Suturing has been around for thousands of years, but techniques have changed over time. There are many choices of suture material and needles. But, the goal is the same. The goal is closing a wound or incision so that the incision will support the wound until it heals. It’s also important to make sure the edges are as close as possible, and using the correct method of suturing so the scar will be minimal. The wound being sutured correctly also minimizes the bleeding and chance of infection. However, even if you use the correct technique, it won’t compensate for improper wound closure.
Suture techniques depend on the area of the body, how thick the skin is, how much tension there is, and the desired cosmetic result. The wound closure should also allow for restoration of natural contours. The proper technique helps minimize the tension on the wound, and redistributes it over the length of the wound. It’s important that the tissue doesn’t contract during healing.
Regardless of the type of sutures, techniques for how to hold the needle, needles driving and where you place the knot are the same. The two main types of needles are cutting and reverse cutting. A reverse cutting needle is used for cutaneous surgery because the sharp edge is directed away from the wound edge. The needles are put into a needles holder and tightened. Don’t tighten it too hard or it can result in a bent needle making it hard to penetrate the skin.
Forceps are used to hold the skin in place. Penetrate the skin at a 90 degree angle because it minimizes the size of the entry stitch. The two sides of the sutures should be the exact same size. When stitching is done, the most common knot used is the square knot. It is important not to constrict the tissue. It is important not to have too much tension because it increases wound edema.
The most commonly used sutures in surgery are the simple interrupted suture. They are easier to place, and allow the surgeon to make adjustments to align the incision. There is also less chance of wound edema and impaired circulation. There is a risk of crosshatched or train track marks but that can be minimized by removing the sutures early. Another disadvantage is the time it takes to place the tissue.
The simple running suture is a series of sutures which is tied but not cut. Sutures need to be more evenly spaced, and tension should be distributed evenly along the wound. This type of suture is used on long incisions when there isn’t much tension. It’s difficult to make adjustments along the suture line when using the running suture. There is also a chance of crosshatching.
The running locked suture is also known as the baseball stitch because of its resemblance to the stitch on a baseball. This stitch is used when increased tensile strength is needed, or when there is oozing from the wound. This suture can cause tissue strangulation if it is too tight, so it’s only used in areas where there is good circulation. It’s common to use this on the scalp.
Vertical mattress sutures are a variant of the simple interrupted suture. It is a simple interrupted suture wide and deep and a second stitch placed closer to the edge and in the opposite direction. This stitch is used to minimize tension. These stitches should be removed in 5-7 days to avoid scarring and crosshatching.
Half buried vertical mattress sutures eliminates 2 of the 4 entry points and thus minimizes scarring. Entry and exit points are on one side of the incision. This stitch is usually used in cosmetic surgery, such as the face.
The pulley suture is a modified stitch that is used when the closure strength needs to be increased. Another stitch that does the same thing is the far-near near-far modified vertical mattress suture. This is used for inside stitches and can be left in place or removed if the tension is distributed evenly with the outer stitches.
The horizontal mattress suture is used for temporary stitches to hold the edges of the wound together. They can be left in place but if they are in longer than 7 days. It’s important not to pull to too tightly to avoid tissue strangulation.
Half buried horizontal sutures are also known as tip stitches. These are used on the corners of V-Y closures and M-plasties.
Absorbable buried sutures provide extra support to the wound and reduce tension on the outside wound. Other sutures that do the same thing are dermal-subdermal sutures and buried horizontal mattress suture.
Variations to running sutures:
- Running horizontal mattress sutures
- Running subcuticular sutures
- Running subcutaneous sutures
Sutures are removed 1-2 weeks depending on where it is located. It’s important to remove them on time to reduce the chance of infection or scarring. The more tension along the incision the longer the sutures should stay in place. Steri-strips can be used after the sutures are removed to provide extra support.
Alternatives to surgery sutures are:
- Tissue Adhesive
- Barbed Sutures