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It is recommended to add additional simple interrupted sutures.
Sutures can be resorbable or nonresorbable. If resorbable sutures are used, avoid fast resorbable sutures that resorb in less than two weeks, such as the Chromic Gut. When using nonresorbable sutures, they should be taken out 10-14 days post-op.
The sutures do not have any influence on muscle engagement. The flap design and the way it is reflected, together with a lack of releasing incisions, are the factors that prevent muscle engagement.
The flap is the part that should not be connected to the muscles; therefore, the flap is minimally reflected, as explained in the protocols. The sutures are not the issue.
I used bond apatite today for the first time and it didn’t harden at all at the surgical site, and kept almost flowable about 20 minutes.
How could that be?
In order for the material to harden properly it should be used as follows:
During activation the shaft of the syringe should be advanced until the first piston reaches the blue line. Then the cap is removed, and the material should be injected into the site. Immediately place on it a dry gauze, not too folded, simply in two layers. Then press strongly with a finger on top of the gauze for 3 seconds, and again with a periosteal elevator for an additional 3 seconds. That’s all you need to do and the material will set instantly. It will never be hard like a stone, but it is definitely stable. During suturing, if the material breaks, place a dry gauze on it and press for one second before continuing to suture.
If the material didn’t harden, it’s probably because the pressure with the gauze was not done immediately. As such, the crystals are soaked with blood and it will not set properly, and will be flowable.
Please see our online course for more instructions on proper use.