Suturing is a method for closing cutaneous wounds. Although the technique of suturing is thousands of years old, the materials used and aspects of its technique have changed over time. The primary goals of suturing are closing dead space, supporting wound healing, minimizing bleeding and risks of infection, and modifying skin contours for aesthetically pleasing and functional results.
A meticulous suturing technique cannot compensate for improper surgical technique. However, an incorrect suture technique or execution can compromise the postoperative appearance. The choice of a particular suture technique depends on the type of wound, anatomic location of the wound, thickness of the skin, degree of tension, and the intended cosmetic result.
In this article, we will help you to gain an understanding of the various types of surgical sutures, the rationale for choosing one technique over another, and an appreciation of the basic methods of placing each type of suture.
Simple interrupted sutures:
These sutures are placed and tied individually. For the inexperienced, simple interrupted suturing is the preferred technique due to its ability to close a wound cleanly and securely. In case infection occurs in one part of the wound, only a few interrupted sutures need to be removed to treat the wound leaving other sutures intact.
Interrupted sutures give a good result in curved and non-linear wounds or incisions. It offers the highest level of control overwound closure and the result. The downside is that interrupted sutures take considerably more time to place. Also, the operator has to push the needle through healthy skin adjacent to the wound margins. This brings the possibility of leaving a visible row of small scars on either side. That is why it is not recommended to leave interrupted facial sutures in for longer than a week.
Insensitive areas like a tongue laceration interrupted sutures with buried knots can be used effectively to avoid the irritation from the free ends left by a normally interrupted suture. Always use an absorbable surgical suture in this technique.
The subcutaneous suture is applied in the depth of the tissue in a surgical or traumatic wound. Its technique is similar to that of interrupted sutures with buried knots. It is primarily used to eliminate dead space in the depth of a wound. Of course, one must always use absorbable sutures in this technique. To save time in closing a long incision, use the vertical ‘Figure of 8' suture technique, which is a combination of subcutaneous and surface skin suture techniques.
A running suture also referred to as continuous suture, uses one strand of surgical suture material that runs along the length of the wound, normally in a zigzag pattern, which is tied at either end. Running sutures provide adequate closure with even tension distribution, saving both time and suture material. Use this technique when aesthetics are not the priority but saving time is. It is the right choice in cases like scalp lacerations when the wound is actively bleeding and fast action to minimize it is critical.
The drawback of this technique is that suture breaks may cause wound gaps. In case the suture material breaks, the whole wound will break down. Therefore, make sure that you secure the knots on the two sides and consider adding a couple of strategically placed interrupted sutures in addition to the running suture.
The subcuticular suture is applied under the epidermis leaving external knots at the far ends of the laceration or incision so that the suture can be removed easily. While it allows for a very pleasing result in terms of aesthetics, it offers very little wound eversion by itself. Surgeons will have to get wound eversion by placing the subcutaneous sutures properly if they intend closing the surface with subcuticular sutures. As these sutures are easily removed, they are the most common technique to use on children. The main drawback of this procedure is that it is very time-consuming.
Horizontal mattress sutures:
This suturing technique is used to create moderate tension to prevent bleeding and improve wound tension strength for better healing. The horizontal mattress suture is also effective at wound eversions and provides a fair approximation. However, care must be taken to not tighten excessively and prevent the possibility of tissue ischemia.
Vertical mattress sutures:
The vertical mattress technique is the right choice of technique for achieving wound edge eversion and approximation. It can be applied on either thin or thick skin using two bites. The first bite approximates the wound edges and the second reduces wound edge tension. The downside is that vertical mattress sutures can only remain in place for 5-7 days and there is a high risk of permanent crosshatch marks.
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