Pro-Health Blog
By Admin | 15 April 2022 | 0 Comments

Selecting the type of suture

Simple interrupted suture

This technique is usually applied to simple wounds, both traumatic and surgical, following the excision of a skin lesion, for example.

The needle is placed perpendicular to the wound on the opposite side approximately 3-5mms away (depending on the size and position of the wound) from the wound edge. The needle is passed preferably in a way so that it produces a pathway, which is wider at the base of the wound than at its surface. The proximal side is dealt with in a reverse fashion. This will result in a “brandy” glass shape to the suture pathway. When the wound is approximated, eversion will occur.

It is important to ensure that the width and depth of the ‘bites” are similar on both sides to prevent an overlap of the wound edges. Small bites will produce a precise approximation of small wounds, whereas larger bites are useful for eliminating dead space and for reducing tension in larger wounds (preventing ischemia of the wound edges).

The interval between sutures will vary with the particular wound. Too many sutures will lead to ischemia; too little may lead to a poorly approximated wound.

Continuous suturing instead of placing individual simple sutures is an alternative method. However, in the day-to-day closure of simple wounds, it is rarely used. It can produce ugly crosshatch marks and it may be difficult in making fine adjustments.

 

Vertical mattress suture

A wide bite is taken on the opposite side of the wound and is passed as in a simple suture. A wide bite is taken on the proximal side before passing the suture back, by taking smaller proximal and distal bites.

Horizontal mattress suture

As above, the first part of the stitch is placed. However, the suture returns to the opposite side by placing the stitch a short distance from the exit point so that it lies parallel to the first pass. The knot is tied to the side where the needle was first inserted.

These stitches are useful in producing eversion, eliminating dead space, and reducing tension. However, it can lead to major cross-hatching marks.

Subcuticular suture

Sutures are placed in the sub-dermis level in a horizontal fashion taking equal bites. The ends are knotted so that they are also lying subcutaneously. Normally the intention is to leave the suture in situ so an absorbable suture is needed. The suture is useful where the dead space and tension are minimal. If these situations exist, deep sutures are placed before inserting the subcuticular stitch. As the stitch is placed in the sub-dermis, cross-hatching is prevented.

You can read more on suture knowledge here.

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