Sutures are a necessary component of the healing process after a serious
injury or surgery.
Broadly, there are two types of sutures: absorbable and non-absorbable sutures. The first is usually used for internal tissues and organs and is absorbed by the body over time. The latter is used in case of external wounds and serious internal cuts. These need to be removed by reopening
the body at a later date.
However, even the simplest surgery can go awry and possibly result in fatality if the sutures are performed incorrectly. Stitching up the wound is an exact science that needs immaculate care and enough time. The process should never be rushed. Sutures have been known to come undone weeks after the surgery, causing infection, serious complications, and even death. In most cases, this is considered negligence on part of the surgeon and can even be regarded as medical malpractice. Therefore, utmost caution must be taken when stitching up surgical as well as injury wounds. Following are some of the common mistakes made
during suturing you should be aware of and thereby avoid in your practice
- Unequal tension strength
Too much or too little tension on the wound closure is perhaps the most common error that occurs, regardless of the selected suture technique and materials. Too little tension results in poor cosmesis and an increased risk of infection. Too much tension can result in skin necrosis. It is advisable to bring the suture over the needle holder towards the short end and tighten the knot in the opposite direction.
- Not ensuring square knots
Square knots are crucial to successful sutures because they prevent the stitches from slipping and coming undone. However, square knots cannot be formed unless the surgeon crosses his/her hands with every throw. This is critical even in the case of alternating throws.
Another point to keep in mind is to not bring the needle driver behind the suture. Doing so makes achieving a square knot difficult.
- Driving the needle at less than 90 degrees
If the needle does not enter and exit the tissue at a minimum of 90 degrees, the edges of the wound will invert. Inverted edges cause a variety of complications and are very undesirable. Driving the needle in and out at 90 degrees ensures that inversions are avoided at all times and that the wound heals well. Sometimes, the tissue will need to be manipulated to achieve good wound edge eversion.
- Mismatched depth and width of sutures
If the suture is wider than it is deep, the wound will again be at risk of inversion. Therefore, caution must be taken to make each stitch deeper than it is wide. This will create eversion,
which is the desirable outcome.
- Unequal “bites”
The “bite” that is taken on one side of the wound, must be equal to the bite taken on the second side. This means that the needle must re-enter the skin directly across the needle exit site. If not, the edges may overlap and the wound closure can get rippled. The depth
that the needle passes through the tissue also should be equal on both sides.
Suturing skills are fundamental to all surgeries. Thus, it is critical to continue practicing different suturing techniques. Synthetic skin or pigs feet are available in most surgical skills
laboratories so that surgeons can practice independently to improve their skills and speed.