Operative tips 289

Fig. 7-77. The interrupted inverting or continuous Lempert sutures are particularly good when the tissues are flabby. (Drawing courtesy Ethicon, Inc.)

Fig. 7-78. Whenever surface contact of the submucosal tissues is desired, continuous or interrupted mattress sutures may be used. (Drawing courtesy Ethicon, Inc.)

Fig. 7-79. The Halsted interrupted mattress suture is also good for surface-to-surface contact. (Drawing courtesy Ethicon, Inc.)

only a few are used in modern surgery. Those specific to implant surgery include the following and their applications.

When a surface-to-surface contact of the edges of the wound is required, blanket or continuous locked sutures (Fig. 7-74), continuous over-and-over closing sutures (Fig. 7-75), or simple interrupted sutures (Fig. 7-76) may be used. These are good for closing first incisions, such as those made to expose the bone for taking a bone impression for a subperiosteal implant. They are useful when the tissue is moderately thick and healthy, and they can be closed without pulling or stretching. If the tissues are loose and the wound somewhat ragged, a neat closing may be accomplished with either interrupted inverting or continuous Lembert stitches (Fig. 7-77). The interrupted inverting stitch and interrupted sutures are most popular for securing the tissues over a blade implant, since its shoulders are buried in bone and thereby do not stretch the tissue sutured over it.

When additional anchorage is needed to prevent the tissues from tearing, as they may when stretched over a subperiosteal implant, continuous or interrupted mattress sutures may be needed (Fig. 7-78). They are used whenever a surface contact of the submucosal tissues is desired, rather than an edge-toedge contact of the overlying tissues. This suturing technique is also particularly useful around the protruding necks of a subperiosteal implant framework. The Halsted interrupted mattress suture can also be used for subperiosteal implant situations (Fig. 7-79).

Purse-string suturing, which is usually done in general surgery around an open stump, is useful

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Fig. 7-80. A variation of the characteristic purse-string suture is used around a protruding implant abutment post. (Drawing courtesy Ethicon, Inc.)