge Earthquake struck at 4:31 a.m. on January 18. The Van Nuys Breast Center was severely impacted. Four mammography machines that were not bolted to the floor, because it was not standard at that time, toppled over and could have severely injured or even killed the patients clamped within them had the event occurred during normal work hours. Shelves, books, drugs, supplies, records, everything, was thrown to the floor. The air conditioners on the roof, although strapped down, tore free, resulting in broken water pipes. The entire sixth floor of the building was flooded. We were closed during the next 6 weeks for repairs. When we reopened, we realized that we needed to be part of a larger financial entity, so we undertook negotiations with Salick Healthcare. We sold the Van Nuys Breast Center in 1996. Salick Healthcare purchased the physical plant and the technical component. The doctors kept ownership of the practice.
While I was in the hospital on 2 August 2002, the second edition of the DCIS book was officially published with a dedication to Sara.12 After her death, the dedication became the purpose of the book for me. I cried when I wrote it:
The surgery went well. The surgeon was able to repair both valves. But my blood pressure stayed low. That night, the cardiovascular fellow ordered a chest x-ray, which showed my mediastinum filled with blood. I went back to the operating room. I came out 10 hours later, after 20 units of blood and multiple bags of platelets, with a Dacron ascending aorta but still alive. It took 2 hours of pressure to stop the bleeding from every suture hole. The aortotomy had torn apart and could not be repaired, necessitating replacement of the ascending aorta. How this was done successfully, in the middle of the night, without a full team, amazes me to this day. For 2 or 3 years, when I went to sleep, I thought about the Dacron graft simply ripping apart at the suture line.
The work went on. By the time I left USC in 2008, we had started an oncoplastic breast fellowship, trained 16 oncoplastic fellows, and published 64 additional papers, 30 book chapters, and the second edition of the DCIS book.12 I had given hundreds of lectures all over the world, and we had tripled the number of new breast cancer patients at the USC Norris Comprehensive Cancer Center, many of whom were from Orange County. This out-migration from Orange County to USC led to my recruitment by Hoag.
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Open abdominal drainage incision. The incision should be closed with a single layer of nonabsorbable suture material to provide an opening that allows drainage but does not allow abdominal viscera or omentum to herniate through the open incision. A preassembled sterile bandage is placed over this incision and is changed daily, or more frequently as required to prevent strike-through.
A, Closed suction drainage may be accomplished by placing a single Jackson-Pratt drain cranial to the liver (a second drain also may be placed in the caudal abdomen along the ventral body wall in large dogs), exiting paramedian to the abdominal incision. B, The tubing is secured to the body wall with a purse-string and Chinese finger trap sutures. Once the abdomen is routinely closed, the suction reservoir is attached and a vacuum is created by compressing the bulb. An abdominal bandage is placed to allow attachment of the drainage tubing and reservoir to prevent entanglement and premature removal by the patient.
Surgical closure of wounds is a process that has been performed with needles and thread since prehistoric times. The goal then and now is to re-approximate wound edges under minimal tension. This enables hemostasis and healing by primary intention to minimize bone loss at surgical sites. This activity outlines the various suture materials and needles while highlighting the techniques utilized by the oral surgery healthcare team when managing the closure of surgical wounds within the oral cavity.
Objectives:Review the classic suturing instruments utilized for oral surgery.Summarize the characteristics of typical resorbable and non-resorbable suture materials used in oral surgery.Review the most common needles used and their indications for use.Describe common surgical knots, suturing techniques, and indications for each.Access free multiple choice questions on this topic.
Strings and animal tendons have been used to suture for thousands of years. Over time, innovations in suture materials and improved techniques decreased the complications associated with wound closure. The primary goal when suturing is to re-approximate wound edges under minimal tension enabling hemostasis and healing. This article outlines the various suture materials and needles while highlighting the techniques utilized by the oral surgeon when managing the closure of surgical wounds within the oral cavity.[1]
Wounds heal by first, second, and third intention. Ideally, a wound heals by first intention whereby the wound edges are reapproximated, and the sutured is closed. The site will heal through the process mentioned above with minimal scar formation. Second intention healing is when the wound is too wide, deep, or jagged to re-approximate the tissue edges. These wounds are not closed, and the healing process begins at the wound base, migrating superficially to the epidermis. Finally, third intension healing is when a wound is infected or necrotic; therefore, it must be cleaned or drained until the infection has resolved to be definitively closed.[4][3]
To provide consistent and repeatable wound closure, it is critical for the dental surgeon to understand the suturing armamentarium, including suture materials, needle types, and suturing instruments.[1]
A variety of suturing materials are available for use at the discretion of the dental surgeon. A key consideration when choosing the most appropriate material is tensile strength. Sutures vary in how they distribute tension across the wound after re-approximation. Tensile strength is directly related to the size of the thread material. Therefore, dental surgeons should select the smallest thread that achieves appropriate tension to minimize tissue damage. The suture material also needs to be easy to handle and provide secure knots. Thread materials utilized for suturing consist of resorbable materials and non-resorbable materials.[1]
Natural suture materials are composed of highly purified collagen derived from animals such as sheep and beef intestines. Surgical gut sutures are absorbed rapidly by enzymatic degradation. For this reason, surgical gut sutures are reserved for scenarios where the surgical flap is under minimal tension. The plain gut suture thread loses 50% of its tensile strength within 24 hours of exposure to the intraoral environment and completely resorbs in 3 to 5 days.
The most common synthetic resorbable suture material used is made from polyglycolic acid (PGA). PGA is digested by hydrolysis, which takes 21 to 28 days in the intraoral environment. In addition to the extended absorption profile that PGA suture materials possess, it also maintains high tensile strength for approximately three weeks. PGA is the resorbable suture material of choice when placing mattress sutures to keep tension against the muscles of mastication. Its braided structure tends to improve handling characteristics and maintain knot integrity. This suture also comes coated with an antimicrobial agent. Another synthetic resorbable material commonly used to close the dermis is polydioxanone. This is a monofilament that holds 70% of its tensile strength for two weeks.[5][6][7][1] 2ff7e9595c
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