RGUHS Mahabaleshwara C H et al.

, RJDS 2021;13(3):198-201

Journal of Dental Sciences

ORIGINAL ARTICLE

Simple Interrupted and Continuous Interlocking Suturing Techniques

Comparison in Maxillofacial Trauma – A Randomized Controlled Trial

Mahabaleshwara C H1, Mariea Francis2, Prasanna Kumar D3, Thamil Amudhan C R4*, Radhika Pethkar5,
Shravani B6
1
Professor, Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Sullia
2
Consultant, Oral and Maxillofacial Surgeon, Veeyes Dental Hospital Coimbatore
3
Professor & HOD,Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Sullia
4
PG student, Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Sullia
5
Fellow, Head and Neck Onco Surgery, Mazumdar Shaw Cancer Center, Bangalore
6
PG student, Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Sullia
*Corresponding author:
Dr. Thamil Amudhan C R, PG student, Department of oral and maxillofacial surgery, KVG dental college and
Hospital, Sullia. Affiliated to Rajiv Gandhi University of Health Sciences, Karnataka.
E-mail: [email protected]
Received date: March 1, 2021; Accepted date: June 21, 2021; Published date: June 30, 2021

Abstract
Aim: To compare the efficacy of simple interrupted and continuous interlocking suturing techniques using 3-0
vicryl (polyglactin) sutures.
Method: The study sample included 20 patients (16 males and four females) with maxillofacial trauma
requiring ORIF (Open Reduction and Internal Fixation) of maxilla or mandible fractures. They were randomly
allocated to two groups (Group A and Group B). Patients in the age group of 20-50 years, requiring ORIF
under local anesthesia or general anesthesia through an intraoral approach and incision measuring 4-6 cm
were included in the study. Exclusion criteria included patients requiring extra-oral incisions, comminuted
fractures with acute illness, infection, pregnancy, immune compromised conditions and patients not willing
to participate in the study. Surgical site was closed in single layer using 3-0 vicryl sutures. Intraoperatively,
time taken for suturing, wound dehiscence and wound healing were monitored on third, seventh and 30th day
post-operatively.
Results: In terms of time taken for suturing, dehiscence of wound and wound healing, continuous interlocking
sutures showed superior results than that of simple interrupted sutures.
Conclusion: Even though simple interrupted suturing is an easy technique, continuous interlocking suturing
technique showed superior results. However, surgeons operating maxillofacial trauma may have their own
point of view and selection of technique depends on individual preferences.
Keywords: Suturing, Simple interrupted, Continuous interlocking, Vicryl, Maxillofacial trauma

Introduction Suturing in oral cavity is technically challenging due to

Suturing is a fine skill in the specialty of surgery to keep its anatomical nature of confined space and obstacles
the dermal/mucosal edges in close contact and heal such as teeth, tongue, buccal musculature, saliva, etc and
together to attain a scarless or relatively fine scar line.1 maintenance of the suture postoperatively plays a major

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role.2 There are various types of suturing techniques

(simple interrupted, continuous, mattress, subcutaneous,
buried, etc) and the suture materials (absorbable and non-
absorbable) are preferred based on the location, ease
of suturing, properties of suture material, and comfort
of the patient.1 Colonization of pathogens is more in
multifilament/braided suture.3 Simple interrupted and
continuous interlocking techniques are used most
commonly which are simple and vicryl (polyglactin)
is preferred absorbable intraoral suture material.4
This study compared intraoral simple interrupted and
continuous interlocking suturing techniques using vicryl
sutures, both intra-operatively and post-operatively in
maxillofacial trauma patients.
Figure 1: Instruments for suturing (Needle holder, Vicryl
Patient selection and methodology 3-0 suture material, Adson’s tissue forceps, Scissor)
The study sample included 20 patients (16 males and
4 females) reporting to the Department of Oral and
Maxillofacial Surgery, K.V.G. Dental College and
Hospital, Sullia, with maxillofacial trauma requiring
ORIF (Open Reduction and Internal Fixation) of
maxilla or mandible fractures between December
2016 to May 2017. They were allocated randomly to
two groups (Group A and Group B). Patients in the
age group between 20-50 years, requiring ORIF under
local anesthesia or general anesthesia through an
intraoral approach and incision measuring 5 cm were
included in the study. Patients requiring extra-oral
incisions, those with comminuted fractures with acute
illness, infection, pregnancy, immune compromised
conditions and not willing to participate in the study
were excluded. Patients underwent pre-operative
radiographic and hematological investigations prior to Figure 2: Group A - Simple interrupted suture
surgical intervention under local or general anesthesia.
Patients planned under general anesthesia were operated
after attaining satisfactory fitness from the department
of general medicine and anesthesiology. Patients were
surgically treated with ORIF through intraoral approach
with standardized aseptic precautions. Surgical site was
closed in single layer using 3-0 vicryl sutures (Figure
1) with surgeon’s knots (four throws). Intraoperatively,
time taken for suturing was noted. Wound dehiscence
and wound healing were monitored on third, seventh and
30th day post-operatively and the results were compared
using ANOVA test.
Group A: Closure with simple interrupted suturing
(Figure 2).
Group B: Closure with continuous interlocking suturing
(Figure 3). Figure 3: Group B - Continuous interlocking sutures

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Results Table 2: Shows the wound dehiscence (debris) present

A total of 20 patients (16 males and 4 females) who postoperatively on day 3, day 7 and day 30
reported to the Department of Oral and Maxillofacial
Day 3 Day 7 Day 30
Surgery, K.V.G. Dental College and Hospital, Sullia, with
maxillofacial trauma requiring ORIF (Open Reduction Group A 9 (90) 3 (30) 2 (20)
and Internal Fixation) of maxilla or mandible fractures
Group B 10 (100) 0 0
were included in the study. They were randomly divided
in to two groups (Group A and Group B) and were p value 1 0.21 0.456
compared for time taken for suturing (intraoperatively),
wound dehiscence and wound healing (post operatively) Table 3: Shows the wound healing (H-index) noted
using ANOVA test. postoperatively on day 3, day 7 and day 30

The results showed that the mean time taken (in minutes) H index 3 H index 4 H index 5
for intraoperative suturing was 22.2± 4.13 and 17.1±
Day 3 1 (5) 16 (80) 3 (15)
6.02 from the beginning of the first bite of tissue till the
end of the suturing for group A and group B respectively, Day 7 10 (50) 10 (50) 0
with p value of 0.04 (Table 1). Group B (Continuous
1 month 1 (5) 18 (90) 1 (5)
Interlocking) required less time when compared to
Group A (Simple Interrupted). Wound dehiscence (Table
Discussion
2) was observed in 9/10, 3/10 and 2/10 patients on 3rd,
The maxillofacial region is most prone to trauma owing
7th and 30th post-operative day respectively in patients of
to its prominent position. There are diverse causes of
group A. In group B, debris was observed only on 3rd
maxillofacial trauma. Factors like geographical location,
post-operative day and was absent in subsequent follow-
seasonal variations, means of livelihood, psychological
up visits. This indicated gradual reduction of dehiscence
make-up and living standards of individuals influence
with each post-operative day in both the groups. Wound
its pattern and incidence. Facial fractures can have
healing was assessed and compared which is depicted in
long term residual effects on hard and soft tissues both
Table 3. On the third post-operative day, healing index
functionally and esthetically, regardless of nature and
2 (1 patient), 3 (7 patients) and 4 (2 patients) in group
accuracy of treatment.5
A and healing index 3 (9 patients) and 4 (1 patient) in
group B was seen with p value of 0.453. On the seventh Maxillofacial fractures often require ORIF via intraoral
post-operative day, healing index 3 (7 patients) and 4 approach. The optimum closure of these soft tissue
(3 patients) in group A and healing index 3 (3 patients) wounds can pose a challenge to the most skilled surgeons.
and 4 (7 patient) in group B was noted with p value of Most surgical interventions require primary wound
0.18. On the 30th post-operative day, healing index 3 (1 closure. Soft tissue healing depends on good surgical
patient) and 4 (9 patients) in group A and healing index intervention and soft tissue management. Gentle flap
4 (9 patients) and 5 (1 patient) in group B was seen manipulation, ideal incision placement and appropriate
with p value of 0.368. Overall, continuous interlocking suturing techniques are required for optimal healing.
sutures showed superior results when compared to Proper technique and material for suturing will promote
simple interrupted sutures in all the aspects, such as time wound healing through close approximation of the flap
consumption for suturing, wound dehiscence and wound edges, minimized dead space, reduced postoperative
healing. bleeding, reduced tension over the flap margins and
prevention of infection.
Table 1: Mean time taken (in minutes) for intraoperative
suturing from the beginning of the first bite of tissue till There are various methods for wound closure which
the end of the suturing procedure for both the groups includes sutures, staples, adhesive tapes and fibrin glue.
For wound closure, a variety of suture materials are
Mean time p value
available depending on the surgeon’s requirements and
Group A 22.2± 4.13 various other characteristics.
0.04
Group B 17.1± 6.02
Various suturing techniques such as simple interrupted,

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continuous (simple and interlocking), mattress, the operating surgeons can have their own point of view
subcutaneous, barbed sutures,6 knotless sutures7 are and the technique selection depends on their individual
available. Among these techniques, simple interrupted preferences.
and continuous interlocking are commonly used.8 Simple
interrupted suturing may have poor knot security due to
Conflict of Interest
multiple number of sutures which may cause loosening None.
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