Suture type Advantages Disadvantages Common uses Simple interrupted (SI)(Figure 9.7) Easily and quickly appliedPrecise suture tension possibleMinimally alters the skin architectureProvides secure, anatomic closureConcurrent closure of skin, subcutis, and underlying fascia may reduce dead spaceMinimal alteration in blood supply Requires increased time Skin, subcutis, for placementExcessive fascia, blood tension causes inversion of vessels, nerves skin margins Interrupted intradermal (II) or subcuticular(Figure 9.8) Similar to SI (upsidedown SI suture placed in dermis and subcutis) Requires increased time for placement compared to SI and continuous suture patterns Interrupted cruciate or cross mattress(Figure 9.9) Easiest of all mattress sutures to apply, more rapidly applied than SINo alteration of blood supply even when placed under tensionProvides stronger closure than SIResists tensionPrevents eversion of wound edges at fascia level Excessive tension causes Fascia inversion of skin (occasionally marginsSkin margins tend skin) to gap between sutures Intradermal skin closureRarely used Interrupted vertical Provides precise wound mattress edge‐to‐edge apposition (IVM)(Figure 9.10) with slight eversion when tiedMinimal alteration in skin blood supplyA single layer can be used for concurrent closure of skin and subcutis to eliminate dead space Takes longer to apply and creates slightly more inflammation because suture passes through tissue four times Skin, subcutis, fasciaCan be alternated with SI sutures to prevent inversion and gaping Allgöwer corium vertical – Skin Minimal trauma (through dermis only)Perfect alignment Suture type Advantages Disadvantages Common uses mattress(Figure 9.11) of skin margins without inversion and with minimal or no eversionCosmetically superior closure Interrupted horizontal mattress (IHM)(Figures 9.12) Appositional to everting suture, depending on suture tension and whether suture penetrates tissue full or split thicknessRequires less suture material than IVM Tends to reduce skin blood Skin, subcutis, supplyPotential for tissue fascia, muscle, strangulation (can be tendon reduced with stents)Excessive scar formation when used alone because of skin eversion and gaping Simple continuous (SC)(Figure 9.13) Saves timePromotes suture economyProvides good apposition of wound edges or skin marginsProvides airtight or watertight seal Good only for layers under Skin, subcutis, low tensionProvides less fascia, blood strength than SIGain in vessels wound tensile strength delayed compared to SIExcessive tension causes puckering and strangulation of skin Continuous Similar to IISaves intradermal or timePromotes suture subcuticular(Figure economy 9.14) Provides less strength than Intradermal skin closure skin closure Continuous mattress; horizontal (Figure 9.15a) and vertical (Figure 9.15b) Horizontal: can cause skin Skin, subcutis, eversion/gapingVertical: fascia difficult to apply; rarely used Horizontal: appositional to everting suture, depending on suture tension; facilitates rapid closureVertical: minimal alteration in blood supply; precise edge‐to‐ edge contact Continuous lock or Similar to SCProvides Ford greater security than SC interlocking(Figure if broken 9.16) Similar to SCRequires large Skin amount of sutureTime consuming to applyMay cause pressure necrosis and become buried when placed under tension Suture type Advantages Disadvantages Common Uses Interrupted vertical Minimal alteration to mattress cutaneous blood (IVM)(Figure 9.17) supplyAdding more, widely placed rows of IVM suture reduces tension on appositional primary suture lineStronger than IHM in tissues under tension Occasionally suture will cut out when placed under excessive tension Undermined skin under tensionUsed with supports (bandage, buttons, stents) Interrupted Placed widely, IHM horizontal mattress suture reduces tension (IHM)(Figure 9.18) on appositional primary suture lineLess suture material than IVM Tends to compromise skin blood supplyDoes not reduce tension as effectively as IVMPotential for tissue strangulation (can be reduced with stents) Skin, subcutis, fascia, muscle, tendonSupports are added to reduce cutting out of sutures in regions that cannot be bandaged Quilled or stented(Figure 9.19) Skin necrosis underneath the quilled/stented sutures can occur if too much suture tensionShould not be used under a cast Combined with appositional suture for skin in areas of extreme tension where bandage cannot be applied Similar to IVM (variation of IVM that loops over a stent on either side of incision)Very effective in reducing tension on appositional primary suture lineEverting mainlyCan also be a variation of the IHM Near and far (or far Combines tension suture and near)(Figure (far portion) and 9.20) appositional suture (near portion)Higher tensile strength than either SI or mattress patternProvides necessary tension for wound edge approximation without applying tension to wound edge itself Excessive tightening Skin, subcutis, fascia can cause inversionLeaves large amount of suture material in wound Looking loop (LL)(Figure 9.21) May compromise intrathecal blood supply Provides good apposition compared with other tendon Tendons Suture type Advantages Disadvantages Common Uses sutures, with equal holding strength Three loop Has slightly higher More suture is Tendons pulley(Figure 9.22) tension strength exposed compared to compared to LLMinimal LL alteration to blood supply Intraneural(Figure Centrally placed N/A 9.23) neurorrhaphy suture anchored externally with silicone buttons Nerve Figure 9.15 Continuous mattress suture pattern. (a) Horizontal mattress. (b) Vertical mattress. Figure 9.20 A far–near near–far suture pattern. The far component reduces tension while the near component holds the tissue edges in apposition.
