BASIC SUTURING 1:
Tim Brandys MD FRCSC
Principles of Wound Closure:
1.Equal Bites on each side of the wound
2.Distance between sutures = distance suture
is from wound edge
3.Apposition,Eversion (skin),or
Inversion(bowel)of wound edges depends
on tissues being closed
Principles of Wound Closure:
4.Follow curve of Needle,levering causes
damage
5.Approximation not Strangulation:avoid
excessive stitches placed too close
together,be careful of post-op swelling with
running and running locking sutures.
Principles of Wound Closure:
6.Principle of Halving: 1st suture placed
centrally.Next suture placed halfway
between end of wound and 1st suture.And
so on.
Avoids mismatch of wound edges with
“Dog Ear”
HEMOSTATIC SUTURES:
SUTURE LIGATURE (STICK
TIE,TRANSFIXION SUTURE):
Purpose:Secure control of a vessel
Technique:Suture passes thru
vessel to anchor the knot
Uses: 1. One chance to ligate
vessel may retract ex:
mesentery,amputation,
pelvis
2.Large Vessel
FIGURE OF EIGHT:
Purpose: Secure ligation of
vessel surrounded by
other tissue(not readily
controlled by a hemostat)
Technique:Two parallel
simple running sutures in
same direction
Uses:1. Any recessed vessel
in other tissue
2. Lumbar vessels in
the aorta
Purse-String Suture:
Purpose: To invert or secure
an opening in a structure
Technique: Encircle an
opening or tube with simple
running sutures
Uses: 1.Secure and prevent
leaks around a drain.
2. Secure Aorta
cannulation catheter
3. Invaginate stump of
the appendix
WOUND CLOSURES:
Interrupted Closure: A new knot every 1 or2
stitches
Advantages: Less interference with vascular
supply to wound edges
M ore secure,if one breaks others
will hold incision together
Disadvantage: Time consuming
RUNNING/CONTINUOUS
CLOSURE:
Definition: Many stitches between knots
Advantages: Faster
Temporary seal against fluid loss
Tension distributed along entire
suture line
Disadvantages: Too much tension makes
entire suture line ischemic
Integrity can be broken at
any point
INTERRUPTED SUTURES:
SIMPLE INTERRUPTED:
Definition: Equal full
thickness bites thru skin
and subcutaneous layers
Vertical Mattress:
Definition: Far-Far
Reverse,Near-Near
Purpose: Everts skin
edges with precise
approximation and
little tension
Uses: Any setting where
you want good approx.
with no tissue
ischemia ex.
Amputation stump
Horizontal Mattress:
Definition: Simple
interrupted ,but
additional parallel bites
are taken in
reverse
Purpose: Everts skin
edges in wounds under
tension
Running:
Simple(Baseball)
Vertical
Horizontal
Subcuticular: Running
Horizontal in the
intradermal level
SUBCUTICULAR
Agenda:
1.Proper needle placement on the driver
2.Simple Interrupted,
Vertical Mattress,Horizontal mattress
3.Running Subcuticular
4.Stick Tie
5.Purse String
6.Figure of Eight