Techniques of suturing: general principles, placement of specific types of sutures, alternative methods of wound closure (2023)

FAQs

What are the 6 types of suturing techniques? ›

Wounds can be closed primarily in the emergency department (ED) by the placement of sutures, surgical staples, skin closure tapes, and adhesives.

Proper suture technique should incorporate three major principles, including proper distribution of tension to the deeper layers, atraumatic handling of tissues, and eversion of wound margins.

Sutures can be placed intradermally in either a simple or running fashion. Place the needle horizontally in the dermis, 1-2 mm from the wound edge. Do not pass the needle through the skin surface. The knot is buried in the simple suture, and the technique allows for minimization of tension on the wound edge.

Sutures are basically of two types: Absorbable: It loses the tensile strength in 60 days. It is generally preferred for a buried type of suturing and does not require removal. Nonabsorbable: The tensile strength lasts for more than 60 days.

The Centers for Disease Control and Prevention created a surgical wound classification system (SWC: I, clean; II, clean/contaminated; III, contaminated; and IV, dirty) to preemptively identify patients at risk of surgical site infection (SSI).

There are two major types of wound closure: primary and secondary. In primary closure, the skin is closed at the end of the surgery, whereas in the secondary closure the wound is left open at the end of surgery and heals by granulation and contraction.

To ensure proper apposition of the wound without excess tissue on one side (also called a "dog ear"), the clinician places the first stitch at the midline of the wound. The next two stitches go on each side of the first stitch, midway between the center stitch and the wound corners.

What is the rule of 3 in suturing? ›

Silverstein's “Rule of Three's” for suturing is just what I needed. Place the thread 3mm from any adjacent suture. Always tie with 3 throws. ( First is a double surgeon's knot, and number 2 & 3 are singles).

Vertical mattress sutures have the advantage of good wound eversion and closure of dead space. Running continuous sutures can be quickly placed and divide tension equally along the skin edge.

Skin staples are an alternative to stitches, which can be applied in an emergency department or urgent care setting. They basically work in the same way as stitches, only they're stronger and can be good for areas where the skin is thicker — such as the scalp. They can also be used to treat very long cuts.

Skin adhesive is an alternative that can be as effective as stitches when used on the appropriate wound. Usually, that means a small wound; not very deep or wide; not “dirty” or prone to infection; and not on highly mobile parts, such as joints.

In this case, a “three-layer” closure is needed: first, the underlying dermis and subcutaneous tissues must be approximated; then, the epidermis is closed; finally, the intra-oral mucosal layer is closed.

The most common suture technique used for wound closure is the simple subcutaneous suture technique. This technique is performed in order to release the tension from the surface of the wound, thus easing the healing of the skin.

In general, surgeons typically use either polypropylene or polydioxanone sutures for fascia, depending on how strong the repair needs to be. Polypropylene is also very common in cardiovascular surgery. Deep dermis closure is with either polyglycolic acid or poliglecaprone 25 sutures.

Although sutures and stitches are often referred to as one and the same, they are actually two different things. Sutures are the threads or strands used to close a wound. “Stitches” refers to the actual process of closing the wound.

There are four major sutures that connect the bones of the cranium together: the frontal or coronal, the sagittal, the lambdoid, and the squamous.

Monofilament, Multifilament and Barb Sutures

Braided sutures provide better knot security whereas monofilament sutures provide better passage through tissues. In general, Monofilament sutures elicit lower tissue reaction compared to braided sutures.

What are the 7 types of wounds? ›

Tissue engineering in wound repair: the three "R"s--repair, replace, regenerate.

Wound healing is classically divided into 4 stages: (A) hemostasis, (B) inflammation, (C) proliferation, and (D) remodeling. Each stage is characterized by key molecular and cellular events and is coordinated by a host of secreted factors that are recognized and released by the cells of the wounding response.

Open wound types include abrasions, excoriation, skin tears, avulsions, lacerations and punctures, according to our Skin and Wound Management course workbook. Traumatic open wounds involve a disruption in the integrity of the skin and underlying tissues caused by mechanical forces.

This has also been observed that the length of abdominal incision increases up to 30% in postoperative period. Therefore, 4:1 suture to wound length ratio will allow adequate bites and would also avoid cutting through the fascial sheath.

Proper placement of sutures enhances the precise approximation of the wound edges, which helps minimize and redistribute skin tension. Wound eversion is essential to maximize the likelihood of good epidermal approximation.

In addition to high tensile strength and low tissue reactivity, ideal features of a suture material include sterility, uniform thickness, flexibility for simple handling, and the ability to retain knot security, as well as low inflammatory response to promote healing.

Traumatic lacerations are often sought to be sutured within six hours which is characterized as the "golden period". However, this rule is based on an animal experiment conducted by Paul Leopold Friedrich in 1898.

What are the layers of suturing? ›

WOUND ANATOMY — The epidermis, dermis, and subcutaneous layer are the tissue layers of concern during skin laceration repair: The epidermis and dermis are tightly adhered and clinically indistinguishable; together, they constitute the skin (figure 1).

Sutures may be placed in two main types of patterns Surgery: suture patterns - basic patterns : Interrupted. Continuous.

Zigzag suturing is also good for long suture wounds because it effectively disrupts the tension on the resulting scar. As a result, zigzag suturing is an effective approach for releasing linear scar contractures. Another major benefit of Z-plasties is that segmented scars mature faster than long linear scars.

As a monofilament suture, polydioxanone causes minimal tissue reaction. It is useful in contaminated wounds or wounds in locations at greater risk for infection. Polydioxanone is also useful as a buried suture in wounds that require prolonged dermal support.

The square knot, or surgeon's knot, is traditionally preferred. The knot should be tightened sufficiently to approximate the wound edges without constricting the tissue and impeding blood flow.

Cover the area with an adhesive bandage or gauze pad if the area is on the hands or feet, or if it's likely to drain onto clothing. Change the dressing and reapply the antiseptic ointment at least every day and whenever it gets wet or dirty. Check the area each day and keep it clean and dry.

"Dissolvable stitches placed internally won't need to be removed," says Dr. Yaakovian. "They will break down and disappear on their own over time. As for permanent stitches placed on the outside of the skin, these are typically left in for about two weeks before being removed."

DIY Suturing Should Only Be Done in Real Emergencies

If you do it incorrectly, at worst you can cause a life-threatening infection or the wound to heal improperly; at best, you'll leave a terrible looking scar on the person.

Two types of stitches are used to repair wounds: non-absorbable and absorbable. The type of injury that you have will determine what type of stitches you need. Non-absorbable stitches are good for skin wounds. These stitches are removed when the wound has healed, and generally have a cosmetically appealing result.

And with wound healing, there are three types of wound closure techniques to consider to achieve this — primary intention, secondary intention, and tertiary intention.

What is the normal closure of suture? ›

The average age of coronal suture closure is 24 years; however, numerous diseases and factors may cause the dysfunction of a suture. The most common dysfunction is early closure or abnormal closure of a suture or group of sutures of the skull. Premature ossification of the sutures is referred to as craniosynostosis.

Layered closure is sequential closure of each fascial layer individually. The primary advantage of this method is that multiple suture strands exist, so that if a suture breaks, the incision is held intact by the remaining sutures. Mass closure is continuous fascial closure with a single suture.

Running subcuticular sutures are considered to be the “holy grail” of suturing techniques by many. That is to say, when done correctly, they give the best cosmetic outcome. Hand in hand with that, they are certainly the most technically challenging and time consuming of suturing techniques.

'Reverse' type sutures are the most commonly used in most Emergency Departments. This type of suture gives optimum control of the depth of suture to the operator.

In general, surgeons typically use either polypropylene or polydioxanone sutures for fascia, depending on how strong the repair needs to be. Polypropylene is also very common in cardiovascular surgery. Deep dermis closure is with either polyglycolic acid or poliglecaprone 25 sutures.

Adhesive Tape

Doctors use sticky strips of tape (such as Steri-Strips) to pull together the edges of minor skin wounds. Skin tape costs less than other types of materials used to close wounds.

Percutaneous closure — The simple interrupted suture is the most common method used to close most small, uncomplicated, traumatic skin lacerations [1,14,15]. For proper healing, the edges of the wound must be everted by each stitch.

Polyglactin Sutures

The Polyglactin Suture comprises a synthetic braid, which is good to repair lacerations on the face and hands and is the most preferred option for general soft tissue approximation. Like the Poliglecaprone suture, this suture too is used in of vascular anastomosis procedures.

Optimal cosmetic results can be achieved by using the finest suture possible, depending on skin thickness and wound tension. In general, a 3–0 or 4–0 suture is appropriate on the trunk, 4–0 or 5–0 on the extremities and scalp, and 5–0 or 6–0 on the face.

What are the strongest suture types? ›

Steel wire has exceptional tensile strength (it is by far the strongest suture material) and provides long-lasting security as it does not break down.

The monofilament sutures performed better than the multifilament sutures. Lubricating coatings had no effect on infectibility. Natural sutures performed poorly and should not be used in wounds that are potentially susceptible to infection.