To obtain the desired outcome, it is essential to have good quality instruments depending on the nature of the wound.
The different types of suturing techniques include:
- Simple interrupted suture: It is the most common and simple form of suturing technique. The suture is placed by inserting the needle perpendicular to the epidermis. Inserting it perpendicularly helps in a wider bite of deeper tissue to be included in the suture than at the surface leading to rapid wound healing. It results in a thinner scar and cosmetically appealing outcomes. The stitch should be wider at the base than at the top. In the end, a knot is tied to secure the suture.
- Continuous (running) suture: It is a simple interrupted suture without interruption. The suture is started by placing a simple interrupted stitch, which is tied, but not sliced. Simple sutures are placed in succession, without cutting or tying the suture material. In the end, the stitch is secured by tying a knot after the last pass.
- Running locked suture: A simple running suture may either be locked or left unlocked. At first, the knot of a running locked suture is tied similarly to that in a traditional running suture. Next, the stitch is locked by passing the needle through the loop as each stitch is placed.
- Vertical mattress suture: It is a variation of a simple interrupted suture. The needle is inserted at the wound edge and a wider bite of tissue is included before exiting the skin in the same position at the opposite end of the wound edge. The needle is then re-inserted on the second side of the wound and exits the skin in the same position on the first side of the wound. The stitch is secured with a knot.
- Horizontal mattress suture: The needle is inserted 5 to 10 mm from the wound edge and exits on the opposite side of the wound. The needle is then re-inserted on the second side of the wound and exits the skin in the same position on the first side of the wound. The stitch is secured with a knot.
- Running subcuticular sutures: It is a buried form of a running horizontal mattress suture. The stitch is placed in a zigzag form through the deeper layer of the skin. No scar or marks are visible.
What is the importance of suturing?
The goal of suturing involves:
- Supporting and strengthening the wounds until healing occurs
- Minimizing the risk of bleeding and infection
- Reducing the skin edges for a cosmetically appealing outcome
- Closing dead space
However, choosing the correct suturing technique and meticulous planning is essential for a desirable outcome. The removal of non-absorbable sutures at the right time is important to avoid suture shaped marks on the skin.
What are the tools necessary for suturing?
To obtain the desired outcome, it is essential to have good quality instruments depending on the nature of the wound. The basic suturing kit includes:
- Needle holder
- Fine suture scissors
- Toothed tissue forceps
- Appropriate suture material
- Sterile field
What is the suture material used for suturing?
The important considerations for choosing a suture material include:
- Tensile strength
- Knot strength
- Handling
- Tissue reactivity
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. It is generally preferred for skin surface sutures and requires removal.